[Comment: While this article is rather long and complicated, it does answer the question about the Hyde Amendment restricting taxpayer funding.
N. Valko RN, 4 Oct 2015]
· taxpayers subsidize roughly 24% of all abortion costs in the U.S.
· this is equivalent to taxpayers paying the full cost of 250,000 abortions a year, with about 70,000 financed by federal taxpayers
In a fiery exchange with Chuck Todd on last Sunday’s Meet the Press, Carly Fiorina stated repeatedly that American taxpayers are paying for abortion. This may puzzle casual observers who are under the impression that for decades, the Hyde Amendment has somehow protected taxpayers who oppose abortions from having to pay for them. So what’s the truth?
This week’s passage of a continuing resolution to avert a potential government shut-down over the issue of Planned Parenthood funding now has shifted what may be a knock-down-drag-out fight over that issue until December 11. For readers wishing to get better informed in advance of both that debate as well as candidate debates in the weeks ahead, I thought a brief primer was in order.
As best I can determine, taxpayers subsidize roughly 24% of all abortion costs in the U.S. with 6.6% borne by federal taxpayers and the remaining 17.4% picked up by state taxpayers. If we apply the 24% figure to the total number of abortions, this is equivalent to taxpayers paying the full cost of 250,000 abortions a year, with about 70,000 financed by federal taxpayers and 180,000 financed by state taxpayers.
These figures are very rough but certainly are more accurate than subjective guesses on either side of this fierce debate. Here’s how I arrive at them.
A first-trimester abortion costs $397 vs. $854 for a second-trimester procedure, but the fraction of abortions financed using insurance (public or private) is nearly identical (25% for second-term versus 22.6% for first-term). Abortions are financed in a variety of ways.
According to a Guttmacher Institute survey in 2011, 69% of abortions are paid for entirely out of pocket. Another 15.6% report using Medicaid, while 7.3% used a non-Medicaid source of coverage (although this 2011 survey did not indicate the type of coverage–employer-sponsored or non-group, etc.). 8.6% reported not knowing whether they used third party coverage.
Everyone knows that Medicaid is taxpayer-funded, so the foregoing would appear to answer my question. But this is exactly where things get complicated. First, as we’ll see, Medicaid is not the only vehicle by which taxpayers end up subsidizing some part of abortion costs. It’s not easy figuring out what share of abortions is paid by federal taxpayers vs. state/local taxpayers so I’ve done the best I can with readily available data.
Many of the restrictions explained below have changed over time, some as recently as 2013. For simplicity, I have tried to codify current policy rather than explain all these various changes (which interested readers can track using the links provided).
Reality #1: Direct Federal Payment is Allowed for Abortions Under Relatively Rare Circumstances
The Hyde Amendment is a rider to the annual Labor/Health and Human Services (HHS)/Education appropriations bill which prevents Medicaid and any other programs under these departments from funding abortions, except in limited cases.
Medicaid. The current version of the Hyde Amendment (adopted in 1997) allows federal Medicaid funding for abortion in cases of rape and incest, as well as life endangerment, but tightens the life exception to permit payment only when the woman’s life is threatened by “physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself.” Note that the Hyde Amendment has explicitly been extended to include Medicaid managed care plans, hence is binding even in instances where Medicaid has been “privatized.”
· In short, the Hyde Amendment has never posed an absolute ban on federal funding for abortions. (However, without the Hyde Amendment restrictions, Medicaid would be liable for an estimated 300,000 to 500,000 additional abortions every year.)
· Only a small fraction of the cost of the 15.6% of Medicaid-financed abortions are paid with federal dollars. In 2010, the federal government paid for 331 Medicaid abortions, while states financed 113,000.
Medicare. Again, because of the Hyde Amendment, abortions are not covered Medicare procedures “except if the pregnancy is the result of an act of rape or incest; or in the case where a woman suffers from a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would, as certified by a physician, place the woman in danger of death unless an abortion is performed.”
Affordable Care Act. The ACA includes several provisions affecting abortion services.
