Getting an abortion can cost hundreds, if not thousands of dollars, especially if travel is involved. Support groups, called abortion funds, can help people pay for care, but demand for that help has soared since Florida's six-week abortion ban started in May.
Advocates like Bree Wallace with the Tampa Bay Abortion Fund say the funds need more money to keep up.
Wallace typically spends her days glued to her laptop messaging back-and-forth with pregnant clients who need her help getting abortion care –- and fast, if they want to comply with Florida’s six-week ban.
Abortion rights posters cover the walls of the small office Wallace set up in her Tampa home. Boxes of tampons and pads are piled across the room – she gives them out for free in the community. But her day job is with the fund, as its only full-time employee.
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One afternoon in July, a woman reached out through text message from the waiting room of an abortion clinic. She couldn’t pay for her appointment.
Within minutes, Wallace committed to help. All the woman had to do was share her first name and last initial. She could move forward with her appointment and the clinic would charge the fund for the balance: $490 dollars.
“It can be pretty hefty for people,” said Wallace, 27, the fund’s director of case management.
Many people struggle to afford abortions
Abortions in Florida usually cost around $600 to $800 during the first trimester, depending on a number of factors including whether the patient gets a surgical or medication abortion. Part of that cost covers a mandatory in-person consultation and ultrasound that Florida law requires patients get at least 24 hours before their abortion.
There’s been a long-standing ban on using federal funds for abortion, so Medicaid doesn’t cover it unless states choose to spend their own money to pay for the service. Florida does not allow that, and also bans ACA marketplace plans from covering abortion, so many patients have to pay out of-pocket, which is more difficult for those with low incomes.
RESOURCE: If you need help from an abortion fund, you can use this search tool
With a six-week ban in place, if women do realize they're pregnant in time, they often have just days to act if they want an abortion. That can be a hard enough decision to make so quickly, said Wallace, and money adds more stress.
“Especially with six weeks right now you're kind of working against time, you don't even have time to even get that money,” she said.
Abortions have declined in Florida under the six-week ban, but so far thousands are still being performed each month. State data released on July 1 and Aug. 1 show more than 4,000 abortions were reported during each of the previous months.
Some patients who could have saved up their own money for appointments if they had more time, now need the fund’s help, said Wallace.
Costly trips out-of-state are becoming more common
Many people don't even realize they're pregnant by six weeks. Since most nearby states also ban abortion, women have to travel to places like Washington D.C. or Illinois to get care if they're further along.
Between last-minute airfare and hotel stays, Wallace says it can easily cost another $1,000.
“But of course there's also taking off work, that can be hard for a lot of people, finding childcare,” she added. “Sometimes this is the first time people have ever been on a plane, ever left Florida, so it's really a whole new experience for them and it can be really confusing and stressful.”
Some Floridians, like thousands of other Americans living in states with abortion bans, are opting to get abortion pills in the mail from health professionals who can prescribe them online. It’s considered safe and effective, particularly in the first trimester, but Florida bans telehealth abortions. Criminal penalties don’t apply to pregnant women, but abortion funds face legal risks, said Wallace, so they don’t provide any assistance for clients interested in pursuing this method beyond sharing information. All they can legally do for people past six weeks, she said, is help get them out of the state.
But overall need has been so great that Just 12 days into July, the Tampa Bay Abortion Fund had to pause paying for travel costs for the month in order to prioritize people needing appointments in Florida.
The group relies on donations and grants, and had set a $50,000-per-month budget to avoid running out of money. They spent that much in about two weeks.
Leadership is having tough conversations about the future, said Wallace.
“I think money is always going to be an issue, unfortunately,” she said. “We're still spending a lot, and with funding cuts, are really getting hit harder than that.”
National group says it has to cut back on aid
The cuts Wallace referred to involve the National Abortion Federation. It's a professional association for abortion providers that also runs the largest patient assistance fund for abortion in the U.S., known as the National Abortion Hotline.
Previously, the federation would cover 50 percent of the appointment cost for patients who qualify for aid based on income and household size. But as of July 1, that’s down to 30 percent.
Local funds say the change puts a burden on them to fill the gap.
“It has been hurting us quite a bit with budget,” said Wallace.
The decision to reduce subsidy rates was "incredibly heartbreaking and painful," said federation president Brittany Fonteno, adding that demand for help around the country has been "overwhelming."
During the first half of this year, the hotline was spending more than $6 million a month on abortion appointments and another $200,000 on travel, said Fonteno. Even more people needed help with out-of-state care after Florida's ban went into effect.
"If we had kept pace with our previous level of spending, we would have run out of funds by the fall," said Fonteno.
The Tampa Bay Abortion Fund co-authored an op-ed published in the Nation earlier this month that criticizes large reproductive rights organizations like the National Abortion Federation for focusing too much of their resources on advocacy rather than patient care. More than 30 local abortion funds around the U.S. signed on to the piece.
In a follow-up statement the federation shared with WUSF via email, Fonteno said her team “deeply understands” local funds’ frustrations.
“We know these funding changes come at a difficult time and we are so grateful for the collective commitment from our members and local funds to ensure as many people can access abortion care as possible,” she said. “Sadly, our country has a broken health care system where people are forced to rely on donations to cover the cost of essential care.
Balancing helping people now with surviving in the future
Both local and national funds say they haven’t been getting as many donations as they did when Roe v. Wade was first overturned.
Many funds can only cover a portion of a client’s abortion cost, even if that woman can’t pay anything herself. Some have to pause services when they reach their spending limits, often towards the end of each month.
That can be the most challenging time to hear from patients, said Amber Pugh, a care coordinator with the National Abortion Hotline who works with Floridians.
“It's very difficult to hear the desperation in people that they just want to get the health care that they need,” said Pugh. “We will always do our best, but sometimes we can't help everyone.”
Funds work closely together, said Pugh, and often chip in money to support each other, particularly for complex cases.
“As difficult as these bans and these restrictions are, like our communities are still out here taking care of each other,” said Pugh. “We're doing what we can, and I think that's really powerful.”
A woman who was 11 weeks pregnant relied on that community on the July afternoon Bree Wallace was working from her Tampa home. This client needed help getting to D.C. for an abortion. The Tampa Bay Abortion Fund could pay for the appointment, but had already paused travel support.
Wallace tapped the national hotline, and an hour later learned they would cover the flight and hotel.
"So I'm happy about that, happy that the travel is all covered, now this person is all good," she said with a smile before moving on to the next case that demanded her attention.
The Tampa Bay Abortion Fund ended up spending more than $100,000 dollars in July, double their budget for the month. That helped 232 people get abortions — including one woman who texted this to Wallace:
“‘Thank you,' with a million exclamation points,” Wallace read. "'Thank you so much' – with even more exclamation points. 'I appreciate you for what you do, you just helped me more than you know.'"
A proposed constitutional amendment would expand abortion rights in Florida if it passes in November, but Wallace isn’t counting on it. The measure requires 60 percent approval to pass, and even if it does, the state has already said it anticipates legal challenges to resolve “uncertainties” related to implementing it. Besides, Wallace said, if abortion becomes available in Florida until viability again, which is around 24 weeks, the fund will likely still work to help people in states that still have bans come to Florida for care.
Wallace knows the fund could run out of money if donations don't replenish their reserves. But with so much need right now, she said it's a chance they'll have to take.
