Even before a leaked Supreme Court opinion jeopardized the future of abortion in the United States, major corporations were adding a new benefit for their employees: coverage for abortion and other medical travel.
The latest company to add the benefit was Amazon, which announced earlier this week that it will cover travel costs for employees who have to travel out of state for abortions or other medical procedures. This could make it possible for workers who live in states that ban abortion to still get 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 offer that lifeline mark the continuation of a standard of health care in the US, where the quality of care people can access is closely linked to their insurance, which is often linked with the job. As legal protections roll back, employers are the alternative, and each can create or change their own policies at will, making coverage of key services even more uneven across the country.
“We don’t have a fundamental right to health care,” says Liz Brown, a professor who studies gender and business law at Bentley University. “A parallel development of that is that so many Americans get their health care from their employer, which creates all sorts of perverse incentives.”
Companies like Citigroup, Match Group and Yelp began adding abortion tours as a benefit in recent years as states like Texas began passing laws severely restricting abortion. The option gave employees of those companies who lived in those states a safety valve, one that could have an even bigger impact in a post-Roe landscape. But taking advantage of that option would mean that they would have to disclose an abortion, an often sensitive private medical procedure, to their employer.
“It’s almost impossible for me to see how an employee can keep that private,” says Brown.
Employees may not face obvious repercussions for disclosing such information: The federal Pregnancy Discrimination Act protects people from being fired for considering or deciding to have an abortion. But even with that formal protection, people can be (reasonably) uncomfortable telling bosses about a deeply personal and often stigmatized health situation. They might worry about being treated differently, even if they wouldn’t be fired or explicitly penalized. “The big question is whether people will feel like this is a benefit they can use,” says Anna Kirkland, a professor of women’s and gender studies who studies health and law at the University of Michigan.
In some ways, the change brings abortion in line with employer programs that offer mental health services or subscriptions to digital mental health programs, another type of potentially sensitive care that can be difficult to access.
“The more services you receive from your employer, the more likely your employer is to learn about and make decisions about you based on the health services you receive,” says Brown.
But that leaves employees caught between a rock and a hard place: They could be in a position where they must agree to release that information or risk not being able to receive the care at all. “That’s possibly worse than the risk of an invasion of privacy,” she says.
Access to health is closely related to employment in the US, with about half of people getting their insurance from employer plans. Yet abortion has typically been one of the few medical procedures that exists outside of that relationship, says Kirkland. The clinics are specialized and people often do not use their insurance for the procedures. “It’s kind of forced outside of regular health care,” she says.
These travel programs tie abortion, in some way, to employers’ regular health care programs. In some ways, that could help normalize abortion, says Brown. “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 for which people could rely on an employer. Like health insurance in general, people who rely on an employer for that key service may feel pressure to stay in a job to maintain their access to that care, especially if they live in a state that restricts abortions.
It also reinforces the inequities that already exist around reproductive rights. People who work for tech companies like Amazon, and presumably already have relatively high incomes, now have more flexibility to live in places with abortion restrictions while still having access to these services. People who work for companies that don’t see abortion as a top 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, aren’t eligible for the travel benefit.
With the Supreme Court poised to reverse constitutional protections for abortion, and as other institutional protections around people’s rights erode (such as gender-affirming care, for example), the main source of formal institutional support left to people is their employer. , which could change or change the policies at will.
“It would be better to have constitutional protections,” says Brown. But without that, capitalism is the alternative. “We’re keeping the employer protections.”