Abortion is a safe and essential part of health care. As of 2023, medication abortion accounted for 63 percent of all abortions in the United States, and is the method preferred by patients. Since 2020, the use of telehealth for medication abortion care has grown (along with the use of telehealth more broadly) and now accounts for 16 percent of all abortions in the U.S. Telehealth has the potential to increase health equity by improving access to and quality of care, providing culturally competent care, and by generating cost efficiencies. Telehealth for medication abortion care has been endorsed by the American College of Obstetricians and Gynecologists and other professional associations as a safe and effective option for first trimester abortion care. Notwithstanding, there is public misunderstanding over its safety, efficacy, and use.
The Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization eliminated federal constitutional protection for abortion. Many states immediately began to curtail or ban access to abortion, effectively eliminating access to this care for many; at the same time, access to maternal care has deteriorated. Telehealth can help increase access to safe abortion.
There is currently a case before the U.S. Supreme Court on medication abortion, U.S. Food and Drug Administration v. Alliance for Hippocratic Medicine. It appears the Court will reject the case on standing grounds. But if it decides to uphold the restrictions, it will be a step backward in the ability to use telehealth for abortion care. It also would undermine the authority of the FDA’s approval process for medication and impede in the provision of appropriate medical care, including via telehealth.
Using insights gleanded from a workshop with nearly 30 stakeholders — policy experts, abortion and reproductive health providers, nonprofits, investors, and telehealth companies — we identified actions that will expand access to medication abortion via telehealth in the near term, even in a highly constrained policy environment.
Address Regulatory Barriers to Telehealth, Including for Medication Abortion via Telehealth
During COVID, we made great gains in access to care through telehealth; however, we still need to ensure that access to care is equitable. Telehealth for medication abortion care is banned or heavily regulated in many states — usually through restrictions that mandate medically unnecessary interventions, such as ultrasounds, blood testing, or physical exams/in-person visits, which are not evidence-based and do not exist for other health services. Typically states defer to clinical indication and provider expertise when crafting health care policy. The best practice would be to defer to licensed providers’ clinical judgment for medication abortion via telehealth, as we do for other services, like diabetes or hypertension.
Even states that aim to increase abortion access may impose barriers to telehealth for medication abortion, which may exacerbate inequities. For example, some states require that providers maintain a physical location or a formal affiliation with a brick-and-mortar provider to enroll as a Medicaid provider and be reimbursed for services rendered, or limit which providers may enroll as a telehealth-only provider. Removing these barriers would improve equitable access to care.
Improve the Overall Economics and Coverage of Telehealth
Commercial coverage of telehealth lags Medicaid and often does not cover all modalities. The Hyde Amendment generally prohibits federal funds from being used to pay for abortions, including via telehealth. Because of this, 18 states use state-only funds to cover abortons for Medicaid beneficiaries. In these states, the Medicaid state allocation pays for more than 50 percent of all abortions. To increase equitable and expanded access to abortion, states can use state-only dollars to cover abortion and increase reimbursement rates for telehealth, generally and for abortion care.
Eleven states restrict abortion coverage by all private insurers. Approximately one-quarter of large U.S. employers limit coverage of abortion or do not pay for it at all. Commercial insurers and employers should cover and adequately reimburse for telehealth for medication abortion care where it is allowed.
Improve Education About and Referrals for Abortion Care
Among physicians looking to refer their patients for abortion care, about half did not know how or where to make these referrals. Providers — including primary care physicians, physician assistants, and nurse practitioners — can be trained to determine a patient’s eligibility for medication abortion via telehealth and either provide care or refer for care. These providers must receive training and education, including referral pathways and the applicable restrictions in their states. Robust referral channels with warm handoffs must be developed and reinforced to enable access and support continuity of care.
Looking Forward
Despite a complex and highly constrained policy environment, we can expand access to medication abortion via telehealth. States, insurers, providers, emerging tech startups and providers, and employers can all play a role in expanding access. For a longer examination of these issues and additional actions, please see the full brief here.
