To determine if cost impacts administration of local anesthesia vs. sedation during
abortion procedures by comparing rates of anesthesia provided before and after Illinois
mandated Medicaid coverage of abortion.
This is a retrospective cohort study of patients presenting for a first-trimester
procedural abortion at Planned Parenthood of Illinois from January 1, 2016 to December
31, 2019. Effective January 1, 2018, Illinois House Bill 40 (HB40) mandated Medicaid
coverage of abortions. Our primary outcome was to compare rates of local anesthesia
vs. sedation before and after HB40 implementation. Segmented logistic regression models
appropriate for an interrupted time series analysis were performed.
Of the 32,259 patients who met inclusion/exclusion criteria, 14,592 had an abortion
procedure prior to HB40 and 17,667 had a procedure afterward. When we used an interrupted
time series, we found a statistically significant level change in the rates of sedation
following HB40, with rates increasing by 5.39% (p=0.0007).
It is well established that abortion can be cost-prohibitive. However, no studies
have examined how cost affects the administration of anesthesia during an abortion
procedure. An interrupted time series model allows us to adjust for confounders and
analyze the effect of HB40 alone. When looking at the period immediately following
the mandated Medicaid coverage, we found a statistically significant increase in sedation
administration, suggesting that cost may affect the anesthesia that a patient receives.