According to Kaiser Health News, over 114 major US employers have pledged to offer or expand abortion-related benefits since the US Supreme Court’s Dobbs decision reversing federal reproductive rights first leaked in May. Fifty-four of the companies—including Starbucks, Bank of America, Disney, and Apple—are in the Fortune 500. A survey from Mercer found that by June, when the official ruling was released, 14% of companies already had policies or plans in place to reimburse abortion-related travel expenses, while another 25% said they were considering it.
These types of policies represent meaningful gestures of support in the face of drastic rollbacks to reproductive rights. However, they also raise serious concerns about safety and confidentiality. People are understandably wary about the prospect of having to notify their employer about such a private healthcare decision.
There are also tricky tax and compliance issues that businesses will have to sort out, especially if they want to ensure that all workers—including temporary workers and contractors—have access to these benefits.
For workplaces that want to support the reproductive autonomy of their employees and uphold access to abortion, it’s essential to ensure the benefit is being administered ethically and responsibly. Here are some key things to keep in mind.
Privacy and confidentiality in accessing abortion care benefits
Many employees won’t be comfortable disclosing to their employer, whether directly or indirectly, their efforts to make use of an abortion care benefit. As Dina Fierro, a global vice president at the cosmetics company Nars, told the New York Times, “It’s a doomsday scenario if individuals have to bring their health care choices to their employers.”
The Kaiser Health News survey revealed that many companies have yet to publicly detail their confidentiality practices, but many employees likely will be dissuaded from using the benefit if there aren’t explicit protections in place. Of the companies that have described their practices, approaches vary. Starbucks, for instance, is providing employees with access to third-party trained “advocates” who they can go to anonymously with their questions, while the Match Group has partnered with Planned Parenthood Los Angeles, which will handle all the information, booking, and arrangements directly.
These solutions help create channels outside of the corporate hierarchy that can serve as a safeguard, not only from exposure, but also from law enforcement, which could theoretically subpoena documentation related to abortion-related benefits as part of an investigation. In essence, the less an employer knows, the better.
Taxation and compliance
The patchwork of state laws on abortion and insurance coverage makes it difficult for businesses to figure out how to structure abortion-related benefits in a way that is financially and legally compliant—especially for organizations with employees in multiple states. Some states prohibit insurers from covering abortions or related expenses, while other states mandate coverage as part of essential healthcare.
There also are differences for self-insured employers and fully insured employers. Organizations that fund their own benefit plans have more room to navigate around restrictions in state insurance laws, but most small and medium-sized businesses have fully insured plans, which are subject to greater oversight. In states hostile to abortion rights, this could make providing abortion-related benefits much more difficult.
This is why many employers are considering options outside of their existing health insurance plans—such as forming health reimbursement arrangements (HRA), health flexible spending accounts (FSA) or health savings accounts (HSA)— in order to fund out-of-state travel, but these aren’t perfect solutions. For one, a plan that centers on reimbursement means that employees need to have the upfront funds to cover the costs on their own and then wait to get paid back, which many cannot afford. Secondly, the expenses typically have to be substantiated with receipts and documentation, creating a paper trail that raises privacy concerns.
In addition, if the reimbursements are covered outside of the health plan, the amount paid out would likely be treated as taxable income, and the benefit may not be subject to HIPAA privacy laws. If included as part of their regular health coverage, employees may have to meet their deductibles before getting reimbursed. There may also be complications if employees are seeking care from out-of-state providers who are not in-network. All of these factors impact whether the benefit truly does what it aims to do, which is to make abortion care more accessible.
Maximizing the benefit of abortion-care benefits
Travel stipends are emerging as a popular solution to the problem with confidentiality and compliance. Some companies are offering annual travel stipends that cover any type of medical care, including fertility treatments and cancer treatments. Extending the benefit more broadly means that abortion care is not singled out—which both preserves privacy and makes it harder for states to crack down—and enables employees to use the funds at their discretion, without need for approval or reimbursement. Citigroup, Dick’s, Buzzfeed, Reddit, Meta, Warner Bros, Intuit, and Zillow all have said they will offer annual stipends in amounts ranging from $4,000 to $7,500.
Ultimately, to have the biggest impact, companies should consider extending abortion-related benefits—along with paid time off—to temporary workers and contractors. These categories of workers are much more likely to be women of color and to earn less income, while full-time salaried employees are more likely to be wealthier and white. This means that the workers who need this type of benefit the most are the same workers who are most likely to be excluded from it. If the goal of these benefits is to ensure people who need access to abortion care can access it, these workers can’t be left behind.
There’s no question that the Dobbs decision, and the subsequent rush in several states to outlaw or severely restrict abortion, will make it much more difficult for people to access the care they need. Along with activists, advocates, practical support organizations, abortion funds, and reproductive healthcare providers, employers can play an important part in helping to ensure avenues to access remain.