Privacy, stigma may keep workers from using abortion travel benefits

Several major corporations, from Amazon to Walmart, are promising to pay travel expenses for employees and family members who must leave their home states to receive a legal abortion.

But experts who advise those companies say their well-intentioned promises to invest in employee access to reproductive health care are fraught with risk, including potential retaliation by state officials. And it’s not clear whether the proposed benefits will be used by many employees, given the uncertain political climate.

“A lot of companies have talked big about it, but far fewer have actually implemented it,” said Bethany Corbin, senior counsel at health care specialists Nixon Gwilt Law. When companies do begin to offer abortion benefits, she said, she expects worker uptake to be minimal.

Among workers’ potential concerns are the stigma of abortion and worries that private medical information could intentionally or unintentionally leak to state authorities. Unlike health care providers and insurers, Corbin said, most private companies aren’t set up to handle sensitive medical information.

But she said businesses that want to offer an abortion benefit can structure their programs in ways that make the benefit more attractive to employees. Setting up a special fund and contracting with a third-party administrator, for example, is one way to protect employee privacy and reduce stigma, but not every company will have the capability to do that.

“There’s a really strong sense of privacy around abortion,” said Shelly Alpern, director of corporate engagement at Rhia Ventures, which advises companies on policies aimed at supporting reproductive health equity.

For most employees, asking a boss for paid time off for an abortion or filing detailed information on where and when they received the procedure is a nonstarter, she said, noting that many workers worry they could be passed over for a promotion because of an unconscious bias against abortion.

“It’s similar to the stigma around using mental health benefits that has been fading over time, in part because companies have made a concerted effort to encourage employees to talk about mental health,” Alpern said. “The same thing needs to happen with abortion.”

In the meantime, Alpern and Corbin say they advise companies to consider other options, such as partnering with a nearby abortion provider and paying the bill anonymously. They and other abortion rights advocates also recommend donating to nonprofit abortion funds, which are set up to confidentially arrange and pay for abortions and related expenses for patients with low incomes.

Other ways to show support for abortion rights, Alpern said, are to stop contributing to state political candidates who oppose abortion access and start donating to those who support abortion rights. Corbin said companies might also consider shuttering their operations in or relocating from states that ban abortion.

Above all, Corbin said, she advises companies interested in supporting abortion rights to start by surveying their employees to see what they think.

“Let’s say you’re in Texas, and I’m an employee and I’ve seen the internal memo on abortion benefits. I could become a whistleblower,” she said. “Employers who aren’t in tune with their employee base could be opening themselves up to a lot of risk.”

Abortion migration

More than 170 large and small employers have committed to covering travel for abortion care, according to research conducted by Rhia Ventures.

A partial list includes Amazon, Bank of America, Dick’s Sporting Goods, the Ford Motor Company, Google, Johnson & Johnson, Meta, Microsoft, The New York Times, Nike, Starbucks, Tesla, Walmart and the Walt Disney Company.

A major reason companies are promising to offer abortion travel benefits is to retain and attract employees who otherwise may not want either to stay in or to relocate to a state that bans abortion.

But it remains to be seen whether abortion bans expected to take effect in 26 states since the U.S. Supreme Court’s Dobbs decision will affect people’s choices about where they want to live.

Even before Dobbs, nearly 10% of people who obtained an abortion traveled across state lines for care, according to data analyzed by the Guttmacher Institute, which supports abortion rights.

And in states that enacted stricter restrictions on the procedure between 2011 and 2020, shutting down many abortion providers, the percentage of people who left their home states to receive an abortion rose dramatically, Guttmacher found.

National data isn’t yet available on the number of people traveling across state lines for abortions since the Dobbs decision.

But a study conducted by the University of Texas at Austin showed that the number of Texans who left the state to receive an abortion increased more than tenfold after the nation’s strictest abortion ban took effect in September 2020.

“We know the number of people traveling out-of-state for abortions is rising,” said Elizabeth Nash, principal policy associate at Guttmacher. She noted that many of the low-income women who need help with travel expenses either are unemployed or work for companies that don’t cover those costs and don’t offer sick leave, much less paid time off for an abortion.

“One of the things that keeps me up at night,” Nash said, “is that nonprofit abortion funds won’t be able to keep up with demand and that contributions to those funds may dwindle over time.”

Corbin said she lauds companies that want to support abortion rights, but she added: “I have a problem with placing reproductive health care in the hands of companies and having companies decide whether a woman can afford to cross state lines for an abortion. It could encourage even more disparities in access to health care based on what company you’re working for.”

Even within companies that offer abortion travel reimbursement, disparities can occur. Many low-wage workers may not be able to take advantage of an abortion travel benefit, because they’re unable to pay the costs upfront and don’t have a credit card to charge the expenses with, according to a report from the Kaiser Family Foundation.

State retaliation

So far, Texas is the only state where lawmakers have threatened to sanction companies that help employees seek abortions.

The Texas Freedom Caucus, made up of conservative GOP state representatives, sent a letter to ride-sharing company Lyft in May, vowing to “introduce legislation next session (2023) that bars corporations from doing business in the state of Texas if they pay for elective abortions or reimburse abortion-related expenses — regardless of where the abortion occurs, and regardless of the law in the jurisdiction where the abortion occurs.”

In July, the caucus sent a similar letter to international law firm Sidley Austin threatening to disbar any lawyer who violates Texas’ felony abortion law by “furnishing the means for procuring an abortion knowing the purpose intended.”

Abortion rights advocates speculate that other states may try to sanction companies that pay employee travel expenses for an out-of-state abortion. But constitutional law experts, including U.S. Attorney General Merrick Garland, argue that the Dobbs decision did not give states authority to ban abortion outside their borders.

Prohibiting interstate travel is clearly unconstitutional, said David Cohen, a law professor at Drexel University. “But there’s a good chance this Supreme Court would uphold such laws anyway.”

Clarke Forsythe, senior counsel at anti-abortion organization Americans United for Life, agreed that prohibiting interstate travel for any reason other than escaping a felony charge is not constitutional. He said his organization would not advise state lawmakers to pursue such a strategy.

Still, more extreme anti-abortion groups known as abortion abolitionists are promoting state laws that criminalize out-of-state abortions.

The Thomas More Society, a conservative legal organization, is drafting model state legislation that would allow private citizens to sue anyone who helps a resident of a state that bans abortion get access to the procedure in another state, according to The Washington Post.

If Republicans score huge gains in the November elections, even though most Americans favor abortion rights, political experts predict Texas and other conservative states likely will attempt to clamp down on abortion travel and companies that support it.