L.V. found out she was pregnant Aug. 7. The next day, she called Women's Health and Family Care in Jackson, Wyoming - the only abortion provider in the state - to schedule an abortion.
She was told the procedure would typically cost $600 at the clinic, but a state law banning abortion might take effect soon. In that case, she would have to travel out of state, setting her back even more.
L.V., who asked to be identified only by her initials, panicked. She had recently been in a car accident and had outstanding medical and car bills to pay.
"When the clinic told me how much, my mouth dropped," she said. She was told to contact Chelsea's Fund, a Wyoming nonprofit organization that is part of a national network of abortion funds, to ask about financial assistance.
Abortion funds have for decades helped cover the cost of the procedure - about $500 in the first trimester and $2,000 or more in the second trimester - for those who cannot afford it. But they are playing a bigger role since the Supreme Court's decision to overturn Roe v. Wade, taking in more donations and disbursing more money to more patients than ever before.
Since the court's decision, abortion has been banned in large parts of the Midwest and the South. Those seeking abortions must travel farther and stay longer, often spending thousands of dollars on added costs beyond the procedure itself, including flights, hotels, child care, food and gas.
About half of women who have abortions are living below the poverty line, and most states do not allow the use of state Medicaid funds to cover the cost of the procedure. Abortion funds have been inundated with callers seeking money and support.
Before the court's decision, the Midwest Access Coalition handled around 30 cases each week. A typical patient's expenses used to cost the fund around $1,000. The group now helps upward of 50 people each week and spends twice as much.
"Our wraparound service cost is easily becoming $2,000 per client or more," said Alison Dreith, the group's director of strategic partnerships. "We've staffed up, we're taking on this increased workload, but we're still not going to be able to meet all of the need."
Patient Travel Expenses
Each abortion fund operates differently, but the process is generally the same: A patient must first confirm an appointment with a clinic, and then the fund will pledge a certain amount toward the cost of the procedure. Afterward, the clinic invoices the fund. Funds that offer practical support will often book flights or bus tickets and hotels for their clients. Money for food or gas might be sent via PayPal or Venmo, or offered to clients in cash.
A survey of abortion funds around the country shows that the cost of patient support has risen - in some cases steeply - since the court's decision. Last year, the average patient pledge for the D.C. Abortion Fund was $250. In August, that amount rose to $850.
"Part of what we're seeing is folks coming to get care later in gestation," said Alli Korman, the fund's operations director. She said that because of long wait times - clinics nationwide are booked as much as three weeks out - and a more complicated landscape for patients to navigate, they must now delay care until later in pregnancy, when the procedure is more expensive.
More Complicated Care
In 2020, the National Network of Abortion Funds, an organization of nearly 100 member funds around the country, received $1.9 million in individual donations.
In just the first week after the court's decision in June, the network received more than $10 million in donations. Of that, $3.7 million went to the network, and an additional $6.7 million went directly to member funds. That windfall has allowed many of its members to spend more already this year than they pledged to patients in all of 2021.
But abortion funds also face their own rising costs and uncertainty in a world after Roe. Many are run by volunteers, and they said they are struggling to keep up with the increasing volume and complexity of cases as more states move to ban abortion.
"Calls are taking twice as long. We're having to reexplain to people this new shifting landscape, to reassure people that abortion is still legal - or to reset expectations because now they might have to travel several states over," said A.J. Haynes, the board president of the New Orleans Abortion Fund, which saw the legal status of abortion in Louisiana change three times this summer.
Even after the flood of donations in recent months, more money is needed to cover paid staff members, data infrastructure and legal guidance.
"In October, we will be significantly rolling back the amount of support we are able to offer," Haynes said. "We are simply unable to meet the needs of our callers with the funds we have available for the remainder of the year without a significant increase in support."
Legal Issues Add Costs
Anti-abortion groups say some funds are operating in a legal gray area, if not in violation of state laws. In Texas and Oklahoma, private citizens may sue anyone who aids an abortion, while those who assist patients in Alabama in obtaining out-of-state abortions could face felony charges.
Kristan Hawkins, the president of Students for Life of America, said she expected abortion funds would come under more scrutiny. "There are questions of how these outside entities are operating and if they are now violating state laws to facilitate illegal abortions," she said. "Lawmakers are asking those questions."
Providers are already wary of new restrictions, and abortion funds said policy changes by some of the national reproductive rights groups have created more hurdles and expenses for their clients. In Idaho, where abortion is banned, patients who could travel to nearby Utah for the procedure are being denied medication abortion from the Planned Parenthood affiliate there over concerns about legal liability.
"That was really poorly communicated to us, and it creates a much greater burden on abortion funds working in these states," said Riley Keane, a practical support lead at the Northwest Abortion Access Fund.
Given the ongoing uncertainty in many places, some funds have decided to spend what money they have now.
"We have been fully funding patients. We made the decision to get everyone their abortions because we don't know what the legal landscape will be next month," Eloisa Lopez, the executive director of the Abortion Fund of Arizona, said in an interview in August. On Friday, abortion became illegal in Arizona.
In Wyoming, a judge temporarily blocked the state's abortion ban, and L.V. was able to secure an appointment. Chelsea's Fund told her it could pay only $300, but another group, the Wyoming Abortion Fund, had agreed to cover the remaining $300.
"I expected them to come back to me and say, 'Oh, we can only pay this much,'" she said. "I was so surprised. I didn't have a plan. I would've just put it on my credit card and gone into even more debt."
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