Overturning Roe v. Wade: Increased Prevalence and Economic Impacts of Congenital Cardiac Defects
Cardiovascular Medicine and Society
Introduction
On June 22, 2022, the U.S. Supreme Court reversed their decision in Roe v. Wade, by stating that the constitutional right to abortion no longer exists. The court majority grounded their decision in the belief that Roe v. Wade had weak arguments that were an abuse of judicial authority.1 Because this Supreme Court decision effectively returns decisions on abortion access and rights to the individual states, abortion rights will be immediately revoked in many states, which, as the dissenting opinion stated, causes young women to have fewer rights than their counterparts in older generations.1 Many medical societies have voiced their disapproval, including a notable piece in the New England Journal of Medicine voicing the medical fraternity’s bleak perception of a future where a constitutional right to abortion does not exist.2 The Congenital Heart Surgeons Society also voiced their concern, highlighting the ramifications of this decision that will be observed by their patient population.3 The pertinent scenarios they outline include terminating pregnancy for a mother for whom pregnancy is a life-threatening condition because of her own congenital heart disease, prenatal identification of terminal conditions that may warrant terminating a pregnancy, and a preterminal status of one fetus with congenital heart disease threatening another fetus in multiple gestation.3 Although many of the consequences of overturning Roe v. Wade will be unpredictable, there are even more we can anticipate. The overturning of Roe v. Wade will increase births, and this will include children with birth defects, such as congenital cardiac disease. The strain on the health care system needs to be assessed and planned for. Using the Healthcare Cost and Utilization Project database from the Agency for Healthcare Research and Quality, we estimated the resources required to care for 1 year of additional children who would be born with congenital heart disease.
Roughly 1 in 100 children is born with a congenital heart defect.4 In total, 1 in 4 of these will require at least 1 cardiac surgery in the first year of life.5 Of these surgical patients, 20% to 30% have additional noncardiac congenital defects requiring medical attention, with a higher rate of severe cardiac and noncardiac defects among elective terminations.6 Many of these patients require neurodevelopmental and school assistance, and all require life-long follow-up.7
Myers et al8 and others have modeled the effects of restricted access to abortions on birth rates in the United States, estimating a 33% reduction in elective terminations, resulting in 118,554 (95% CI: 93,546-143,561) more births per year. Myers et al8 determined the number of abortions that would result based on a patient’s distance to an institution providing abortion care, and assumed 21 high-risk states would ban abortion. Assuming the incidence and severity of congenital heart surgery in these new births is no different than the existing U.S. population, we would estimate an additional 539 (95% CI: 425-653) infant cardiac surgeries in the first year after Roe v. Wade. This assumption reflects a best-case scenario, with the reality likely being the incidence of congenital heart defects and the need for congenital heart surgery in these new births being higher than that of the existing U.S. population. Over 10 years, there will be an additional 7,243 congenital cardiac surgeries (95% CI: 5,715-8,771), after including the additional volume from patients aged 1 to 17 years. With fewer than 300 pediatric cardiac surgeons currently operating nationwide and a chronic shortage of pediatric intensive care beds—particularly in urban centers—hospitals will need to begin planning now to accommodate this increased volume.9 The health care system will also need to begin training additional physicians to address this patient population. If hospitals and the health care system do not plan to accommodate the increased patient volume, the effects of overturning Roe v. Wade will extend beyond the new babies with congenital cardiac defects to other children who are unable to receive timely intervention.
Beyond the manpower and space constraints, there will be economic burdens for the national health care system. The average inpatient costs alone of managing a patient with congenital heart disease surgically in their first year of life is approximately $127,000, and $58,000 for each year from ages 1 to 17 years, in 2022 U.S. dollars, with inflation adjustments substantiated on the medical care consumer price index. An additional 7,243 additional pediatric cardiac surgeries represent an additional inpatient cost of $820 million (95% CI: $647 million to $992 million) over 10 years. Comprehensive medical care will never be begrudged by those providing care to congenital cardiac patients, but the resources needed to treat this new population on an already overworked system are substantial. In a climate in which debates continuously exist over the prospects of universal health care and endowing health care as a human right, the overturned Roe v. Wade only signals a departure from that notion. Therefore, if health care costs cannot be covered for those after they are born, why preclude families from the opportunity to pursue abortion? Further, our estimates represent the lower bounds for inpatient costs. First, it is known that the incidence of severe congenital heart disease and multiple anomalies is higher among elective abortions. Second, surgical costs represent only a fraction of the total direct health care costs. Cardiac surgical expenses are estimated to represent less than one-half of the costs associated with medical care, and direct medical costs do not account for lost wages associated with care or other indirect financial and nonfinancial strains for families.10 Additionally, children with heart defects represent only a fraction of the children who will need additional health care resources. Analyzing the full scope of the impact on the health care system will be necessary in preparing for, and mitigating, the consequences of limited access to abortion so that we can be better prepared to care for our patients and be better equipped to advocate on their behalf in the future.
Funding Support and Author Disclosures
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
References
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Footnotes
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.