· Essential Benefits. The ACA establishes a minimum level of benefits that must be offered in the individual and small group markets. However, abortion coverage is prohibited from being required as part of this federally-established essential benefits package
· Restrictions on Federal Funding on Health Exchanges. President Obama signed an Executive Order 13535 extending Hyde Amendment restrictions to federally-subsidized coverage on the ACA health exchanges. That is, federal subsidies (for premiums or cost sharing) are prohibited from being used for coverage for abortions beyond those permitted by federal law.
· Restrictions on State Funding on Health Exchanges. The ACA also allows states to impose even greater restrictions than the Hyde Amendment on any abortion coverage provided by plans in their state Marketplace; to date, at least 25 states have enacted laws that place at least some additional restrictions on abortion coverage for all plans offered through the exchanges.
· Segregation of Funds by Exchange Plans. Private insurance carriers may offer a plan in the state Marketplace that includes coverage of abortions beyond those permitted by federal law only if they comply with the requirement to segregate federal funds. In order to segregate funds, plans that choose to offer coverage for abortions beyond Hyde limitations must estimate the actuarial value of covering abortions by taking into account the cost of the abortion benefit (valued at least $1 per enrollee per month) and cannot take into account any savings that might be gained as a result of the abortions. Any state Marketplace plan that covers abortions and includes enrollees that receive federal subsidies must collect two separate premium payments from all enrollees – one payment for the value of abortion benefit and one payment for the value of all other covered services.
Federal Employees and Dependents. FEHBP funds likewise cannot be used to pay for insurance coverage of abortion, except in cases of life endangerment, rape or incest–a restriction renewed with each annual appropriations bill (details and history in this CRS report).
Military Personnel and Dependents. DOD funds also may not be used to perform abortions except in cases of life endangerment, rape or incest. This restriction applies both to care provided directly by military health facilities and staff and care provided by civilians and paid for through TRICARE, the health care and insurance program for military service personnel, their spouses, and their dependent children. Note that military facilities are barred from performing abortions even if they are paid for out of private funds, again excepting cases of rape or incest or to save the life of the mother (details and history in this CRS report).
Indian Health Services (IHS ). The IHS comprises several hundred hospitals, health centers, clinics and health stations that provide medical care to 2.2 million American Indians and Alaskan Natives. Since 1996, IHS funding has been subject to Hyde amendment restrictions permitting abortions solely in cases of life endangerment, rape or incest. However, reportedly, “the vast majority of Indian Health Service facilities are unequipped to provide abortions under any circumstances,” resulting in less than 2 IHS-funded abortions per year .
Women in Federal Prisons. The Department of Justice is prohibited from paying for abortions for women in federal prisons, except in cases of life endangerment or rape. Note that a female inmate who can afford to pay for an abortion is permitted to obtain one outside the prison using private funds; if so, she must be provided an escort at no cost (such escort obviously being a federal employee paid with taxpayer funds). However, there also is a “conscience” provision allowing workers in federal prisons to refuse to serve as an escort.
Net Impact of Federal Abortion Restrictions. According to a survey by Guttmacher Institute of self-reported reasons for abortions, only 1% of abortions are due to rape and another 1/2% due to incest; 12% are due to mothers reporting “physical problems with my health” although probably only 2.8% represent ”life-endangering” situations . So it’s fair to say that the vast majority of abortions–more than 95%–would not meet the stringent Hyde Amendment standards.
While candidate Obama pledged to repeal the Hyde Amendment, he was never able to do so and indeed, in a last-minute deal, ended up having to sign an Executive Order extending Hyde Amendment restrictions to the Affordable Care Act as a condition of getting enough votes for it to pass. Gallup poll figures have rather consistently shown about half the population supports abortion being legal only under some circumstances, while less than one third support it being legal under any circumstances and only one fifth support it being illegal in all circumstances. Thus, the odds of the Hyde Amendment restrictions being lifted anytime soon appear quite remote.
<span display=”]As a very rough approximation, it appears that no more than 1,000 abortions a year are directly funded by federal taxpayers[/tweet_quote] –i.e., roughly 1 in 1,000 abortions .
Reality #2: Some States Taxpayers Unequivocally Pay for Abortions
Medicaid. The Hyde Amendment only applies to federal funding. One of the conditions of Medicaid funding is that states are required to cover all abortions allowed by the Hyde amendment exceptions, which all do with the exception of South Dakota (which allows state Medicaid funds to be used solely for abortions where the mother’s life is in danger). But the rules likewise
permit states to fund abortions not allowed under the Hyde Amendment so long as such states use their own funds rather than federal matching funds to do so.
