Monday, December 21, 2009

Why abortion coverage is so important: A primer

If, for some reason, you haven't been following the health care reform debate involving abortion coverage, or you've been trying to follow it but gave up because it's too confusing, or you happen to agree that abortion should not be covered by insurance, read up.

Let's start with health insurance as it now relates to abortion coverage: "A Guttmacher Institute survey found that 86.5 percent of employment-based health plans cover medical abortion and 86.9 percent of employment-based health plans cover surgical abortion. The Kaiser Family Foundation’s 2003 Employer Health Benefits Survey found that 46 percent of workers have coverage for abortion services. And when looking at larger firms, the rate is more than 50 percent."

OK, so around 86 percent of employment-based plans cover abortions, and 46-50 percent of workers have abortion coverage. Conversely, about 14 percent of employment-based plans do not cover abortion, and about half of the workers in this country do not have abortion coverage. (You can see some abortion coverage restrictions by state here.)

Then there's the Hyde Amendment, which was passed in 1976. This amendment bars the use of federal funds to pay for abortions. That means that the following do not have, by law, health insurance coverage for abortions: women on Medicaid, federal government employees, U.S. military personnel and their families, Peace Corps volunteers, Indian Health Service clients, and federal prisoners. The only exceptions currently allowed under Hyde are cases of rape, incest, and life endangerment. Not allowed: health of the mother, fetal abnormalities.

That's where abortion coverage stands now: most employment-based insurance plans cover abortion; about half of workers have abortion coverage; and the Hyde Amendment prevents any federal funds from covering abortions (thus affecting a number of women).

Moving on to the health care reform discussion on abortion coverage, including the Stupak-Pitts Amendment in the House, the Nelson-Hatch Amendment in the Senate, and the compromise in the Senate.

Stupak-Pitts: This amendment was introduced in the House by Bart Stupak, a Democrat, and Joe Pitts, a Republican. "The amendment prohibits use of federal funds 'to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion' except in cases of rape, incest or danger to the life of the mother, which is being interpreted to mean abortions not included in the exceptions may not be covered in the public option or in any of the exchange's private plans that take subsidized customers. The amendment also specifically allows individuals to purchase supplementary insurance that covers other abortions."

Basically, if a woman buys health insurance with her own money from an insurance company that receives any government funds, abortion coverage cannot be included in the plan. At this point, you're going to be talking about nearly every woman who has health insurance, except those who have the funds and foresight to purchase the supplementary insurance (if that is in fact offered under such circumstances, which I highly doubt it would be). This amendment would take us from 86 percent of employer-offered insurance covering abortion to virtually zero. And obviously the Hyde Amendment still applies, so women in the military, women who receive Medicaid, etc., still wouldn't have abortion coverage. Pretty much no one would. For more on what this amendment would mean, read this study (PDF) on the subject from George Washington University.

Nelson-Hatch: This amendment was the Senate version of the Stupak-Pitts Amendment, and was defeated by the Senate. It was introduced by Ben Nelson, a Democrat, and Orrin Hatch, a Republican. Because it was defeated, the Democrats found themselves having to court Nelson in order to secure his vote for the health care reform bill. And in order to do that, they had to reach a "compromise" on abortion coverage in the Senate health care reform bill. As it stands now, that compromise involves this: "States would be allowed to decide whether or not abortion could be covered by health plans operating in a new insurance marketplace under the bill. Plans covering abortion would have to collect a separate premium for the procedure, directly paid for by the person buying coverage. Premiums for abortion would be kept in a separate account."

This is slightly better, on paper, than the Stupak-Pitts amendment. However, the same group that released the George Washington University study on the outcome of Stupak-Pitts looked at this compromise and concluded that insurance companies will probably stop offering abortion coverage under this legislation, because the funding is too complex and (likely) won't be available in every state. Please read the study results here.

Health care reform is going to bring about some good changes to health insurance: no more maximum lifetime payouts, no more denials for pre-existing conditions, more people will have coverage, to name a few. However, it's all but certain that coverage of women's reproductive health care will be worse off under any final bill that is signed into legislation. This is a huge step backwards and a completely unnecessary assault on women's health care. Something that is currently available to millions of women, something that should be available to all women, probably won't be available to any woman.

Republicans, none of whom are likely to vote for any health care bill anyway, are willing to kill any bill that even hints at abortions being covered by even $1 of federal funds. Democrats, all of whom are needed (at least in the Senate) to vote for the bill, are easily willing to compromise women's health care away to secure the votes they need. Neither side as a whole is standing up for women. Why?

