52
legislaturestopassTRAPlaws,arguesthattheregulationsare
necessarytoprotectwomen.Shesaysthat,whileshewould
prefertherebenoabortionsintheU.S.,“rightnowabortion
is legal.Aslongasit is,I amgoingtofightforeverywoman’s
safety.Thatmayendupcostinga littlebitmore.”I
n aneraofhighmedicalcostinflation,abortionis anout-
lier.A first-trimesterabortionmightcostbetween$400and
$1,000,dependingonthemethodandtheclinic.InMinnesota
it’sabout$650.“Youcan’tgeta moleremovedfor$650,”says
NikkiMadsen,executivedirectoroftheAbortionCareNetwork.
Shecalculatesthatinher 15 yearsinthefield,thepriceofan
abortionhasgoneuponly$50.Goback 45 years,andit was
$125to$200,accordingtoa 1974NewYorkTimesarticle.Based
onU.S.BureauofLaborStatisticsdata,a procedurethatcost
$200in 1974 wouldbearound$2,686todayhadit keptpace
withmedicalinflation.
Pricesremainstaticbecauseabortionexistslargelyout-
sidethetraditionalhealthinsurancemodel.Elevenstatesban
orheavilyrestrictabortioncoveragebyprivateinsurers,and
morethanhalfofallstateshavestringentrulesthatlimitcov-
erageontheinsuranceexchangescreatedbytheAffordable
CareAct,accordingtothenonprofitGuttmacherInstitute.
Mostofthedemandcomesfromlow-incomewomen,whogot
3 outof4 abortionsintheU.S.in2014.ButMedicaid,which
providesmanyofthesewomenwithcoverage,is prohibited
bya 1970slawfromusingfederalfundstocovertheproce-
dure,andstatefundingfillsthebreachonlyif politicsallowit.
Allofthatleavesabortionlargelya cashbusiness,withdoc-
torschargingwhattheybelievea patient,ratherthananinsurer,
canpay.Manyclinicscovertheentirecostofservicesforthose
whocan’taffordit,oftendrawingondonorsupport.
It canbea struggleeventoopenthedoors,letaloneto
keepthemopen.BeforeJulieBurkhartstartedherclinicin
Wichitain2013,shespenttwoyearstryingtogetfunding.
EveryonefromBankofAmericaCorp.toWellsFargo& Co.to
somesmallerregionalinstitutionsdeclinedtogivehermoney.
“AfterI announcedthatwewouldbeprovidingabortioncare,
that’swheretheconversationstopped,”shesays.Intheend,
shereliedondonations,openingthesamemonthasKansas
lawmakerspassedsweepinganti-abortionlegislation.“Toall
thelenderswhothoughtweweretoohigh-risk,herewearestill
opensevenyearslater,”shesays.(Ina statement,WellsFargo
said,“Wedonothavea policyagainstlendingtofamilyplan-
ningproviders.”BankofAmericadidn’trespondtoa request
forcommentbuthaspreviouslysaidit doesn’thaveinforma-
tiononBurkhart’sclinic.)
Thechillhasspreadtopro-choiceregions,too.AfterTrump
waselected,Burkhart,concernedthatRoev.Wademightbe
overturned,decidedtosetupanoperationsomewheremore
politicallyhospitable.ShesettledonSeattle,a liberalcityina
statewithabortionprotectionswrittenintolaw.Eventhere,
shequicklyranintoissues.HerleasewiththeUniversityof
Washingtonforspaceina skyscraperhadclausessayingthat
Burkhartcouldn’tengagein“advocacy”andthatshecouldbe
evictedif herbusinesscaused“anydemonstration,protest,Burkhartpicketing,rally”formorethantwostraightbusinessdays.In
May2018,aftera pictureofBurkhartinherofficeappearedin
thelocalnewspaper,shegota cease-and-desistletterfroma
lawyerfortheuniversity,warningherthatshe’dviolatedthese
clauses.Themessagecitedthearticle,aswellasa protestthat
hadtakenplaceoutsideinDecember 2017 anddescriptions
ofherclinic’sadvocacyforreproductiverightsonitswebsite.
“Iwasa littledisturbed,andfloored,bythefactthatan
organizationinthestateofWashington,inthecityofSeattle,
wouldtakesucha punitiveapproach,”Burkhartsays.Topla-
cateherlandlord,sheagreednottodomediainterviewsin
herofficeanymore.Ultimately,feelingmuzzledandseeingless
businessthanexpected,sheclosedandrefocusedheratten-
tiononherclinicinKansas.(Ina statement,theuniversity
said,“Theleasetermsareestablishedtoensurethatanydis-
ruptionsinthebuildingpotentiallycausedbya tenant’suse
canbeaddressedbythelandlord.”)
Anotherproviderdescribeda similarexperienceinNew
YorkCity,whichlastyearallocated$250,000toestablishthe
country’sfirstmunicipalabortionaccessfund,forhelping
lower-income women living in states with restrictive laws to
pay for abortions in New York. The provider, who asked to
remain unnamed for fear of reprisal, was on the verge of open-
ing a clinic in Manhattan in 2018 when she discovered a clause
buried deep in her lease that said the tenant couldn’t termi-
nate a life or end a pregnancy. After a heated negotiation, she
agreed to a provision that allowed her to provide birth con-
trol and the emergency contraceptive Plan B, but not abor-
tions, for three years. The landlord told her he wasn’t against
abortion but was concerned that protests would limit his abil-
ity to lease property.Bloomberg Businessweek