Even before a leaked Supreme Court opinion shook up the future of abortion in the United States, big companies were adding a new benefit to their employees: coverage for abortion and other medical travel.
The latest company to add this benefit is Amazon, which announced earlier this week that it will cover travel expenses for employees who need to travel out of state for abortions or other medical procedures. This could allow workers living in states that ban abortion to continue to receive the care they need. It’s a potential lifeline for employees — especially if the Supreme Court decides to overturn Roe v. Wade, eliminating the right to abortion in the United States and allowing states to criminalize the safe and life-saving medical procedure.
Employers stepping in to provide this lifeline mark the continuation of a standard of health care in the United States, where the quality of care people can access is closely tied to their insurance, which is often tied to the job. As legal protections recede, employers are the fallback — and everyone can craft or change their own policies at will, making coverage of key services even more uneven across the country.
“We don’t have a basic right to health care,” says Liz Brown, a professor of business and gender law at Bentley University. “A parallel development to this is that so many Americans get their health care from their employer, which creates all kinds of perverse incentives.”
Companies like Citigroup, Match Group, and Yelp have started adding abortion travel as a perk in recent years, as states like Texas have begun passing laws severely restricting abortion. The option gave employees of companies who lived in those states an escape valve, one that could have even more impact in a post-Roe landscape. But taking advantage of this option would mean they would have to disclose an abortion — an often sensitive and private medical procedure — to their employer.
“It’s almost impossible for me to see how any employee could keep this private,” Brown says.
Employees probably couldn’t face obvious repercussions for disclosing this information — the federal pregnancy discrimination law protects people from being fired for thinking or deciding to have an abortion. But even with this formal protection, people might be (reasonably) uncomfortable talking to bosses about a deeply personal and often stigmatized health situation. They might fear being treated differently, even if they weren’t explicitly fired or penalized. “The big question is whether people will feel like this is an advantage they can use,” says Anna Kirkland, a professor of women’s and gender studies who studies health and law at the University. from Michigan.
In some ways, the change brings abortion into line with employer programs that offer mental health services or subscriptions to digital mental health programs — another potentially sensitive type of care that can be difficult to access.
“The more services you get from your employer, the more your employer can potentially learn about you and make decisions about you based on the health services you receive,” Brown says.
But that leaves employees caught between a rock and a hard place — they may be in a position where they either have to agree to release this information or risk not being able to get care at all. “You could say that’s worse than the risk of privacy breaches,” she says.
Access to health care is closely tied to employment in the United States, and about half of people obtain their insurance through employer-sponsored plans. Abortion, however, has usually been one of the few medical procedures that exists outside of that relationship, Kirkland says. The clinics are specialized and people often do not use their insurance for the procedures. “It’s kind of forced out of regular health care,” she says.
These travel programs combine abortion, in some respects, with regular employer health care programs. In some ways, it could help normalize abortion, Brown says. “It puts abortion more on a par with something like cancer treatment, where you might want to travel to another state to find a specialist.”
But it also makes abortion another service people might depend on an employer for. Like health insurance in general, people who depend on an employer for this key service may feel pressured to keep their jobs to maintain access to this care, especially if they live in a state that restricts abortions.
It also reinforces the inequalities that already exist around reproductive rights. People who work for tech companies like Amazon and who likely already have relatively high incomes now have more flexibility to live in places where abortion is banned while still having access to those services. People who work for companies that don’t consider abortion a high priority or who don’t have full-time jobs with employer health care will have less access. Even at Amazon, contract employees, who often have lower incomes, are not eligible for the travel allowance.
As the Supreme Court moves to strike down constitutional protections for abortion and other institutional protections around people’s rights (like gender-affirming care, for example) erode, the main source of institutional support formal that people are left with comes from their employer. , who could change or alter policies on a whim.
“It would be better to have constitutional protections,” Brown says. But without that, capitalism is the fallback. “We end up with employer protections.”