OBJECTIVE: 

To evaluate the association between state Medicaid coverage for abortion and abortion access measures among U.S. patients.

METHODS: 

We analyzed data from the Guttmacher Institute’s 2014 Abortion Patient Survey. Respondents were included if they reported being enrolled in Medicaid, regardless of whether Medicaid covered the abortion. The exposure was self-report of residence in a state where Medicaid can be used to pay for abortion. Access outcomes included more than 14 days’ wait time between decision for abortion and abortion appointment, presentation at more than 10 weeks of gestation when in the first trimester, and travel time more than 60 minutes to the clinic. Multivariable regression was performed to test the association between state Medicaid abortion coverage and dichotomous access outcomes, controlling for patient demographics.

RESULTS: 

Of 2,579 respondents enrolled in Medicaid who reported state of residence, 1,694 resided in states with Medicaid coverage for abortion and 884 resided in states without Medicaid coverage for abortion. Patients residing in states with Medicaid coverage for abortion had lower odds and rates of waiting more than 14 days between deciding to have an abortion and the appointment (adjusted odds ratio [aOR] 0.70; 95% CI 0.57–0.85, 66.8% vs 74.1%, P<.001), having abortions at more than 10 weeks of gestation when in the first trimester (aOR 0.62; 95% CI 0.49–0.80, 13.6% vs 20.1%, P<.001), and traveling more than 60 minutes to the abortion clinic (aOR 0.63; 95% CI 0.51–0.78, 18.7% vs 27.6%, P<.001) when compared with patients residing in states without Medicaid coverage for abortion.

CONCLUSION: 

Availability of state Medicaid coverage for abortion is associated with increased abortion access. Our findings support repealing the Hyde Amendment to promote equitable access to reproductive health care, particularly in the post-Roe era.

中文翻译：

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美国国家堕胎医疗补助覆盖率与堕胎准入协会

客观的： 

评估美国患者堕胎的州医疗补助覆盖范围与堕胎准入措施之间的关联。

方法： 

我们分析了古特马赫研究所 2014 年堕胎患者调查的数据。如果受访者报告参加了 Medicaid，则包括他们在内，无论 Medicaid 是否涵盖堕胎。暴露是自我报告的居住在可以使用医疗补助计划支付堕胎费用的州。访问结果包括从决定流产到流产预约之间超过 14 天的等待时间，在妊娠 10 周以上的妊娠早期就诊，以及到诊所的旅行时间超过 60 分钟。进行多变量回归以测试州医疗补助堕胎覆盖率与二分访问结果之间的关联，控制患者的人口统计数据。

结果： 

在 2,579 名参加 Medicaid 并报告居住州的受访者中，1,694 人居住在堕胎医疗补助覆盖范围内的州，884 人居住在没有堕胎医疗补助覆盖范围的州。居住在有堕胎医疗补助计划的州的患者在决定堕胎和预约之间等待超过 14 天的几率和比率较低（调整后的几率比 [aOR] 0.70；95% CI 0.57–0.85，66.8% vs 74.1% , P <.001), 在妊娠早期流产超过 10 周 (aOR 0.62; 95% CI 0.49–0.80, 13.6% vs 20.1%, P <.001), 并且旅行超过 60 分钟流产诊所 (aOR 0.63; 95% CI 0.51–0.78, 18.7% vs 27.6%, P<.001) 与居住在没有堕胎医疗补助覆盖的州的患者相比。

结论： 

州医疗补助对堕胎的覆盖范围与堕胎机会的增加有关。我们的研究结果支持废除海德修正案以促进公平获得生殖保健，特别是在后 Roe 时代。