Abortion reimbursement rates must increase if we’re to provide health care to people who need it

I am proud to claim Minnesota as the state where I was born and raised. I am equally proud to be an independent abortion provider as I reflect on this year’s anniversary of the Hyde Amendment, a federal budget amendment that bans federal funds from going toward abortion care. 

In August of 2022, with a looming trigger ban about to take effect, my staff and I took on the enormous task of moving Red River Women’s Clinic from our home of 24 years in Fargo, North Dakota, across the river to Moorhead, Minnesota. We were forced to move across state lines if we wanted to continue to provide abortion care to the pregnant people of our region. Since that time, the North Dakota Legislature enacted an even stricter six-week abortion ban with very narrow exceptions.

Contrast that cruel ban with the work that Minnesota Democrats did this legislative session. They used their trifecta to make abortion rights and access a priority. Bills passed solidifying and strengthening the right to abortion care and rolling back unnecessary and troubling restrictions. Minnesota Democrats moved early, moved swiftly and made Minnesota a leader in abortion access. Democratic legislators stood firm and fought back against dangerous rhetoric from the opposition. The 2023 Legislative session will go down in history as a case study illustrating how a pro-choice majority can make great strides with diligence and hard work.  

Now that the dust has settled and abortion providers are seeing increasing numbers of Minnesota and out-of-state patients, we need to tackle another issue: the abysmal state of Medical Assistance reimbursement rates for abortion. 

Patients who are on Medical Assistance, which is Minnesota’s version of the federal Medicaid program, should have their abortion care covered, treated no differently than any other health care. Minnesota has long been a state that values equality by seeing that MA patients will have abortion care covered and not carved out of coverage, like so many other states that deny Medicaid coverage for abortion. MA covers abortion care through state funds because the Hyde Amendment bans federal funds from going toward abortion care, leaving individual states to create patchwork coverage systems that are unsustainable for providers.

Red River Women’s Clinic has been enrolled as an MA provider for over 20 years. In that time, reimbursement rates for MA have not kept up with the increasing costs to deliver health care. The reimbursement rate for an in-clinic procedural abortion is only about a quarter of what it actually costs to deliver the service. Medication abortion reimbursement rates are even lower, barely covering the cost of the medication alone. This is not sustainable for providers, and when providers are disincentivized from administering health care, it impacts patients. 

Minnesota abortion providers are seeing increasing numbers of patients who are on Medical Assistance. If we are to pay our staff a living wage, cover all the costs of running a business and, most importantly, keep our clinic doors open, we need MA reimbursement rates to keep up with the increasing costs to deliver that health care. The Hyde Amendment already restricts federal funding for abortion care, and keeping state reimbursement rates low further restricts our ability to provide abortion care during a national public health crisis.

If we want to continue to tout Minnesota as a leader in abortion policy and access, Medical Assistance reimbursement is one of the most important aspects of that status. It is within abortion providers deeply held values to continue to accept Medical Assistance patients, but to do that, we cannot be expected to write off three-quarters of what it takes to deliver that very care. We want and need our elected leaders to strive forward and keep their commitment to both abortion seekers and abortion providers alike. A 50% increase in Medical Assistance reimbursement is a necessary step in keeping that commitment. 

We ask that Gov. Tim Walz and Democratic legislative leaders work with providers and coalition partners to accomplish this task.