Sexual Assault Survivors Are Being Billed Thousands for Emergency Care

A new study published Wednesday in the New England Journal of Medicine found that out of about 112,000 sexual assault survivors who sought emergency care after their assaults, 17,000 faced charges averaging nearly $4,000. The study, first shared with Jezebel this week, analyzed national data from almost 36 million visits to the emergency room in 2019, and found costs for sexual assault-related visits averaged $3,551 for all victims, while pregnant victims faced even higher average charges: $4,553.

It’s an appalling revelation at a time when the overturning of Roe v. Wade has upended the health care system for pregnant people, survivors, and of course, pregnant survivors. The study’s findings are also a reminder of the extensive financial ramifications that can follow sexual assault, which also include losing jobs and income; being forced to drop out of school; and facing costly defamation lawsuits—on top of the exorbitantly high medical bills, this study revealed. A separate study found rape costs victims more than any other crime, with total estimated costs reaching $127 billion per year. Years after experiencing abuse, women have health care costs that are 19% higher than costs for women who haven’t been abused.

Samuel Dickman, one of the researchers and an abortion provider who’s worked with a number of patients who have survived sexual violence, told Jezebel a high medical bill in itself can be retraumatizing. “They’re victimized when they’re assaulted, and then, essentially, by being asked to pay these bills, they’re being told they’re responsible for what happened, when they’re not,” Dickman said.

The details of the new study this week are especially alarming: Researchers found while Medicaid was the expected payer of 36.2% of visits, 16% of patients were expected to pay out-of-pocket, and the average cost for these self-paying victims rises to $3,673. The majority of the victims who sought emergency care after an assault were young women between 18 and 44.

“Our medical system has just utterly failed to protect them financially. They’re put in that position, with no choice but to pay hundreds, sometimes thousands, out-of-pocket for essential care,” Dickman said.

He also emphasized that shortcomings in the Violence Against Women Act contribute to this. The law mandates that victims can’t be charged for the evidence-gathering portion of their medical care after an assault, but it still allows hospitals to bill victims for a range of health services commonly received after sexual violence, including diagnostic testing, laceration repair, counseling, prevention of sexually transmitted infections, and even emergency contraception, which has become increasingly inaccessible after the fall of Roe, in part due to its inaccurate conflation with abortion. In June, the Kansas City, Missouri, city health system briefly paused providing Plan B to sexual assault survivors fearing legal ramifications.

Dickman was moved to research this issue last year after witnessing the horrendous conditions many of his patients faced—even before the fall of Roe. Just before Texas’ near-total abortion ban, SB8, took effect last summer, he helped a patient in Texas who had been impregnated by rape and was already in her second trimester. “It had taken her a huge amount of emotional strength and also logistical support for her to finally be able to come in for care” Dickman recalled. Abortion can be an essential health service victims seek after their rape, especially given the prevalence of rape-related pregnancies. In July, a 10-year-old rape victim from Ohio was forced to travel to Indiana for an abortion because she was a week past Ohio’s six-week cut-off that lacks a rape exception.

The rapid spread of state abortion bans—most of which lack rape exceptions, including SB8—means abortion and all the associated logistical barriers to access it are more expensive than ever. That’s on top of Dickman’s research showing that pregnant sexual assault victims already faced the highest average charge for emergency care ($4,553) in 2019, years before Roe was overturned and states implemented bans. Forced pregnancy and costly medical bills for seeking care after an assault go hand-in-hand: Both show how the state punishes victims simply for being victims.

The new study also emphasizes that young women and young women of color are more likely to be low-income and uninsured, and more likely to experience sexual assault. In that vein, Dickman noted how his research is limited to victims who sought out emergency care in the first place. “There’s an uncountable number of people who know they would be hit with large medical bills if they go to the emergency room after an assault, and so they just don’t go,” he said. “And that’s even worse.”