The following comes from a May 2 FiveThirtyEight article by Madeleine Schwartz:
In many ways, Shauna Heckert, the executive director of Women’s Health Specialists of California, a group of six abortion clinics in Northern California, feels lucky to be working in a blue state. California abortion laws are among the most favorable to providers. The state is the only one rated A+ by the lobbying group NARAL Pro-Choice America in its state-by-state survey.
Yet even as her organization celebrates its 40th anniversary, Heckert worries that she may no longer be able to keep all of them open. In the past few years, she’s seen other small providers close their doors because they simply couldn’t afford to keep going. The fees for services they charged were too low, the reimbursements from Medicaid and insurance too small and too infrequent. And the demand for abortions has fallen with the rate of unwanted pregnancies.
“We are a dying breed,” Heckert said. Clinics in California and around the country have stopped operating, not only because of restrictive legislation and policy changes but “because of economics,” she said.
As the Supreme Court debates a Texas law that has led to the closure of at least 20 clinics, providers and researchers are noticing a quieter trend: Abortion clinics are closing in blue states, too.
Twelve clinics have closed in California since 2011, along with three in Washington and a number in New York, New Jersey and Connecticut, according to data compiled by Bloomberg — all states considered relatively favorable to abortion rights because of their legislative policies. According to Nikki Madsen, executive director of the Abortion Care Network, a national association for independent abortion care providers, for every three independent abortion clinics in her network that close in more conservative states, about two have closed in more liberal states over the past five years.
Even in states that are friendly to abortion rights, the costs of operating a clinic can make it nearly impossible to keep one open. In 2011, 94 percent of abortion procedures, including both surgical and medication abortion, took place in clinics, according to the Guttmacher Institute, a research organization that advocates for abortion rights. Of those, independent clinics provided about two-thirds of abortions. Planned Parenthood provides the other third. Although Planned Parenthood is a 501(c)(3) charitable organization, small clinics usually have for-profit status and thus must operate as businesses.
They often have a hard time staying afloat. One important factor is the price of the procedure. Clinics try to keep the price of abortions as low as possible so women can afford the procedure, Madsen said. Women seeking abortions are usually poor: 42 percent have incomes below the federal poverty level, and most pay for the procedure out of pocket.
At the same time, fewer women are seeking abortion services, potentially reducing patient numbers at small clinics. In the U.S., 1.06 million abortions were performed in 2011, the last year for which Guttmacher has data for all 50 states, down 13 percent from 1.21 million in 2008. (In 1991, the number was almost 50 percent higher, at 1.56 million procedures.) Johnston says her clinic sees about a third fewer patients than it did a decade ago.