The trial for Kermit Gosnell, the Philadelphia abortion doctor charged with murder and who apparently ran a hellish and illegal clinic, has many people wondering why any women would choose to go there for abortion care. The answer for many was likely simple: finances. Abortions are expensive, and they get even more expensive the later into a pregnancy they occur. The average abortion costs $470, and scraping that money together if you’re living in poverty and on a razor thin budget takes time. Seventy percent of women who have had an abortion would have done it earlier in their pregnancy if they hadn’t had to delay to get the money. By the time the funds are raised, the pregnancy can be so far along that few providers will perform an abortion, but Gosnell regularly performed late-term procedures.
On top of this, Gosnell undercut the competition on prices, not having real nurses or equipment at the facility. The grand jury report showed that a first trimester abortion at Gosnell’s clinic cost $330, much less than the average. A procedure at 23–34 weeks was $1,625, at least a thousand dollars less than what the few other facilities in the Northeast charge.
Those discounted prices likely went a long way toward influencing Philadelphia-area women to patronize Gosnell’s illegal clinic, since many poor women are on their own when they pay for an abortion. Although two-thirds of abortion patients have health insurance, 57 percent pay for it out of pocket — and some of them are likely women who receive Medicaid, which is barred from covering abortions under the Hyde Amendment. Thanks to that federal law, the Pennsylvania women on Medicaid would have had to come up with the entire amount on their own.
As social worker Jeff Deeny wrote this week in The Atlantic, he’s seen many Philadelphia-area women living in poverty struggle with this very problem. He recounted the story of Ashley, a young mother on welfare struggling with homelessness and worried that another pregnancy would throw everything she was working toward off track:
Watching Ashley struggle with a decision that on one hand could ruin her own future but on the other ruin her relationship with her mother and her church was heart rending.
What’s worse is that the cost of the abortion, $300, would break Ashley’s budget. There was no such thing as an extra $300 in Ashley’s world. If she was going to go through with it, could she raise the money, and could she do it in time? I was concerned that if she paid for the abortion she would get behind on rent, and wind up back on the streets. If welfare medical assistance provided funds for women to have abortions, she could have very quickly and safely had the procedure done. Instead, the clock was quickly ticking as she explored every avenue for getting the money together. The longer it ticked, the more expensive the procedure would become, until ultimately it would become illegal and she would have to bring the baby to term. Or, if she was that desperate, she might have turned to Kermit Gosnell, who allegedly exploited exactly this scenario of poor women past the term limit for a legal abortion, maybe because while they were struggling to get the money together for it the clock ticked to long, maybe because they were ignorant of other, better resources for the service. […]
[I]f access to safe and legal abortions were expanded, and public funds used to provide them, there wouldn’t have been a Kermit Gosnell. The poor women upon whom Gosnell preyed would not be shunted into the black market if earlier on there had been safe, free services available to everyone in need.
Even after 40 years under Roe v. Wade, the right to access a safe and legal abortion is often far from reality for many women living in poverty. Worse, if a woman fails to obtain an abortion she is even more likely to become poor. A woman of means can access a timely abortion and her private insurance will usually cover it. But a woman on Medicaid just barely getting by will have to go hat in hand, risking having the procedure once it’s more dangerous and costly. Some will end up turning to black market providers like Gosnell who prey on the vulnerable, unless we remove the economic barriers that stand in between women and reproductive care.