Not long after Governor Brian Kemp signed a bill banning abortions in Georgia at as early as six weeks, the owner of Eastside Gynecology in Manhattan—who asked not to be named “because I don’t want to get shot”—says his office received a call from a woman in the state looking to fly to New York to terminate a pregnancy. It’s impossible to know her political views (the office didn’t ask), but it’s also impossible not to wonder if she’s among the 70% of white women who cast their ballots for Kemp over pro-choice candidate Stacey Abrams. In fact, there’s been an influx of calls from women in the South recently, the doctor said, including a woman in Alabama—which in May, passed a law banning just about all abortions within its borders. (The laws in both states will play out in court, meaning women there can still get abortions locally—although they might not realize it.)
“When this all started happening, that week we had someone from Georgia, someone from Alabama,” said the doctor. “We said, ‘Wow, this was just in the news, and here we are.’”
Technically, the smaller, more exclusive waiting room at Eastside Gynecology—festooned with a glass chandelier, a smattering of fake orchids, and generic paintings in gold frames—is for MedSpa clients: women with vaginal dryness who pay thousands of dollars to get zapped by a laser called the MonaLisa Touch. But it’s also for a small number of the roughly 4,200 women who seek abortions here every year, the ones able to pay as much as $10,000 for what the practice calls its “Ultimate VIP” service. For these patients, Eastside Gynecology will shut down the entire office, assuring complete privacy and exclusive attention from the staff.
In addition to extra privacy, VIPs—sometimes celebrities or public figures, sometimes the girlfriends or mistresses of celebrities or public figures, sometimes rich women who can afford extra perks—can watch TV with their support person in a private room with a bed covered in a burgundy-and-gold comforter before their procedure, and rest there afterward. If they’d like, round-trip black car service can be arranged to take them to and from the office (women who receive anesthesia or sedation aren’t permitted to drive directly afterward, a safety precaution that’s true of all abortion facilities). And if they’re coming from out of town, a staffer is available to arrange flights and hotels. As Eastside Gynecology’s website states, “All you need to do is tell us what you need and we will arrange it for you.”
In many ways, what the practice offers women seeking an abortion isn’t all that different from the concierge services widely available across other areas of medicine, where patients pay a hefty fee for more individualized attention and doctors offer extended hours to accommodate busy schedules. Looking at VIP abortion through that lens, it puts what is too often seen as a taboo area of medicine rightfully in the mainstream. But in a time where more and more states are restricting abortion access—and as Planned Parenthood is forced to withdraw from Title X, the federal program through which it receives some $60 million of its annual funding—the stark contrast between what’s available to wealthy women versus low-income women can be unnerving. It also highlights the way conservative women with means are able to circumvent a system they very well may have put in place with their vote.
The doctor at Eastside Gynecology has been performing abortions there since he bought the practice 20 years ago. Just like the Planned Parenthood six subway stops away, he performs terminations up to 24 weeks. He says that about 40% of patients come specifically for abortions. Eastside Gynecology accepts insurance, but for those paying out of pocket, prices start at $420 and can go “north of $3,000,” depending on how far along a patient is in their pregnancy. The vast majority of patients don’t opt for the VIP service.
Still, patients who can’t afford the full VIP treatment can buy their way into some perks. There’s a fast-track option where, for an additional $450, patients are guaranteed they’ll be seen next upon their arrival—no matter how many women are already waiting—and will have use of one of the two private rooms with a TV. This is often preferable for women looking to return to work in the afternoon.
The idea for VIP service came years ago, when the doctor was talking to a friend and abortion provider in Washington, D.C. “He had something like this down there, and he said, ‘It’s totally private, I shut the whole thing down for an individual patient who would pay a lot of money.’ He said that this was for politicians and their girlfriends, you know? They can’t take them to a hospital or anything like that, so they needed discretion. So he said, ‘They come here and we shut the whole place down and charge them a lot of money and say, It’s all yours.’” This doctor, the one in New York, decided that the model could work in Manhattan, and began to offer it at his practice.
“It gets used occasionally—not as much as you’d think,” he told me from behind his desk. “Occasionally, a celebrity will call up, or a private doctor of a celebrity, who will basically book out a whole session and that’s it…It’s totally private and nobody knows anything about it and they come in and they leave.”
Payman Joseph, MD, owner of My Choice Medical Center in Los Angeles, also advertises “VIP Concierge Services” on the office’s website, noting, “We are accustomed to the needs of celebrities, public figures, and high-profile individuals.” It happens “very frequently” that he recognizes a patient from the screen or somewhere else. During the 2016 election cycle, he said a patient who was a visible figure in the Republican Party cried and told him, “Nobody can know.”
