Full statement

Statement of the Center for Reproductive Rights
1600 K Street NW, Washington, DC, 20006

November 19, 2025

Senate Committee on Finance Hearing

“The Rising Cost of Health Care: Considering Meaningful Solutions for all Americans”

Chair Crapo, Ranking Member Wyden, and Members of the Committee:

Thank you for the opportunity to submit testimony on the critical issue of rising health care costs. The Center for Reproductive Rights (the Center) is a global legal advocacy organization that uses the power of the law to advance reproductive rights as fundamental human rights. Since our founding in 1992, the Center’s game-changing litigation, legal policy, and advocacy work—combined with unparalleled expertise in constitutional, international, and comparative human
rights law—has transformed how reproductive rights are understood by courts, governments, and human rights bodies around the world.

On June 24, 2022, the Center’s work in the United States was brought into sharp public focus when the Supreme Court overturned Roe v. Wade and almost fifty years of precedent cementing the constitutional right to abortion. The fallout of the decision in Dobbs v. Jackson Women’s Health Organization was immediate and nothing short of devastating. Anti-abortion state lawmakers rushed to ban abortion entirely, leaving patients without access across large swaths of the country, particularly in the South and Southeast. As a result, abortion is now illegal in 12 states and the right to access care is threatened in an additional 14 states¹.

With millions of people of reproductive age now living in these ban states²,
some patients are being forced to carry pregnancies to term against their will or to travel hundreds of miles to access time-sensitive abortion care. In fact, the Guttmacher Institute estimates that the number of people traveling across state lines to access abortion care has more than doubled since 2020, reaching 170,000 people in 2023 and nearly 155,00 people in 2024³. In total, this represents 15 percent of all abortion patients obtaining care in states without total bans⁴.

This dramatic increase in travel has come at an immense cost, especially for those already bearing the brunt of inequitable access to care, such as Black, Indigenous, and other people of color; the LGBTQ+ community; immigrants; people with fewer economic resources; those living in rural communities; and so many others. These costs are not only financial—expenses associated with the abortion itself and with traveling—but also logistical and emotional: coordinating accommodations and childcare, taking time off work, and navigating an increasingly complex legal landscape and healthcare system, all while patients are being ripped away from their homes and support networks.

What’s more, the impact of these increased costs extends far beyond individual patients to the broader healthcare system. Shortly following Dobbs, experts identified yet another “clear” result of the decision: the states’ race to outlaw abortion would increase rates of pregnancy-related deaths, complications, and hospitalizations as well as infant mortality rates and, therefore, increase the cost of providing health care to women overall⁵. Over three years later, this prediction has become our lived reality.

Abortion bans strain our healthcare system by delaying or eliminating access to essential care, forcing more patients to carry complicated and high-risk pregnancies, increasing maternal and infant mortality, and pushing health care providers out of ban states. Even before Dobbs, Texas saw a 17 percent increase in infant mortality due to the 2021 passage of its vigilante abortion ban, Senate Bill 8, including a significantly higher than expected death rate for Black infants⁶ and a 50 percent increase in maternal sepsis rates⁷. Post Dobbs, these trends spread throughout the country, with infant death rates 5.6 percent higher than expected in abortion ban states⁸ and a nationwide 7 percent increase in overall infant mortality and 10 percent increase among infants with congenital anomalies⁹. Similarly, pregnant people living in ban states became almost twice as likely—or 3.3 times as likely for Black women—to die during pregnancy, childbirth, or soon after giving birth than those living in supportive states where abortion was legal and accessible¹⁰. Notably, over the same time period, maternal mortality fell by 21 percent in supportive states¹¹.

Overall, in the wake of Dobbs, studies demonstrate that state abortion bans have resulted in 22,000 additional births, 478 excess infant deaths, and 59 excess pregnancy-associated deaths¹² and have had a chilling effect on the provision of high-quality, evidence-based care¹³. All of this comes at financial cost for our healthcare system: the cost of additional pregnancy, childbirth, postpartum,
and infant care amidst increased numbers of higher-risk pregnancies, complicated births, and newborn health complications¹⁴.

