US Abortion Bans Force Later Procedures

Abortion providers are seeing more patients needing procedures later in pregnancy due to widespread state bans and falling insurance coverage. Diane Horvath, cofounder of the only all-trimester clinic owned and operated by women in the US, said patients are arriving "later and sicker."

About 41 states now have abortion bans or significant restrictions. Over 20 million people have lost Medicaid coverage since 2023, and between 3 and 5 million have lost or dropped Affordable Care Act exchange plans. "People are getting chucked off of Medicaid. The premiums are all going up," Horvath said. She added that instead of seeking early care, "They're just not going in. There's no place to go."

The cost of a later abortion, loosely defined as after the first trimester, rises the further a pregnancy progresses. Alisha Dingus of the DC Abortion Fund said, "Sometimes you're looking at a $22,000 gap with maybe three days to pull together funding." A recent Jama study found rising costs and decreasing availability may create substantial barriers.

Costs and Access Barriers Rise

"Further into pregnancy, the cost of care goes up, the number of providers goes down, and more and more restrictions go into effect," said Erika Christensen of Patient Forward. She noted the later abortion population is disproportionately young people living below the poverty line in healthcare deserts. "They're sort of in a perfect storm: they have the least amount of time to find the money for the most expensive care ..."

Only clinics in four states and Washington DC offer all-trimester care to all patients. In Maryland, where the state constitution protects reproductive freedom, two all-trimester clinics serve patients nationally and globally. Horvath said abortions in later pregnancy happen for all the reasons people seek earlier abortions, including new health information, job loss, or abusive partners. For some, particularly children, pregnancy may not be diagnosed until very late.

"At any point in the pregnancy, abortion is going to be lower risk than continuing the pregnancy," Horvath stated. Legal barriers and appointment difficulties now force longer waits. Patients might seek care in several states, hitting gestational limits each time, and frequently arrive in Maryland past the second trimester. "It is a multiday procedure, and the barriers to access it are so high," Dingus said.

Funding Challenges and Clinic Support

In 2025, Partners in Abortion Care stopped accepting Medicaid for later procedures due to losing thousands per case under reimbursement rules. "It hurts access, and it's awful," Horvath said. But the clinic hasn't turned patients away, working with about 40 different abortion funds to often get people fully funded. The DC Abortion Fund helps pay for at least 20 people weekly getting care at 28 weeks' gestation and later.

Dingus noted an uptick in people needing funding at 30 weeks and later in the past two years. While donations spiked after the Dobbs decision, funding has slowed to a trickle as needs increased. "We are seeing much larger gaps than we've ever seen," she said.

Christensen, who needed an abortion at 32 years ago, said the provider landscape has changed. Modern later-abortion care is now offered by younger, more diverse, mostly female providers in normal healthcare centers. The Partners clinic, for instance, has soft lighting, blanket warmers, and offers gowns of all sizes. "We've tried really hard to set our clinic up in a way that people know their autonomy is being respected," Horvath explained.

Autonomy is central, Christensen said, getting at "the core of whether women get to be people." Horvath recalled a 12-year-old patient who, after her procedure, said she just wanted to be a kid again. That moment cemented Horvath's path. "This is sacred work. This is life-saving work," she said. "This little girl gets to go be a little girl again."