Joseph doesn’t accept insurance, so patients pay $850 out of pocket for a medication abortion, which includes a consultation, ultrasound, the pills themselves, and a follow-up ultrasound and consult. The rate for a surgical abortion, which he performs up to 15 weeks, is $1,500. For those looking to come in during off hours or have the clinic to themselves for an extended period of time—the main features of the VIP service—those numbers jump to $1,600 and $2,600, respectively. Similar to Eastside Gynecology, he has also seen a recent surge of patients from out of state, especially Arizona and Texas, which he attributes to the states’ mandatory waiting periods.
Perhaps it’s not surprising that in New York and Los Angeles, those seeking abortions are paying for care that’s quick, private, and exclusive. But the VIP treatment extends beyond wealthy, liberal enclaves. Health centers in Florida, Georgia, and even Texas advertise similar services. Amy Hagstrom Miller, owner of Whole Woman’s Health, whose case challenging a Texas law that would have shuttered most of the state’s abortion clinics went all the way up to the Supreme Court, now has seven offices that provide abortions in Texas, Virginia, Maryland, Minnesota, and Indiana. She offers VIP, private, and fast-track care at all of them.
Hagstrom Miller said it’s “extremely uncommon” for patients to pay extra for such services. Across all locations, only 55 patients a year choose VIP care, which includes being the only patient in the office; zero wait time; a post-abortion care basket with tea, a hot pad, and a blanket; and a personal follow-up several days after the procedure. About 1,000 patients go for either the private option (a private room for the duration of the appointment) and a fast-track option (patient is the next person seen upon their arrival). The average cost ranges from $500 to $1,000, although the price can vary for the VIP services, especially in a place like Texas, where state law requires that 24 hours pass between a patient’s consultation and procedure, and the same doctor—sometimes flying in from out of state—must complete both.
In Hagstrom Miller’s view, abortion patients should have what she calls a “menu” to choose from, where they can select extra services that suit them—which yes, depend on what they can afford. Although 75% of abortion patients in 2014 were considered poor or low-income, according to the Guttmacher Institute, “Not every patient is a poor, down-and-out, distraught person,” said Hagstrom Miller. CDC data from 2015—the most recent year for which numbers are available—shows that 638,169 legal abortions were performed in the U.S. that year. Based on both numbers, more than 150,000 abortions were performed on those not experiencing economic hardship. “I think we have this stereotype of the kind of people who have abortions, and it’s not true,” Hagstrom Miller said. “No matter where you are…there are women who have had abortions.”
It’s not new for women of means to have more options when it comes to abortion. Before Roe v. Wade, it was mostly wealthy women—and women connected to wealthy men—who had any safe, legal options at all. Rachel Benson Gold, vice president for public policy at the Guttmacher Institute, explained that before abortion was available nationwide, those seeking legal abortions had two choices: they could either prove that the pregnancy threatened their life, or was the result of rape or incest. But the process of providing proof was difficult and expensive. In many instances, multiple physicians had to agree that an abortion was permissible, including a licensed psychiatrist in cases in which mental health was a factor. Having a relationship with a private physician made this process much easier, Gold noted. “In practice, this meant that the option was only available to those who were able to pay for the review process,” she wrote in a policy review. A 1965 study examining therapeutic abortions at private, not-for-profit New York City hospitals from 1951 to 1962 found that almost 90% of abortion patients had a private doctor.
Another option was to travel, whether to a country where abortion was legal, or to one of the U.S. states that, by 1970, allowed providers to perform terminations, such as New York. But this too required money, and low-income women or women without their own means who needed to keep their pregnancies private often resorted to risky self-inductions. Wire hangers. Toxic substances. Throwing themselves down staircases.
Now, the two-tiered system that existed before Roe is beginning to take shape again, as conservative state lawmakers chip away at abortion access. By late May of this year, nine states had passed bans or extreme limitations on abortion. An Alabama bill drafted by the founder of an anti-abortion group purposefully took aim at Roe. It was signed into law, and will now play out in the courts, perhaps making its way up to the conservative-leaning Supreme Court, just as intended.
Meanwhile, at Eastside Gynecology in New York—a state that recently expanded abortion access—the calls keep coming in from parts of the country where restrictions are being passed. The practice only expects to hear from these women more, the office administrator tells me. “Access is changing,” he said. “It pushes people toward big cities, cities where the law will allow this.” (Those cities are often in blue states and along the coasts; a 2018 study found that 27 U.S. cities, mostly in the South and Midwest, are 100 miles from an abortion clinic.)
What he doesn’t say is what we both know: that only certain women can pay to travel to New York City, and that the women calling from Alabama and Georgia asking about appointments do not represent the majority of women who need abortions. They represent the minority who can afford them. If conservative lawmakers continue to get their way, we might be looking at a future that more closely resembles the past—one in which abortion care is more starkly stratified than ever, with VIP treatment on one end, and dangerous self-induction, unlicensed procedures, or even death, on the other.
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