Whether you view the controversy surrounding abortion as a legal issue, a religious issue, a gender issue, a pharmaceutical issue, or a human rights issue, most people have clear, if not opposing, opinions. The success of several telehealth abortion services has increased access to abortion pills over state and international borders, raising questions that fuel the fire.
Multiple telehealth abortion companies have successfully prescribed and delivered abortion pills since 2020 when it was first permitted by the Federal Drug Administration. That policy was made permanent in 2021.
As of this article’s writing, multiple courts are involved in the fight for reproductive rights; the pharmaceutical industry is in an uproar around states; and previously successful telehealth abortion services are holding their breath to see what will happen next. The US Supreme Court has allowed the continued sale of the abortion pill mifepristone until Friday, April 21, 2023. This article is written to clarify the telehealth issues surrounding the controversy and draw attention to one of the industry’s newest services as telehealth proponents struggle to find their place in the shifting US landscape.
Telehealth.org’s July 2022 article, titled, State Laws & Telehealth Abortion Pills for Remote Abortions, pointed to the telehealth issues created by the 26 states poised to ban abortion after the US Supreme Court’s landmark decision to overturn the 1973 Roe vs. Wade judgment. The digital privacy invasions allowed by some states advocating for prohibitions against telehealth abortion add yet another layer of dismay for advocates of abortion and telehealth abortion providers in particular.
How Telehealth Abortion Services Are Delivered
While telehealth abortion services operate from a limited number of states, consumers can access them worldwide. Reputable companies, however, follow state licensing laws, offering licensed clinicians in the states where patients are served. Investors and private grants finance some such programs, many health insurance companies reimburse others, and some patients pay cash.
In our August 2022 article, Is Birth Control Covered by Insurance?, we explained current US policy requiring group health plans and health insurance issuers to provide contraceptive coverage, including emergency contraception, and for services to be delivered to patients at no cost. Reimbursement is uneven across the states. Abortions are another matter. Only some states require private insurers to cover abortions. Sixteen states use state funds for abortion pills. Other states bar abortion altogether. Many women are not registered with health plans, and some simply prefer to pay cash.
Leading telehealth abortion, companies offer services through text messaging, video conferencing, or brick-and-mortar offices. The choice of modality seems to depend on the payor. For instance, large healthcare insurance companies often require videoconferencing or at least one in-person visit to a brick-and-mortar office. If not mandated by a payor, telehealth abortion services usually involve HIPAA-compliant, text-based interactions. The use of telehealth for abortions paid privately has been a legal way for women seeking abortions to obtain safe and medically monitored services from trained, licensed prescribers at a reasonable cost.
Privacy & Other Concerns
Telehealth.org’s earlier article, How the Supreme Court Upending of Roe vs. Wade Could Effect Telehealth Privacy Rights, underscored concerns about how the information being collected by some apps, such as menstrual cycle or health activity trackers, could violate their user’s privacy if unchecked. The concern stems from classifying apps as educational or self-help rather than used for diagnosis or treatment. Educational or self-help apps are not offered the same protections as medical records. Companies are not considered covered entities under HIPAA.
In light of the recently published research into privacy policies often written at a 12th-grade reading comprehension level, members of the “plain language” community that privacy notices should match the average reading level in the United States, which is 7 or 8-th grade. The finding suggests that many people, including women seeking or discussing abortion pills, will not understand the privacy implications of the apps that track their behavioral or other health information.
Even if women’s health or reproduction apps had appropriately worded privacy notices, the recent rash of Federal Trade Commission and Department of Justice investigations into the top telehealth platforms and US hospitals raises concern. Privacy policies often seem to be a sham, duping the public into a false sense of security. At the same time, large corporations go about the potentially more lucrative business of sharing such data with marketing companies such as Google, Facebook, Instagram, or TikTok to increase profits through “creative” marketing strategies.
The latest research about mental health app data being sold to data brokers behind the scenes to law enforcement and any other buyers interested in making the purchase. Such sales of data identified as mental health data raises the question of how information about menstrual cycles is handled by such apps, mainly if the app is not considered a “health” app.
The head of the Surveillance Technology Oversight Program, Albert Fox Cahn, commented that pregnant women have been arrested for years because of electronic surveillance. Before the overturn of Roe vs. Wade, he expressed a concern that authorities may overtly seek to breach telehealth privacy policies to apprehend women seeking telehealth abortions.
The Centers for Disease Control and Prevention has conducted abortion surveillance for decades. The CDCs Abortion Surveillance System FAQs explain that:
CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions. Many states and reporting areas conduct abortion surveillance. CDC compiles the information these reporting areas collect to produce national estimates. CDC’s surveillance system compiles information on legal induced abortions.
According to the Guttmacher website, the US Centers for Disease Control and Prevention (CDC) has worked with the states to collect aggregate statistics on US abortions for the last four decades. While states are not required to submit abortion data to the CDC, most do.
The form that vital statistics agencies have designed for abortion for providers to use requires the following types of information:
- Identification of the facility at which the abortion was performed and the physician performing the procedure;
- Patient’s demographic characteristics (e.g., age, race, ethnicity, marital status, and number of previous live births);
- Gestational age; and
- Abortion procedure used.
Many states have recently adjusted their forms to include questions about medication (nonsurgical) abortion. States also have reconfigured their systems so that reporting is increasingly completed on the Internet.
Punitive Stance Taken by Many States
The stark reality of how few companies honor their publically-posted privacy policies, juxtaposed with the collection of abortion data by many states, is daunting when considering how many states currently impose legal sanctions on abortion patients.
Laws fall into five categories, as depicted in a map of abortion access in the 50 states on the Center for Reproductive Rights website. Many states, including Texas and Oklahoma, already impose legal sanctions legal against women who have obtained an abortion since the overturn of Roe vs. Wade. If passed in South Carolina, the Prenatal Equal Protection Act of 2023 would redefine “person” under state law to include a fertilized egg. The law would give the egg at the point of conception equal protection under the state’s homicide laws, including the death penalty to women who receive abortions.
The Guttmacher state legislation tracker is a no-cost service for policy activity on many sexual and reproductive health topics.
Telehealth Birth Control Pill Reimbursement by Insurance Companies
This week, the Washington Post featured an article that discussed several telehealth abortion pill companies‘ recent successes at contracting with the insurers: Anthem Blue Cross Blue Shield of Connecticut, Empire Blue Cross Blue Shield of New York, and Sana, which offers health plans nationwide for small businesses. Another company named Hey Jane reportedly accepts Aetna in eight states. Pricing also includes a sliding scale, financial assistance from abortion funds, and HeyJane accepts payments from Health Savings Accounts.
HeyJane’s success with insurance partnerships serves as validation for its telehealth abortion model, and the demand for the service has been high. The affordability of using telehealth to obtain abortion pills makes it more appealing as a less expensive alternative to in-clinic procedures for patients and insurers. While the Hey Jane method of assessing patients is through text messaging, some insurers require video or in-person through local clinics with which Hey Jane has contracted.
Leading Telehealth Abortion Services
The following companies have taken the lead in offering telehealth abortions (these have not been vetted by Telehealth.org but rather are provided for your review):
- Planned Parenthood operates nationwide.
- HeyJane operates in CA, CO, CT, IL, MD, NJ, NM, NY, and WA.
- Maitri Wellness operates in New Jersey.
- Juniper Midwifery operates in six states.
- Abortion on Demand and Aid Access operate in a large number of states.
- Carafem offers telehealth abortions in 16 states and has several physical clinics.
Your thoughts are invited.
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