Overturning Roe v. Wade will grievously harm the triple aim of care

The Situation: In 1973, the US Supreme Court legalized abortion with its Roe v. Wade decision, though the judgment is not absolute since Congress never codified it. The judgment is summarized as follows:

• The United States Constitution provides a fundamental “right to privacy” that protects a person’s right to choose whether to have an abortion, based on the 14^th amendment.
• But the abortion right is not absolute. It must be balanced against the government’s interests in protecting health and prenatal life.

The implications of overturning this landmark judgment will be most egregious against the triple aim of care (see Exhibit 1). It will impact women’s and children’s health, increase costs for everyone, and worsen care experiences.

Exhibit 1: Overturning Roe v. Wade will torpedo all three attributes of the triple aim

Source: HFS Research, 2022

Exhibit 2 shows 13 US states with trigger laws in place to ban abortions if Roe v. Wade is overturned and nine states with other sorts of bans, such as pre-Roe and six-week limits. Some of these states already have regulations making it almost impossible to conduct abortions. For example, Texas made abortion illegal as of Sep 1, 2021. Oklahoma banned abortions from the stage of fertilization and allows, as of May 26, 2022, private citizens to sue abortion providers who knowingly perform or induce an abortion. While overturning the decision will not constitute a national ban, it would essentially allow each state to make its own laws. Some will strengthen the legalization of abortion, while others will weaken protections.

Exhibit 2: Nearly half of US states have anti-abortion laws in place or ready to go if Roe v. Wade is overturned

Data: Guttmacher Institute
Source: HFS Research, 2022

If Roe v. Wade is overturned, the US will be steps away from joining 26 countries, including Iraq, Egypt, and Nicaragua, that have total prohibition. The US will buck the global trend that has been expanding women’s rights. The US stands unique both as the world’s largest economy and bulwark of liberal democracy in its regression of women’s rights.

Hold on to your hats! Healthcare is going to get even more expensive

In the Centers for Disease Control and Prevention’s (CDC’s) most recently published 2019 data, the US had 3.7 million new births and 630,000 legal abortions. The abortion rate was 11.4 per 1,000 women aged 15–44 years, and the abortion ratio was 195 abortions per 1,000 live births. While abortions include voluntary procedures and miscarriages, it is nevertheless a significant number that has remained steady over time.

Abortions, like childbirth, require medical expertise (primary care, gynecology), lab testing, surgical services, mental health to address the trauma, and more. For both commercial and ideological reasons, overturning Roe v. Wade will drive specialists in women’s health to migrate based on their beliefs. According to Pew Research Center, approximately 60% of the population supports abortion rights. It is, therefore, reasonable to expect that there will be a net migration to states that support abortion rights. Consequently, women’s health will become expensive in states that ban abortion purely as a function of supply (a reduced number of clinicians) and demand (the same or higher need for women’s health support).

The basic tenet of health economics is that healthcare costs are not secular, given the dynamics of provider contracts; the same procedure may have different prices at the same hospital, based on contracts between health plans and hospitals. However, healthcare costs have a tendency not to be concentrated, translating into cost increases for everyone as the median expenses nationwide go up.

Women and children to get third-world healthcare in America

Access to healthcare includes the availability of resources (insurance, funds), clinicians (primary care, specialists), time, transportation, childcare, and more. Consequently, access is fundamental to health outcomes.

Access takes on an even more critical position when abortions are banned since women who need medical attention may not be able to seek or afford it. These same conditions will extend to their children in cases where an abortion is not conducted. There is ample evidence to indicate untreated medical conditions can lead to poor outcomes, including death.

There is another grave danger in situations where legal access is limited or restricted: the proliferation of back-alley providers. We know from pre-Roe v. Wade that abortions in an unregulated environment led to higher death rates, high levels of post-procedural infections, and the risk of clinicians being prosecuted. The outcomes are a double-whammy of unnecessary deaths and the loss of clinicians when we are already suffering from clinician shortages.

The experience of care will be negatively impacted

US healthcare has the reputation of being an un-empathetic factory line dispensing care without feeling. This perception extends from the unengaged health plan to the hurried healthcare provider on a tight schedule to see the next patient—and nobody in the middle to help with your health.

Another argument is that there is no “good” experience in healthcare; irrespective of the outcome, a visit to the dentist or the proctologist will never be considered a good experience.

So, consider that women seeking help for their health may have to travel out of state, pay out-of-pocket, and generally be put out of any sense of comfort or security. The situation will only worsen the experience of care.

The Bottom Line: Overturning Roe v. Wade is detrimental to women’s healthcare. It will make healthcare more expensive, further deteriorate health outcomes, and worsen the experience of care.

While there is likely no effect on births or abortions, the network effect across the healthcare ecosystem will be impacted. Every birth of a child requires a mom to take time off (loss in income where there is no family medical leave of absence [FMLA]), pressure on limited income, childcare, and more, and abortions require a variety of stakeholders that cost money and time. All of this is going to require the market to adapt as self-insured employers are by creating vehicles to support their employees with non-medical emergencies and abortions if they must travel out of state. There will be opportunities to support the new state of normality by leveraging technology smartly and with empathy to aid both clinicians who want to help and consumers who seek it.