· Apart from South Dakota, 25 states and District of Columbia simply adopt the Hyde amendment restrictions on what types of Medicaid abortions can be funded (i.e., life endangerment, rape or incest), while 6 states allow state-only Medicaid funding to be used for other abortions related either to maternal physical health or fetal impairment (IN, IA, MS, UT, VA, WI).
· The remaining states have even fewer restrictions; they can use their own funds to cover other medically necessary abortions – usually defined by states as those to protect the physical or mental health of the woman – for Medicaid beneficiaries. Currently, there are 17 states that fund all or most medically necessary abortions. It’s worth noting that 13 of these states are doing so under a court order (AK, AZ, CA CA +0.00%, CT, IL, MA, MN, MT, NJ, NM, OR, VT, WV) and only 4 are doing so voluntarily, i.e., the result of explicit state legislation (HI, MD, NY, WA).
· In 2010, states financed 181,000 abortion procedures through Medicaid, virtually all occurring in the 17 states that use their own funds for this purpose.
State Employees. Only 21 states restrict abortion coverage in health insurance plans for state employees; 2 states (CO, KY) prohibit abortion coverage altogether, while the remaining states only allow coverage for limited exceptions (e.g., life endangerment, rape, incest).
Taxpayers in these various states may or may not be aware that their states have either been forced and elected to fund Medicaid abortions or that their tax dollars are used to pay for abortions for state employees; hypothetically, in the worst case, any state resident is free to move to another state should the idea of being forced to contribute to such abortions be a violation of conscience or religious beliefs.
As a very rough approximation, it appears that about 165,000 abortions a year are directly funded by state government taxpayers –roughly 1 in 6 abortions.
Reality #3: Taxpayers Indirectly Fund Abortions Through the Tax Exclusion
Recall that up to 16% of abortions are financed through third-party coverage other than Medicaid (inclusive of the 8.6% who report not knowing whether they used such coverage to finance their abortions). Of those with private health insurance, 7 in 8 get their coverage through employer-provided health plans (I’ve excluded those who get private coverage on the ACA Exchanges since these are accounted for earlier). But everyone with employer-sponsored health insurance benefits from the tax exclusion, meaning that what their employer pays in premiums is not taxed as compensation (whereas the equivalent dollar amounts paid in wages or salary would be). In many cases, employee premium contributions also can be done on a pre-tax basis, increasing the amount of this tax benefit event further (this primer explains in detail).
Because workers avoid paying both payroll and income taxes, the average federal tax benefit amounts to about 30 cents per dollar of coverage ; in states with income taxes, there could be an additional savings of up to 13 cents per dollar (CA). Thus, for workers with high marginal tax rates, the savings could exceed 50 cents per dollar of premiums.
There’s mixed evidence regarding the extent of abortion coverage among employer-provided health plans.
· A 2002 survey of insurers showed that 87% of employer plans provided abortion coverage.
· In contrast, a 2003 survey of employers showed 46% of covered workers had plans that included abortion coverage.
· Note that these figures are not necessarily inconsistent for two reasons: 1) employers may offer multiple plans and employees may be selecting the plans without abortion coverage; 2) if large employers were less likely than small employers to offer such coverage, the fraction of employees with coverage could easily be much lower than the fraction of employers offering such plans.
The same employer survey conducted in 2010 showed that 3 in 10 employers said they covered “elective” abortions, but the non-response rate was much higher (71%) in the 2010 survey compared to the 2003 survey (26%).
There are 10 states that imposes restrictions on private coverage for abortions, with 8 limiting such abortions to life endangerment and others allowing for various exceptions. Thus, the extent to which abortion coverage is available in employer-based plans depends on what state you live in.
For all these reasons, it is hard to be precise about what share of abortions are implicitly tax-subsidized. If 7 in 8 of abortions funded through private insurance are financed with employer-based plans then as a rough approximation, roughly 100,000 abortions are indirectly financed in this fashion. Assuming a 30% federal subsidy per abortion, this implies that federal taxpayers finance ~4% of abortion costs in this fashion, while state taxpayers pick up less than 1% .
