The introduction of Medicaid abortion coverage in Illinois
The Hyde Amendment is legislation that does not allow for United States federal spending to go towards abortion, which includes federal government assistance programs such as Medicaid. While federal spending is prohibited from being used on abortion through Medicaid, it is up to the states to decide if they want to allocate state spending on it. Seventeen states currently use state funding to cover abortion care within their Medicaid programs. However, causal evidence on how Medicaid coverage for abortion care affects pregnancy outcomes is limited.
Writing in the Health Affairs journal, Faculty Associates Julia Steinberg and Michel Boudreaux, along with their colleagues Taehyun Kim and Jacqueline Ellison, employed a study to fill this gap in the literature. They employed a difference-in-differences study design and used birth and abortion data from the CDC from 2014-2021, which predates the 2022 US Supreme Court Dobbs decision. Using this study design with the data, they analyzed a 2018 policy that introduced Medicaid coverage for abortion care in Illinois.
They found that the change in the 2018 policy increased the number of abortions in Illinois by 2.43 per 1,000 reproductive-age females, which reflects an 18.2% increase in abortions. Additionally, they found that births in the state were reduced by 1.66 per 1,000 reproductive-age females, which reflects a 2.8% decrease. These changes were relative to twenty-nine comparison states that did not cover abortion care during their study period. They also analyzed subgroups of birth rates, with their findings suggesting that the decrease in birth rates “were more pronounced among Black and Hispanic residents, residents in counties with higher poverty rates, and residents closer to an abortion facility.”
The findings of this study suggest that Medicaid can have an important involvement in abortion access.
Kim, T., Ellison, J., Steinberg, J.R., Boudreaux, M.H. (2025). “Abortion Rate Increased and Birth Rate Decreased After Introduction of Medicaid Abortion Coverage In Illinois.” Health Affairs Vol. 44 No. 2. https://doi.org/10.1377/hlthaff.2024.00145