The stories of the countless people directly impacted by draconian abortion bans and restrictions are further illustrative of their human costs. For example, the Center has brought a series of lawsuits filed in Texas, Idaho, and Tennessee on behalf of women denied medically necessary abortion care despite severe and dangerous pregnancy complications threatening their health, lives, and future fertility¹⁵. Our Texas case was named for lead plaintiff Amanda Zurawski, who was denied abortion care after her water broke prematurely at 18 weeks pregnant, leaving her fetus with no chance of survival. Three days later, Amanda developed sepsis, a severe and potentially deadly infection, and was rushed to the ICU. Her life was saved, but her future fertility was not, as one of her fallopian tubes is now permanently closed¹⁶. Samantha Casiano, another Zurawski v. Texas plaintiff, learned at her 20-week scan that her fetus had anencephaly, a fatal condition preventing fetal skull and brain development, and would not survive. Because Samantha lacked the time, finances, and resources to travel out of state for abortion care, she was forced to remain pregnant. Tragically, her daughter died just four hours after Samantha gave birth¹⁷.

Against the backdrop of this healthcare crisis created by bans and restrictions, anti-abortion federal lawmakers continue to push policies that stretch our overburdened system and jeopardize patient health, lives, and well-being. A Guttmacher Institute analysis estimates that new work requirements passed in July as part of the reconciliation package threaten to eliminate Medicaid coverage for 2.1 million women of reproductive age¹⁸. Moreover, in a blatant, targeted attack on Planned Parenthood, the package also included a provision blocking patients from using their Medicaid coverage at certain family planning providers who also provide abortion care, leading to the closure of at least 20 health centers across the country¹⁹. Maine Family Planning (MFP)—the backbone of sexual and reproductive healthcare in the Pine Tree State serving 8,000 patients annually at its 18 clinics and mobile unit—was similarly stripped of its Medicaid funding and
recently forced to end its primary care practice²⁰. Nearly half of their patients rely on Medicaid and many live in rural communities without any alternative providers.

MFP, represented by the Center, is suing the Trump administration to restore its federal funding. However, due to the rising costs of care, it remains unclear how long MFP can rely on its limited reserves to continue providing services before being forced to discharge family planning patients or to close their clinics entirely. Already, many of MFP’s discharged primary care patients have nowhere else to turn and the same may soon be true for their family planning patients as well. Those who may be able to access alternate care will face significant delays, further travel distances, longer wait times, and higher costs in Maine’s already overstretched health care system. Many will be forced to forgo health care altogether. These additional burdens will fall on patients who already face significant hurdles in accessing care in the first place. For instance, necessities like heating and electricity are expensive in Maine’s rural counties and paying out of pocket for one pack of birth control pills costs $25 per month. If MFP cannot accept Medicaid, patients will be forced to make tough decisions about whether they can afford to pay for birth control out of pocket, potentially experiencing a life-changing unplanned pregnancy as a result²¹.

What’s more, anti-abortion lawmakers are now expanding this coverage fight beyond public funding by interfering with the decisions of state officials and private insurers. As the Affordable Care Act’s (ACA) premium tax credits inch toward expiration at the end of this year, 20 million people who benefit from the subsidies face higher premiums and millions are expected to lose their health insurance absent an extension agreement²². Nevertheless, some lawmakers are taking advantage of negotiations around extending the subsidies to further attack abortion access.

To be clear: the law already prohibits federal dollars from being used to pay for abortion coverage in Marketplace plans and places burdensome requirements on insurers to keep any non-federal funds used to cover abortion in separate accounts. Federal subsidies are not being used to cover abortion care beyond the limited circumstances explicitly outlined in ACA Section 1303²³. These existing restrictions already severely limit access to essential care for millions. At the same time, ACA Section 1303 also makes clear that states have the right to mandate abortion coverage in all plans participating in their Marketplaces, prompting 12 states to pass laws requiring all fully insured group plans and individual plans (including Marketplace plans) to cover this essential care²⁴.

Still, anti-abortion lawmakers are demanding new restrictions that would prohibit the use of government subsidies for plans sold in state ACA Marketplaces that include abortion coverage. These proposals would force insurers to offer nearly duplicate plans with and without abortion coverage for those who do and do not use subsidies—or to drop abortion coverage altogether. Additionally, the proposed restrictions would directly conflict with states’ rights to enforce their
laws and to codify new protections. Ultimately, this logistical nightmare and unprecedented interference in private health insurance would likely drive most insurers to leave the ACA Marketplaces altogether²⁵.

As such, the Center calls on Members of Congress to reject efforts to weaponize ACA tax credit negotiations to gut abortion coverage from the ACA Marketplaces; to permanently extend ACA tax credits that keep health care affordable for millions of families; and to remove existing restrictions that put abortion out of reach for so many.

Thank you again for convening this hearing and for the opportunity to contribute the Center’s expertise to the record.

Citations