Reality #4: Taxpayers Indirectly Fund Abortions Through the Non-profit Tax Exemption
Guttmacher Institute maintains a continuously updated database of abortion providers which it annually surveys to determine the total number of abortions performed. Among 1,720 such providers in 2011, the Institute reports that 63% of all abortions were performed in “abortion clinics” (defined as clinics in which more than half of patient visits are for abortions).
Another 31% are performed in “other clinics” which by inference must be a reference to Planned Parenthood (which mendaciously  claims that only 3% of its services are for abortion clients) since their clinics evidently do not meet the definition of “abortion clinic.” Planned Parenthood performed 327,653 abortions in 2013. Assuming no change in the number of abortions from 2011 and 2013 (1,058,500), that would represent 31% of all U.S. abortions, which matches the figure reported by Guttmacher Institute for 2011.
Hospitals account for only 4% of abortions, while physician offices account for 1%.
I have been unable to locate a breakdown of these 1700+ providers by ownership status, but everyone knows that Planned Parenthood is a non-profit organization, as are the vast majority of hospitals. Given that such a large fraction of health care organizations are non-profits, it is easily possible that one quarter to one half of abortion clinics likewise are structured as non-profits. However, to be conservative, I’ve assumed that only one third of all abortions are performed by such providers, i.e., Planned Parenthood and half of hospital-provided abortion procedures.
While there’s no way of knowing what the mark-up is on abortion services, Planned Parenthood’s latest annual report shows net income over expenses of 8.6%, so I will assume the equivalent profit rate is applicable for abortions. A for-profit corporation in the services industry would face an average tax rate of 26.1% (inclusive of income, sales and property taxes) ; the tax exemption implies that taxpayers are implicitly financing 2.3% of every abortion performed by Planned Parenthood or other nonprofit hospitals.
But remember that donations to non-profits also receive a tax benefit. On average, taxpayers finance 14 cents of every dollar contributed to charity. In 2013, Planned Parenthood received $257.4 million in charitable contributions, of which $34.9 million was kicked upstairs to the National Office in the form of dues. The remaining amount constituted 21.1% of the more than $1 billion spent by affiliates on various activities. Assuming the same was true of abortions, this represents an additional 2.9% implicit taxpayer subsidy for a total of 5.2%. For simplicity I will assume that this subsidy is equally divided between federal and state/local taxpayers, although it is likely that federal taxpayers pick up more than half this cost.
If one third of all abortions are performed by non-profit organizations, these figures imply that federal and state taxpayers each finance 0.9% of abortion costs in this fashion.
Reality #5: Taxpayers Indirectly Fund Abortions Through Title X
In 2013, Planned Parenthood received a total of $528.4 million in government health services grants and reimbursements. CBO estimates that about $450 million of this represents annual federal funds, including $390 million through Medicaid, $60 million through Title X and $1 million for Medicare/CHIP services. Even if Planned Parenthood has a pro rata share of federally-funded Medicaid abortions allowed by the Hyde Amendment, this would account for less than $100,000 in Medicaid spending, so the vast majority of the organization’s Medicaid funds are for non-abortion services. Title X services likewise cannot be used for abortions per se (although critics note that these can be used for counseling and “if any pregnant woman requests an abortion referral, the affiliate must provide such a referral;” hence such funds indirect support the abortion “industry”).
What’s more important is that these federal revenues represent 35% of the $1.4 billion in revenues reported by Planned Parenthood in FY2014. Some opposed to federal funding for Planned Parenthood, such as Michigan Rep. Jim Sensenbrenner, argue that these funds are “fungible.” Hence every tax dollar provided to Planned Parenthood frees up a dollar that can be spent on abortion services.
Pro-choice advocates argue that since Planned Parenthood bills and is paid for specific services–pregnancy tests, Pap smears, abortions etc.–funds are not fungible at all. Title X funding, for example, can be used to provide discounted contraceptives, but not abortion. If funds for discounted contraceptives were eliminated, the price of contraceptives presumably would have to go up (Planned Parenthood would not longer have taxpayer funds with which to offer the former subsidy), but the price of abortion services would remain unchanged.
