title: Out of time and out of pocket: experiences of women seeking state-subsidized insurance for abortion care in Massachusetts.
abstract: BACKGROUND
  Massachusetts has implemented reforms aimed at providing universal health care coverage and covers abortion through subsidized state insurance programs. Three Massachusetts abortion funds evaluated their referral processes for low-income women from April to October 2010 to learn about women's experiences applying for subsidized insurance and to identify barriers to obtaining insurance or its use for abortion services.
  
  
  METHODS
  Follow-up interviews were conducted with 39 low-income women thought eligible for subsidized insurance at least 1 month after their initial contact with the funds.
  
  
  RESULTS
  Health insurance literacy was low, and participants reported confusion distinguishing between levels of subsidized insurance. The process of applying for subsidized insurance delayed a substantial proportion of procedures. More than two thirds of the women who applied for state coverage had become insured or expected to become insured shortly, but only one third of respondents who applied were able to secure insurance in time for their abortion care. Two women were unable to obtain abortions as a result of delays. Delays also limited low-income women's ability to obtain medication abortion.
  
  
  CONCLUSIONS
  This analysis suggests that the process for enrolling in subsidized insurance does not currently meet the goal of providing women with coverage for abortion care (and other health needs) in a timely way. Systemic improvements are needed to ensure that enrollments are processed quickly and disruptions in coverage are minimized. Information resources should be developed to help women and their families understand health insurance and coverage of services.
authors.affiliation: University of Cincinnati, McMicken College of Arts and Sciences, Department of Sociology, Cincinnati, Ohio 45221-0378, USA. danielle.bessett@uc.edu
authors.forename: Danielle
authors.initials: D
authors.lastname: Bessett
authors.forename: Katey
authors.initials: K
authors.lastname: Gorski
authors.forename: Deepani
authors.initials: D
authors.lastname: Jinadasa
authors.forename: Marcy
authors.initials: M
authors.lastname: Ostrow
authors.forename: Megan J
authors.initials: MJ
authors.lastname: Peterson
mesh_terms: D000023:Abortion Applicants; D000028:Abortion, Induced / Q000191:economics* / Q000706:statistics & numerical data; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007182:Income; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008404:Massachusetts; D011247:Pregnancy; D011256:Pregnancy Outcome; D036301:Qualitative Research; D012017:Referral and Consultation / Q000706:statistics & numerical data; D034121:Reproductive Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult