Executive Summary
This week, the Colorado State Senate will begin legislative debate on SB 25-183.[1] This bill will require Colorado’s Medicaid and Child Health Plan Plus programs to cover elective abortions. A very broad body of research from economics, political science, and public health journals shows that when states cover elective abortions through Medicaid, state abortion rates increase. Furthermore, research from the Guttmacher Institute shows that in states whose Medicaid programs cover elective abortions, the state Medicaid program covers a significant fraction of the abortions performed in that state. Overall, this policy analysis estimates that the passage of SB 25-183 will result in 1,840 more abortions being performed on Colorado women in-state annually. Additionally, this policy analysis estimates 4,539 abortions will be covered by the state Medicaid program – costing Colorado taxpayers over $2.0 million.
Background
In 1967, Colorado became one of the first states to liberalize its abortion laws. Starting in 1969, the state Medicaid program funded elective abortions.[2] However, on November 6, 1984 Colorado voters narrowly approved Amendment 3 which prohibited the state from funding abortions except to save the life of the woman or in cases of a fetal defect. On June 4, 1985, legislation implementing these restrictions was enacted and Colorado’s Medicaid program has not funded elective abortions since that time.[3] However, in November 2024, Colorado voters approved Amendment 79. Amendment 79 created a right to an abortion in Colorado’s state constitution and repealed Amendment 3 – allowing the use of public funds for abortion. Currently, the Colorado State Senate is considering SB 25-183 which would require Colorado’s Medicaid and Child Health Plan plus programs to cover elective abortions.
How Medicaid Coverage of Elective Abortion Would Impact Abortion Rates in Colorado
The Hyde Amendment largely prevents federal taxpayer dollars from paying for elective abortions through Medicaid. However, approximately 19 state Medicaid programs use state taxpayer dollars to cover elective abortions.[4] A substantial body of research from economics, public health, and political science journals shows that when state Medicaid programs start to cover elective abortions, abortion rates increase. A 2009 Guttmacher Institute literature review of research on Medicaid funding for abortion identified 22 methodologically diverse studies on this topic. Of these 22 studies, 19 found that Medicaid coverage of abortion resulted in statistically significant increases in abortion rates.[5]
I did a comprehensive analysis of this literature for a Charlotte Lozier Institute policy analysis measuring the impact of the Hyde Amendment on the incidence of abortion in the United States.[6] I excluded studies that were weak methodologically and that had results were statistical outliers. I was left with 5 methodologically sound studies that appeared in reputable academic journals.[7] Averaging the results, I found that Medicaid coverage of elective abortions increases the abortion rate by 1.52 abortions per every thousand women of childbearing age.[8] This information will be used to analyze how state Medicaid coverage of abortion would impact the number of abortions in Colorado and Colorado’s abortion rate.
Data from Colorado’s Department of Public Health and Environment indicates that the incidence of abortion is increasing in recent years in Colorado. This is partly due to a higher percentage of abortions being performed on out-of-state women following the Supreme Court’s June 2022 Dobbs decision.[9] However, both the number of in-state abortions and the in-state abortion rate in Colorado have increased substantially since 2018 (Table 1).
Table 1: The Incidence of Abortion in Colorado
Year Number of Abortions Percentage on CO Residents Number on CO Residents In-State Abortion Rate
2023 14,691 71% 10,430 8.61
2022 14,154 72% 10,190 8.41
2021 11,580 86% 9,958 8.32
2020 9,869 87% 8,586 7.23
2019 9,002 89% 8,011 6.79
2018 8,975 88% 7,898 6.79
Notes
Abortion Data Obtained from Colorado Department of Public Health and the Environment
Colorado Population Data Obtained from CDC Wonder.[10] Since the most recent CDC Wonder population data is from 2022, 2022 population data was imputed for 2023
The most recent data from the Colorado Department of Public Health and the Environment indicates that 14,691 abortions were performed in Colorado in 2023. Approximately 10,430 of these abortions were performed on Colorado residents for an in-state abortion rate of 8.61. It should be noted that data from both the Centers for Disease Control and Prevention (CDC) and Guttmacher Institute provide broadly similar estimates of the incidence of abortion in Colorado between 2018 and 2022. However, for the purposes of this analysis, I am going to use the 2023 abortion data from Colorado’s Department of Public Health and the Environment since it is more current than CDC and also more relevant to calculations for in-state abortions on resident Colorado women.[11]
It should also be noted that the Guttmacher Institute estimates a substantial recent increase in the incidence of abortion in Colorado. Their figures indicate that 27,600 abortions were performed in Colorado in 2023.[12] It is likely that this sharp increase is due to larger numbers of out-of-state women seeking abortions in Colorado after the Dobbs decision and an increase in Colorado doctors prescribing chemical abortions via telehealth to out-of-state women. However, because of this large reported increase, it is possible that Medicaid coverage of elective abortion could conceivably even have a larger impact on both the number of abortions and the cost to Colorado taxpayers.
Overall, if Colorado’s Medicaid program is required to cover elective abortions, I would estimate that Colorado’s in-state abortion rate would increase from 8.61 abortions per thousand women of childbearing age to 10.13 abortions per thousand women of childbearing age.[13] This would result in approximately 1,840 more abortions being performed annually on Colorado women for a total of 12,270 in-state abortions every year (Table 2).[14]
Table 2: How Medicaid Funding of Elective Abortion Will Impact the Incidence of Abortion Among Colorado Women
Number on CO Residents In-State Abortion Rate
Estimates without Medicaid Funding 10,430 8.61
Estimates with Medicaid Funding 12,270 10.13
Again, this is a fairly conservative projection of the incidence of abortion in Colorado. As was mentioned earlier, estimates published by the Guttmacher Institute indicate that the incidence of abortion in Colorado sharply increased in 2023.[15] Estimates from the Society of Family Planning also indicate increasing abortion numbers in Colorado.[16] However, it is reasonable to assume that if SB 25-183 should pass, nearly 2,000 more abortions would be performed on Colorado women annually.
How Medicaid Coverage of Elective Abortion Would Impact Colorado Taxpayers
The most recent comprehensive data on abortions paid for by state Medicaid programs is from the Guttmacher Institute. In a 2017 publication, they published data from Fiscal Year 2015.[17] As Table 3 indicates, in states where state Medicaid cover elective abortion, the state Medicaid program consistently pays for a significant fraction of the abortions that are performed within the state. The percentages of total abortions paid for by state Medicaid range from 15.4 percent in Connecticut to 88.1 percent in Vermont (see Table 3). On average, in states where the state Medicaid program covers elective abortions, Medicaid pays for approximately 37.0 percent of all abortions. As such, I would estimate if Colorado’s Medicaid program were required to cover elective abortions, Colorado taxpayers would be paying for 4,539 abortions every year.[18]
Guttmacher’s 2017 publication also provides actual data on government expenditures for publicly funded abortions. Their data from 2016 shows that each publicly funded abortion cost taxpayers approximately $454.37. As such, a very conservative estimate would be that state Medicaid coverage of elective abortions would cost Colorado taxpayers approximately $2,062,385 (Table 4).
It should be stressed that the more than $2 million of taxpayer funding for elective abortions each year is a conservative estimate. There are a couple reasons for this. First, it is extremely likely that the cost of a publicly funded abortion has increased since 2015. Second, in states whose Medicaid programs cover elective abortions, Medicaid is usually paying for an increasing fraction of all abortions performed in the states. Overall, if Colorado’s Medicaid program is required to cover elective abortions, it would clearly cost Colorado taxpayers millions of dollars.
Table 3: Fraction of Taxpayer-Funded Abortion in States Where State Medicaid Covers Elective Abortions in 2015
Paid for by State Medicaid Estimated Total Abortions Percentage
Alaska 588 1,365 43.1%
California 88,466 149,025 59.4%
Connecticut 1,948 12,675 15.4%
Hawaii 1,345 3,430 39.2%
Maryland 6,866 29,165 23.5%
Massachusetts 3,750 20,110 18.6%
Minnesota 4,027 9,955 40.5%
Montana 461 1,660 27.8%
New Jersey 10,277 46,380 22.2%
New Mexico 1,329 5,000 26.6%
New York 22,493 115,390 19.5%
Oregon 3,737 9,590 39.0%
Vermont 1,216 1,380 88.1%
Washington 10,328 18,290 56.5%
Total 156,831 423,415 37.0%
Notes:
2015 Data on Abortions Paid for by State Medicaid obtained from “Public Funding for Family Planning and Abortion Services, FY 1980-2015” published in April 2017 by the Guttmacher Institute. Available at https://www.guttmacher.org/report/public-funding-family-planning-abortion-services-fy-1980-2015.
2015 Total Abortion data for all states is calculated by averaging Guttmacher Institute abortion data for 2014 and 2016[19]
Table 4: Estimating Annual Cost to Taxpayers of Medicaid Coverage of Elective Abortions
Estimated Number of Abortions performed on Colorado Women 12,270
Estimated Fraction of Abortions Paid for by State Medicaid 37.0%
Estimated Number of Abortions Paid for by Colorado’s Medicaid Program 4,539
Estimated Cost Per Abortion $454.37
Total Estimated Annual Cost to Colorado Taxpayers $2,062,385
Analysis
This policy analysis estimates that if SB 25-183 passes it would result in 1,840 more abortions being performed in Colorado women every year and it would cost Colorado taxpayers over $2 million annually. It should be noted that these estimates are conservative. Data from multiple sources indicates that the incidence of abortion in Colorado has increased since 2023 — the most recent year when abortion data was available from the Colorado Department of Public Health and Environment. Furthermore, the number of women of childbearing age in Colorado has likely increased since 2022 – the most recent year population data was available from the CDC.
