Insurance coverage of contraceptive and abortion services directly impacts U.S. women’s access to reproductive health services. Unfortunately, physician opinions about coverage for such services were noticeably absent during the recent health care debates, perhaps because the organizations representing physicians feared alienating some constituents by taking a stance on such a nationally divisive issue. In this study, we found that the majority of PCPs support health insurance coverage for both contraception and abortion. Furthermore, PCPs widely endorsed tax dollar coverage for contraception for poor women, and the majority supported tax dollar coverage for abortion for poor women. In spite of the controversy that ensued after the recent IOM recommendation that health plan coverage include contraception under the Patient Protection and Affordable Care Act, our findings suggest that PCPs would overwhelming support this recommendation.
Several of the PCP characteristics we tested were independently associated with whether or not physicians supported health plan coverage or tax dollar use for abortion services in low-income women. Specifically, women PCPs were twice as likely as men to support health plan coverage for abortion. PCPs who were 50 years and older were more likely than PCPs younger than 30 years to support tax dollar coverage for abortion in low-income women, which is consistent with other studies , and may reflect support for abortion access among physicians who practiced prior to legalization of abortion. Interestingly, we found that family physicians were less likely than internists to support either health plan coverage or tax dollar use for abortion services in low-income women. This was an unexpected finding, and we are unaware of prior literature that demonstrates differing attitudes toward abortion among these primary care specialties. It is possible that the family physicians were more likely than internists in our sample to be in rural community-based practices, which could account for the differences in attitudes, rather than actual specialty. Finally, we found that our outcomes were predicted by practice location, with the least amount of support for abortion coverage in Central Pennsylvania. This suggests that attitudes toward payment for abortions differs geographically, which likely reflects geographical variation in attitudes toward abortion in the general population .
These findings illustrate the views of PCPs on coverage for reproductive health services, which to our knowledge has not previously been investigated. While our study included PCPs from four geographically diverse locations in the U.S., the majority of PCPs were from university-affiliated practices and thus may not represent the opinions of PCPs in community practices. While our 35% response rate was typical for physician surveys of this type [9-10], we cannot be certain that the participating physicians are representative of their peers. The email invitation to potential participants described this as a research study examining outpatient clinical reminder systems, which was the purpose of the parent study. Since potential participants were not aware that the survey included items on contraceptive and abortion services, they should not have been subject to selection bias due to the topic of the current analysis.
By issuing Executive Order 13535, President Obama upheld the Hyde Amendment continuing the ban on federal funds for abortion in the context of health insurance reform. More recent budget talks have also proposed further limits on the use of federal money for family planning for poor women, both domestically and internationally . Many fear that health insurance companies will be unlikely to provide separate abortion coverage policies for their federally-supported options and their private insurance options, such that eventually private insurance will no longer routinely cover abortion services. How health insurance reform will affect utilization and payment for abortions services in the coming years has yet to be seen. Similarly, it is yet to be seen how contraceptive use by U.S. women will be affected when mandated health plan coverage for contraception takes effect after January 1, 2013 under the Patient Protection and Affordable Care Act. Given the high rate of unplanned pregnancy and abortion in the U.S., physicians bear witness daily to the consequences for individual women and families of restricted access to family planning services, but their voice has been missing from the current debate. Policy makers should heed PCP endorsement of insurance coverage and public funding for contraception and abortion services.