Poster #2 - Effects of the Dobbs Decision on Medical Out-of-Pocket Expenditures

• In Event: Friday Poster Reception

Abstract

This paper examines how restrictive abortion access following the U.S. Supreme Court’s Dobbs decision affects medical out-of-pocket (MOOP) expenditures. In 2022, the U.S. Supreme Court overturned Roe v. Wade and Planned Parenthood v. Casey with its decision in Dobbs v. Jackson. The ruling eliminated the federal constitutional right to abortion, returning the authority to regulate or ban the procedure to individual states. The ruling resulted in substantial state variation in abortion: as of November 2025, 13 U.S. states ban abortion, and an additional 6 states have early gestational limits between 6 and 12 weeks.

A growing literature examines effects of Dobbs decision on abortions, births, and maternal and infant health outcomes. In the years since the decision, the total number of abortions has increased (Maddow-Zimet and Gibson, 2024), reflecting decreases in reported abortions in restrictive states and increases in neighboring legal states (Lantz, 2025). Further research found increases in birth rates above trend predictions in restrictive states, particularly among subgroups with higher rates of negative birth outcomes (Bell, 2025). Surveys of OB/GYN practitioners suggest that many of these providers reported new constraints on their ability to provide care for miscarriages and other pregnancy-related medical emergencies (Frederiksen, 2023). Additional work has found detrimental effects on maternal and infant health outcomes associated with restrictive access including increased maternal and infant mortality (Tseng, 2025; Gender Equity Policy Institute, 2025; Presser et al., 2025; DeBie et al., 2025). Other research has found abortion bans associated with spillover effects beyond reproductive health care into other health care specialties (Heisler et al., 2025).

Through these effects on abortion rates, birth rates, and care complications, these restrictive policies also have the potential to increase medical costs to individuals seeking care. Health costs associated with pregnancy, childbirth, and post-partum care average $20,416, including $2,743 in out-of-pocket expenses, for women enrolled in employer plans over 2021-2023 (Wenger et al., 2025), with substantially higher costs associated with pregnancy complications due to extended hospitalizations and additional interventions (O’Neil, 2022). To the extent that restrictive abortion access leads to increased birth rates and care complications, we would expect to see increased MOOP spending associated with this care. We may also see increased MOOP for insurance premiums if insurers pass these costs onto beneficiaries.

In this paper, we use 2018-2024 Current Population Survey Annual Social and Economic Supplement (CPS ASEC) data to examine individual- and household-level MOOP spending on health insurance premiums and non-premium expenditures. We use difference-in-differences-style analyses to compare expenditures across states with and without restrictive abortion laws and how they changed from before to after the Dobbs decision. We compare effects by individual characteristics (e.g., sex, age, race/ethnicity, education level, insurance status/type, marital status, parental status) and for demographic groups most likely to be affected by the policies (women of child-bearing age, women with newborn children). Our results shed light on the more far-reaching effects of restrictive abortion policies, quantifying the extent to which they pose an economic burden to individuals and families.

Author

• Joelle Abramowitz, University of Michigan
  Presenting Author