The truth is more complicated than either of these accounts. First, from a revenue perspective, funds quite often are fungible. For example, to the extent that federal dollars cover 100% of the costs of very worthy services offered by Planned Parenthood (e.g., cancer screenings, pregnancy testing etc.), this in principle frees up donated dollars (so long as no strings are attached) to be used to help finance abortion services. Donors may be enticed to donate based on marketing that highlights its very worthy services not realizing that their donations are used for abortions.
One can argue that donors should be better informed, but there appears to be a whole cottage industry (led by Planned Parenthood itself) that seems determined to minimize its role in providing abortions. Consider the agency’s own Planned Parenthood at a Glance page whose only mention of abortion consists of “Three percent of all Planned Parenthood health services are abortion services.” But as explained in footnote  below (and many others have pointed out), this is thoroughly misleading given that at minimum 22% of Planned Parenthood revenues come from abortions. Even Washington Post‘s Fact Checker has awarded Three Pinocchios for this decidedly deceptive statistic. But that hasn’t inhibited an LA Times “reporter” from continuing to promote the 3% myth.
All organizations, Planned Parenthood included, face fixed and marginal costs. Airlines that manage to cover their fixed costs by selling high cost tickets to first class passengers are then able to offer heavily discounted fares to their last passengers just to fill seats–i.e., a price that covers the marginal cost of the fuel needed to carry 1 more passenger. In a similar fashion, if Planned Parenthood is able to use its federal funds to cover the vast majority of its fixed costs, it then can offer abortions at their marginal cost, meaning that every abortion offered is implicitly subsidized to some extent.
In a typical physician practice, practice expenses (i.e., everything except physician compensation inclusive of fringe benefits) constitute 51.7% of every dollar paid by Medicare to physicians (Table 1). Some of these costs may be directly allocable to specific procedures, (e.g., wages and salaries for non-physician professional and technical personnel which average 6% of Medicare physician payments). But many costs cannot, such as managerial wages, clerical wages, and non-personnel office expenses, professional liability insurance–the latter two alone constituting nearly 25% of every dollar paid to physicians under Medicare.
In short, any Planned Parenthood clinic that figured out a way to cover all its overhead costs using other resources hypothetically could afford to discount its abortion services by as much as 50%. No clinic could honestly do this. There is, after all, a lengthy OMB circular that lays out the rules non-profit organizations are expected to follow. Organizations generally are permitted to use a simplified allocation method, which is to allocate indirect costs in proportion to direct costs. Thus, if 1 abortion costs 30 times as much as a 1 pregnancy test, as one example, then a clinic doing just as many abortions as pregnancy tests would end up allocating 30 times as much of its overhead costs to the abortion component of its business than its pregnancy testing component.
But organizations also are permitted to use an alternative base if they feel it is justified. Consider this Planned Parenthood agency in Michigan, which according to this audit report “has fifteen clinics and allocates the clinical expenses based on the number of visits for each program” (p. 5). This means that an abortion “visit” gets treated the same as a pregnancy testing visit, hence the abortion program at each clinic is going to get much less overhead cost allocated to it than were the simplified allocation method used. What that means is that when it bills Medicaid or Title X, for example, for pregnancy testing services, those programs will pick up more overhead costs than are really justified. That means that every dollar of Medicaid and Title X funding that at first glance is paying for pregnancy testing in fact is implicitly cross-subsidize abortion services to the extent that it covers some of the overhead costs that a more accurate overhead allocation rule would have assigned to each abortion procedure.
Here’s what’s particularly interesting. When challenged by the auditor to explain why it had not allocated more overhead costs to Family Planning, the agency conceded that “using the expenses for a given department as the basis for allocating administrative costs would result in additional cost being charged to the Family Planning Program.” So why didn’t it do so? “Given the ongoing political controversy that surrounds our mission and work, it is both logical and reasonable to choose a cost allocation method that results in the most conservative statement of allowable costs” (p. 10).
