Maryland Taps Affordable Care Act Fund To Help Pay for Abortion Care

Maryland is the first state to tap into an old fund connected to the Affordable Care Act to help solve a new problem: helping pay the expenses of patients who travel to Maryland for an abortion.

With abortion now restricted or illegal in 22 states, jurisdictions like Maryland have become a destination for patients from as close as neighboring West Virginia to as far as Texas.

With a staff of six, the Baltimore Abortion Fund helps patients who need to travel pay for bus or plane tickets, lodging in Maryland, and sometimes meals. The fund spends about a million dollars a year on that support. Calls to its confidential helpline have increased by 50%-60% every year since Roe v. Wade was overturned, said Lynn McCann-Yeh, the fund’s co-director.

The fund disburses aid as people call in. Often, the weekly allotment is depleted after just one or two days.

“Sometimes that means that our helpline is closing within 24 to 48 hours at the start of the week, because there’s just too much demand for the amount of resources that we have,” McCann-Yeh said. “There are many, many more dozens of callers each week that are just getting a voicemail message saying that we’ve run out of support.”

To help, the Maryland Legislature turned to a pot of money established under the 2010 Affordable Care Act. Under the law, states could decide to require insurance plans sold on the ACA “marketplaces” to cover abortion. The plans were required to charge a minimum fee of $1 a month on every plan bought through the marketplace.

That money was then put into an account that would help pay when insured patients received abortion care.

The state accounts were necessary because of the federal Hyde Amendment, which restricts the U.S. government from paying for abortions, except in cases involving rape, incest, or severe medical risk to the patient.

Because the federal government partially subsidizes insurance plans sold through the ACA marketplaces, commercial insurers had to use their money to pay the monthly fee for each policyholder.

“Insurers have quietly complied with the ACA special rules resulting in these segregated accounts that have millions of dollars in them intended for abortion coverage,” said Cat Duffy, a policy analyst for the National Health Law Program.

Over time, the accumulated fees in such accounts have outstripped the withdrawals for abortion care for women on those insurance plans. Maryland’s account has grown to $25 million and takes in about $3 million each year.

Maryland passed a new law that allows the state health department to tap those funds and allocate up to $2.5 million a year in grants to organizations operating in Maryland that offer abortion assistance. Those groups can use the money for traveling patients, low-income patients in Maryland, or people without insurance.

“We know that we will be able to use those funds wisely and to make sure that we’re not turning away any patient due to their inability to pay,” said Ramsie Monk, the director of development at the Women’s Health Center of Maryland on the border with West Virginia.

Without assistance from abortion funds, many of the patients would not be able to pay for their care, says Diane Horvath, an OB-GYN at Partners in Abortion Care, in College Park, Maryland. Unlike some other health centers, which offer abortion only up to 16 weeks of pregnancy, Partners in Abortion Care can provide an abortion later in pregnancy. Those procedures are more complicated and more expensive.

More than 90% of the patients at Partners in Abortion Care receive financial assistance through various abortion funds.

“I would say a typical patient that we see probably every week is somebody who’s already got at least one child, they’re working a job that doesn’t offer substantial leave for medical care, it may not offer health insurance, or the insurance it offers doesn’t cover abortion, particularly when they’re coming from out of state and they’re struggling and living paycheck to paycheck,” Horvath said.

The new law passed this spring and took effect July 1. The first tranche of money is set to be transferred from the ACA fund to the state health department by the fall.

Since the Supreme Court overturned Roe in 2022, states where abortion remains legal, like Maryland, have seen an increase in abortion procedures, including for patients who can’t get a legal abortion in their home state. Many need financial assistance for the procedure or to cover travel costs from other states, lodging, and related expenses while they recover.

That financial aid is often provided by local and regional abortion funds, such as the nonprofit Baltimore Abortion Fund.

As more patients travel to Maryland, and some abortion funds exhaust their resources, clinics that provide abortions in Maryland are feeling financial pressure to serve traveling patients, as well as uninsured and low-income Marylanders seeking care.

Clinicians in Maryland performed about 39,000 abortions last year, a 28% increase from 2020, according to the Guttmacher Institute, a nonprofit focused on sexual health research.

Maryland’s move to tap the ACA fund represents an innovative solution for states that have opened their doors to out-of-state patients but are grappling with the logistics and costs of the increased clinical demand in a post-Roe landscape.

“This bill is super important for Maryland; we’re making sure our clinics stay open,” said Maryland state Del. Lesley Lopez, a Democrat who sponsored the bill. “Maryland has been a leader on a lot of reproductive bills for the past 30 years, and so in that way, this bill fits into that legacy. It’s also nationally significant, because there’s 25 or 26 other states that can take this model and run with it. We’re looking for California, Illinois, New York, those bigger states that are sitting on potentially hundreds of millions of dollars to take what we’ve done here in Maryland and implement it there.”

Anti-abortion groups in Maryland opposed the bill, saying that the new law will force some insurance consumers to pay for procedures they may disagree with.

“This bill uses insurance premiums from insured women to abort the children of uninsured women,” Laura Bogley, executive director of Maryland Right to Life, told the state legislature on March 6.

“Many of those uninsured women are non-Maryland residents who are trafficked into the state for late-term abortions that are restricted by other states.”

The bill’s supporters deny that traveling patients are being trafficked when they are traveling of their own volition in search of health care.

This article is from a partnership with WYPR and NPR.