Why does Ben Nelson get to lay down the terms under which women can have abortion coverage? To be sure, that is exactly what just happened in the Senate.

Too many people, civilians and those in government, sum up abortion as birth control. When they talk about abortion, they talk about "women who don't want to have babies." It's cut-and-dry. Women could have a baby, but choose to "kill" it instead. And we can't be using government money to "kill babies," now can we? (But we can use it to kill hundreds of thousands of people overseas, and people sentenced to death in this country, no problem.) Either there is some willful ignorance going on, or these people are completely incapable of reading about and/or studying up on the issue. No matter how many times anti-choicers say otherwise, there are medically necessary reasons for abortions. Yes, abortion is used as birth control by some people -- and that is their right. (Remember how it's a legal procedure? Yeah. It is.) For others, however, abortions aren't an "I forgot to take the pill" trip to the doctor's office. They are devastating outcomes to a wanted pregnancy.

A lot of things can go wrong during a pregnancy. A fetus doesn't develop properly, to the point that it cannot survive after birth; complications can arise that would endanger a woman's reproductive system if she continues the pregnancy; fetuses die in utero; and so on. Abortion is often recommended or necessary in such situations. Not only are these abortions not covered now under the Hyde Amendment, they also likely won't be covered under the final health bill.

These are not the abortions anti-choicers talk about. Maybe all abortions are the same to them, I don't know. Many anti-choicers want all or nearly all abortions to be illegal, so perhaps they truly don't care if a fetus develops without a brain and therefore cannot live outside the womb. But for those who aren't so all-or-nothing, you need to know that taking away abortion coverage in health insurance is going to result in a woman having to pay out-of-pocket for an abortion in these cases -- cases where a wanted pregnancy goes wrong -- just the same as a woman who "just doesn't want a baby" will have to pay out-of-pocket. The only exceptions are going to be rape, incest and threat to the mother's life. The latter will no doubt be argued by insurers, and the two former ... well, I suppose incest can be proven by DNA tests, but I have no idea what happens when you tell your insurance company that you've been raped, got pregnant as a result, and need them to pay for your abortion. I don't know what the standard of proof is in those cases, but I'm guessing it's not easy and that most women in those circumstances end up paying for the abortion themselves.

Every single person wavering on this issue or who doesn't really understand the impact of not having abortions covered by insurance (federal money or otherwise) should read these three articles:
  • "The Reproductive Health Consequences of Being Uninsured." (link)
  • "Saving Grace: One Family's Struggle With Abortion and the Catholic Church." (link)
  • "Military Abortion Ban: Female Soldiers Not Protected by Constitution They Defend." (link) ... Just think about that headline for a minute.
Are you starting to see the problems yet?

It seems to me it's too late to do anything about the health care reform bill. (Please correct me if I'm wrong on that, but I'm convinced it's going to pass with very restrictive abortion language in it.) It's never too late to contact your representatives though, and explain why abortion should be covered and why Hyde should be repealed. Our representatives on every level need to understand that abortion is a legitimate medical procedure that is a vital part of women's health care. Until they understand and admit that, we're just going to keep getting more of the same.

By the way, you know what costs insurance companies more money than abortions? Giving birth.

1 comment:

Sharon Phillips said...

Great post & summary... I would also widen the lens even more than you have, regarding those that have an abortion. There is so much in between forgetting a pill or a condom breaking and an abnormal pregnancy or health problems resulting from it. There are people who are taking their birth control correctly and still get pregnant, there are people who are victims of rape who get pregnant (and yes, as you state, the bills allow for abortion in the case of rape, but the reality is that many cases of rape aren't prosecuted and can't be, and even if they can be proven how to you prove it to your insurance company?), women who are in relationships where the male refuses to use birth control, women who trade sex for food or shelter and have lives too chaotic to make a trip to a physician for birth control (or who can't afford it... I have patients for whom a $5 copay for birth control pills is impossible). There are women who think having a child with someone is a good idea but when they get pregnant the relationship turns sour and they decide that cementing a bad relationship with a pregnancy is not a good idea. There are teenagers who are simply too immature to understand the potential consequences of sex. There are women who are mentally ill and can't reliably use contraception because of that. There are people who have not had access to comprehensive sex ed and don't know how to avoid getting pregnant. Every story is unique, and every woman who chooses an abortion has her own personal reasons. And as you state (something I don't see very often), if women want to use abortion as their birth control method, that is their right, even if some people don't like it.
Thank you for this great overview!


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