Keep in mind that if abortions constitute 22% of Planned Parenthood revenues (and hence should be allocated 22% of its overhead costs, it really doesn’t require all that much finagling of the overhead allocations for the other services that Planned Parenthood provides to chip away a large fraction of the overhead costs that otherwise would be allocated to abortions. That is, if the overhead costs for the remaining 78% of Planned Parenthood’s business were overstated by a mere 10%, that alone would reduce the share assigned to abortions by more than one third (i.e., 7.8%/22%). If clinic overhead costs amount to 40% of each dollar paid for clinical services, such a cross-subsidy would amount to 14% of each abortion procedure. Given that Planned Parenthood has 66 separate affiliates operating 700 separate clinics, it would take an army of sharp-eyed and persistent auditors to ferret out this modest degree of financial shenanigans and put a stop to it.
We have seen from a) the above audit report; b) the endlessly repeated deceptive claims that abortion represents only 3% of their business ; and c) the histrionic reaction to the Planned Parenthood videos, an organization highly politically motivated to avoid having the public obtain a clear understanding of either the nature or importance of abortions to its mission. So while I’m not in a position to prove exactly how much of this implicit cross-subsidy actually goes on, I don’t think it’s unreasonable to assume that it is based on the evidence at hand.
So if we assume an average cross-subsidy of 14%, then the federal government implicitly shares 35% of it, picking up a net of 1.5% of all abortion costs (given that Planned Parenthood provides only 31% of abortions), while state government taxpayers absorb 0.3%.
If we tote up all these components, we find that federal taxpayers cover roughly 6.6% of abortion costs. It’s worth noting that this amount is more than 200 times as large as the previously reported direct costs of abortions that are financed using federal Medicaid dollars. The point being that the hidden subsidies are far more consequential for federal taxpayers than they are for state taxpayers. State taxpayers cover 17.4% of abortion costs, but this amount is only 12% larger than the directly-financed costs underwritten by state taxpayers through Medicaid.
Remember that most indirect taxpayer financing of abortions comes in the form of implicitly subsidized discounts on the cost of abortions that may range from 50 cents on the dollar (in the case of taxpayers with high marginal tax rates who use an employer-provided health plan to pay for their abortion) to only pennies on the dollar. But the magnitude of taxpayer subsidies can be perhaps better assessed by thinking in terms of abortion-equivalents. If we apply the 24% figure to the total number of abortions, it is as if taxpayers pay the full cost of 250,000 abortions a year, with about 70,000 financed by federal taxpayers and 180,000 financed by state taxpayers .
For anyone who previously supposed that federally financed abortions were limited to the 331 publicly reported for Medicaid, the contrast between reality and the far more limited view we’ve had of reality to date is likely to be staggering. The Hyde Amendment has actually achieved a very great deal in terms of limiting direct payment for abortions. But if we’re really serious about the proposition that federal taxpayers should not be liable for any abortions except to save the life of the mother or cases of rape or incest, it should be obvious that there is plenty more work to be done.
 This article (unfortunately gated) reports that only 5% of IHS facilities are equipped to perform abortions and that over a 20 year period, IHS evidently only performed 25 abortions.
 According to FactCheck.org, “the Guttmacher Institute, a reproduction research center, did not have statistics on abortions performed to save the life of the mother. A dated 1998 study — published by the International Family Planning Perspectives journal — reported that a 1987-1988 survey found that 2.8 percent of 1,773 women who had had an abortion that year said the reason for the abortion was risk to maternal health.
 This is a very crude calculation derived as follows using estimates of the number of women of child-bearing age in various federal programs reported in Boonstra (2007). There were 212,000 such women in active military and up to 1.28 million female veterans (based on Boonstra’s report that 80% of the 1.6 million female veterans are under age 65); 1 million in FEHBP; 9,600 prisoners (80% in child-bearing years x 12 million). In addition, there were about 9 million such women in Medicaid in 2010 (61.5 million x 14.7% on Medicaid/CHIP). Finally, in 2015, there were ~5.2 million people age 18-44 who selected an ACA Exchange plan during the open enrollment period; 54% of those who selected plans were female, so assuming the same fraction applies to the subset age 18-44 yields 2.8 million. 86% of those selecting plans qualified for federal premium assistance, so again, assuming the same was true of the subset of females age 18-44 yields ~2.4 million subsidized ACA recipients who were females of child-bearing age (all ACA figures reported in Appendix Table A1).
