There is no shortage of coverage on the direct clinical implications of the Dobbs v. Jackson decision, for good reason. According to a recent Advisory Board analysis, over 100,000 patients will be denied an abortion in their home state each year. Our analyses, in combination with academic evidence, highlights two ways abortion bans will worsen gender and racial health disparities in the short term:
These two examples are only the start of the direct clinical implications of the reversal of Roe v. Wade. Experts also expect to see exacerbated behavioral health needs from the stress of trying to secure an abortion or the reality of carrying an unwanted pregnancy.
But as serious as the clinical implications of abortion bans will be (and we're just beginning to understand them), these near-term effects are not the full story of how this decision will impact health equity. And when we don't know the full story, we can't sufficiently prepare for the future.
We predict that the biggest impact abortion bans will have on health equity will be the negative socioeconomic impact that additional unwanted pregnancies will have for generations to come for pregnant people, their families, and their communities. And that's because:
Of course, poverty impacts all clinical outcomes, not just obstetrics. The entirety of health care delivery will feel the ripple effect of this decision.
We can't overestimate the importance of that last point. Abortion bans will lead to higher poverty rates. The health care leaders we work with well know how poverty can stand directly in the way of their most elemental strategic goals: improving patient outcomes and reducing total cost of care.
Life sciences companies see how poverty limits medication adherence. Service line and physician leaders under both fee-for-service and value-based care contracts contend with how poverty complicates care plan adherence and quality goals. Health plan leaders increasingly quantify the impact poverty has on avoidable high-cost utilization.
In response, cross-industry leaders have made public commitments toward advancing equity and have made significant investments in the social determinants of health. There's growing consensus that, to make progress, the industry must address the root causes of disparities.
But the fall of Roe v. Wade will make every effort to advance equity—no matter its focus—more difficult. And let's not forget that these effects are compounded by the Covid-19 pandemic, which laid the greatest clinical, emotional, and socioeconomic burden on the same populations most at risk after Dobbs v. Jackson.
We've spoken with many health care leaders across the C-suite who have described 2020 as their wake-up call for health equity. That mental shift led to marked changes in how executives across the industry set strategic goals and allocated funding.
The overturning of Roe v. Wade should inspire a similar reckoning for health care leaders. If our hypothesis comes to pass, the ripple effects of this decision could mark one of the greatest setbacks for health equity in modern memory. And it's the first major test of the industry's proclaimed commitment to advancing equitable outcomes.
This moment likely feels deeply overwhelming for health care leaders—and for good reason. In many ways, you may feel as though the starting line for advancing health equity has been yanked backward. But the good news is that you're not starting from scratch anymore.
The industry has made real strides toward advancing health equity in the past few years, and our guidance today is the same as it ever was. Here's how to start building a health equity infrastructure that cements equity as a need-to-have, not a nice-to-have:
Now, let's get to work.
Rachel Woods, Alex Polyak, and Sarah Hostetter contributed to this post.
The Dobbs v. Jackson ruling has triggered a cascade of consequences for health care leaders and the people they serve, and has introduced unprecedented complexity to organizations operating across state lines.
Advisory Board has been working to understand the implications for all stakeholders since the draft opinion was leaked in May. Our research will not provide moral guidance, policy advocacy, or political prognostication. Rather, our goal is to provide practical guidance to you as a health care leader—to help your organization adapt to change by distilling the most likely scenarios in this moment of heightened uncertainty, and by pointing you towards actions that will improve outcomes for your organization, people, and patients.
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