Furthermore, the cost of an abortion has certainly increased since 2015 – the most recent year for which Guttmacher Institute released comprehensive data on Medicaid funding of abortion. Additionally, the cost estimates presented in this policy analysis do not account for the health care costs incurred by the state Medicaid program from Colorado women seeking post-abortion health care. They also do not account for health costs that state Medicaid program would incur from Colorado women who encounter physical or mental health problems after obtaining abortions.
Conclusion
A broad body of research shows that when state Medicaid programs cover elective abortions, the incidence of abortion increases and taxpayers pay for a substantial fraction of the abortions performed in that state. This policy analysis analyzes research and data from other states whose Medicaid programs cover elective abortions. It estimates that if SB 25-183 passes, approximately 1,840 more abortions would be performed on Colorado women annually. It also finds the state Medicaid program would pay for approximately 4,539 abortions every year, costing Colorado taxpayers over $2 million annually.
[1] See https://leg.colorado.gov/bills/sb25-183
[2] Merz, John, Catherine A. Jackson, and Jacob Klerman. 1995. A Review of Abortion Policy: Legality, Medicaid Funding, and Parental Involvement, 1967-1994. Women’s Rights Law Reporter 17(1): 1-61.
[3] Id.
[4] https://abortionfunds.org/need-an-abortion/abortion-and-medicaid/#
(Accessed March 31, 2025)
[5] Henshaw, Stanley K. et al., “Restrictions on Medicaid Funding for Abortions, A Literature Review” New York: Guttmacher Institute, 2009.
[6] New Michael J. 2023. “Hyde @ 40: Analyzing the Impact of the Hyde Amendment with July 2020 and June 2023 Addenda,” Charlotte Lozier Institute. On Point. Issue 95. Available at https://lozierinstitute.org/hyde-40-analyzing-the-impact-of-the-hyde-amendment-with-july-2020-and-june-2023-addenda/.
[7] Blank, Rebecca, Christine George, and Rebecca London. 1996. “State Abortion Rates: The Impact of Policies, Providers, Politics, Demographic, and Economic Environment.” Journal of Health Economics 15(5): 513–53; Levine, Phillip, Amy Trainor, and David Zimmerman. 1996. “The Effect of Medicaid Abortion Funding Restrictions on Abortions, Pregnancies and Births.” Journal of Health Economics 15(5): 555–78; Matthews, Stephen, David Ribar, and Mark Wilhelm. 1997. “The Effects of Economic Conditions and Access to Reproductive Health Services on State Abortion Rates and Birthrates.” Family Planning Perspectives 29(2): 52–60; New, Michael J. 2011. “Analyzing the Effect of Anti-Abortion U.S. State Legislation in the Post-Casey Era: State Politics and Policy Quarterly 11(1): 28-47; New, Michael J. 2014. “Analyzing the Impact of U.S. Antiabortion Legislation in the Post-Casey Era: A Reassessment” State Politics and Policy Quarterly 14(3): 228-268.
[8] New, 2023.
[9] https://www.guttmacher.org/2023/12/high-toll-us-abortion-bans-nearly-one-five-patients-now-traveling-out-state-abortion-care (Accessed March 31, 2025)
[10] Single-race Population Estimates, United States, 2020-2022. July 1st resident population by state, age, sex, single-race, and Hispanic origin, on CDC WONDER Online Database. The 2020-2022 postcensal series of estimates of the July 1 resident population are based on the Blended Base produced by the US Census Bureau in lieu of the April 1, 2020 decennial population count, released by the Census Bureau on June 22, 2023. Accessed at http://wonder.cdc.gov/single-race-single-year-v2022.html on Mar 31, 2025
[11] The most recent abortion data from the Centers for Disease Control is from 2022. The most recent abortion data by state of residence from the Guttmacher Institute is from 2020.
[12] https://www.guttmacher.org/monthly-abortion-provision-study#at-a-glance
[13] I added 8.61 (My estimate for Colorado’s in-state abortion rate using abortion data from Colorado’s Department of Public Health and the Environment) to 1.52 (estimated abortion rate increase if Colorado’s Medicaid program were required to cover elective abortions).
[14] The most recent population data from the Centers for Disease Control and Prevention (CDC) is from 2022. It reported that there were 1,211,040 women of childbearing (age 15-44) living in Colorado. Source: CDC Wonder. My calculations are as follows: (1,211,040)*(1.52/1000) = 1,840
[15] https://www.guttmacher.org/monthly-abortion-provision-study#at-a-glance
[16] https://societyfp.org/research/wecount/ (Accessed March 31, 2025)
[17] https://www.guttmacher.org/sites/default/files/report_pdf/public-funding-family-planning-abortion-services-fy-1980-2015.pdf (Accessed March 31, 2025)
[18] 12,270*0.37 = 4,539
[19] Data obtained from Guttmacher’s State Data Center. (https://data.guttmacher.org/states)