In 2010–the latest year I could find for which Medicaid abortions were reported–there were 331 abortions financed with federal Medicaid funds. Using 9,000,000 women of child-bearing age covered by Medicaid, I then computed abortions per 100,000 that meet the Hyde Amendment restrictions and use this ratio to impute the estimated number of such abortions that may have been allowed (federally financed) among the other population groups cited above. The resultant figures sum to only 513 abortions (inclusive of Medicaid’s 331). Even recognizing how crude these figures are, it does not seem likely they are off by more than a factor of 2 (if anything, the life/rape/incest abortion rate is likely to be lower among such groups than among Medicaid recipients), hence my conclusion that at most, 1,000 abortions may have been federally funded.
 There were 1.06 million abortions in 2011 according to Guttmacher Institute (whose count of abortions is more complete and reliable than CDC’s for a variety of reasons). If 15.6% were paid by Medicaid and the number paid using federal Medicaid dollars was only 331 (see footnote ), the residual number paid by states can be imputed as 165,000. There are more than twice as many state government female workers as federal government workers who are female; assuming the same is true of women in child-bearing ages, the total number of state females of reproductive age would be 2.05 million. Assuming 21 states with Hyde Amendment-like restrictions, the number of females age 18-44 can be crudely approximated as 2.05 m. x 21/51=845,000. Based on the estimated number of FEHBP-funded abortions from footnote , total abortions in such states are roughly 31. The average abortion rate in 2011 was 16.9 per 100,000 women age 15-44; applying this ratio to remaining females age 18-44 in non-restrictive states yields an estimated 204 additional abortions.
 CBO estimates that the marginal income tax rate for those with employer-provided health benefits is 16% and the marginal payroll tax rate is 14% (p. 247).
 Up to 15.9% of abortions are financed through insurance other than Medicaid (the Guttmacher Institute survey shows 7.3% reporting such coverage and another 8.6% who are uncertain). Using the higher figure implies that ~117,000 abortions are financed with private insurance, so 7/8 of this amount yields just over 100,000 abortions paid through employer-provided health plans (13.9% of the abortion total) and 30% of this implies that the federally government implicitly covers 4.2% of abortion costs. Assuming 5% savings from the state income tax exclusion implies that states cover 0.6% of abortion costs.
 I do not use the term “mendaciously” lightly. Planned Parenthood’s annual report makes a point of claiming that only 3% of its services are for abortion procedures. But even PolitiFact has demonstrated that when one accounts for the unbundling of services, the figure is closer to 12% (readers can check this for themselves: according to PP’s own annual report, it served 2.7 million patients in 2013 [footnote 6], including 327,653 who obtained abortions, or 12.1% of all patients).
As a Weekly Standard writer put it “An abortion is invariably preceded by a pregnancy test–a separate service in Planned Parenthood’s reckoning–and is almost always followed at the organization’s clinics by a “going home” packet of contraceptives, which counts as another separate service.” More importantly, focusing on the share of services masks the reality that the share of revenues attributable to abortions is likely closer to 17% (again, readers can deduce this on their own. The mean payment for surgical abortions at nonspecialized clinics in 2011-2012 was $518 (Table 1), so multiplying this times 327,000 abortions yields $167 million in abortion revenue; this equals 22% of the $769 million in clinic revenues reported for 2013). And this obviously is a conservative calculation given that average payments for early medical abortions prior to 10 weeks are even higher (moreover, second semester abortions cost more than twice as much as first-semester abortions). In short, Planned Parenthood’s method of characterizing the importance of abortions in its operations understates reality by a factor of at least 7. Readers can make up their own mind, but from where I sit, this is coldly calculated deception on Planned Parenthood’s part.
 For all corporations, the 2013 all-inclusive marginal tax rate is 35.3% (Table 3); the corresponding effective average tax rate is 22% (Figure 2). But for corporations in the services industry, the all-inclusive marginal tax rate is 41.9% (Table 3), so the corresponding average tax rate can be imputed as 26.1%.
[Oct 2, 2015, Chris Conover, http://www.forbes.com/sites/theapothecary/2015/10/02/are-american-taxpayers-paying-for-abortion/ ]