Abortion and Health Care Reform: Q & A

March 24th, 2010 by Al Lewis (alewis)
What Will Be the Law of the Land:
A requirement that anyone who wishes to be covered for a potential abortion AND who is receiving federally subsidized health insurance must pay for that coverage separately with their own money.
How Much Coverage Will Cost:
In a nutshell, very little. 
It is likely that insurance companies will make people sign up for perhaps a year of coverage at a time and not allow people to select coverage after their policies have already started, without a waiting period.  Minimum lengths of coverage and waiting periods are hugely important in the cost calculation because otherwise people would just sign up for coverage the month they need an abortion and then cancel coverage immediately thereafter.  Assuming such minimums and waiting periods, coverage will probably cost $3/month.  Today the average health plan spends about $1 per member per month on abortion but because coverage is not provided in the form of a rider, there is no adverse selection issue — everyone, including males, gets covered.   Even with “adverse selection” – meaning that only childbearing-age women and families who favor abortion might sign up — the monthly premium will not likely exceed $3.
It is also possible that insurance companies, to encourage coverage (and hence avoid paying for more live births), will price the rider at cost or below, instead of making a profit on it.
What It Will Do to the Abortion Rate:
In a nutshell, there could be more abortions.
Though widely viewed as a concession to the pro-life wing of the Democratic Party, the likely low cost of this rider brings abortion coverage into the realm of affordability for everyone.  However, outside the Medicaid population (which the abortion coverage rider does not address), there do not appear to be many women foregoing abortion because they can’t afford the average $413 cost.  Indeed the opposite is true.  Clinics report many women paying out of pocket even when insurance would cover the procedure.
There is, however, strong anecdotal evidence that affordability issues delay abortions, as women (or girls) raise the money to pay for them.   This will not need to happen for women who are already covered.
Therefore, it would appear that the abortion rate might increase slightly (or, more correctly, might decline at a slower rate than it has been declining for the last three decades), but the gestational age might decrease. 
The latter could certainly be considered a win for everybody, though pro-life groups whose other anti-abortion tactics consist of trying to legislate delays for counseling and create other logistical roadblocks (such as increasing the distance that people must travel to get abortions) do not seem to be concerned with gestational age.
How This Amendment Came to Pass
The Nelson Amendment was inspired by my proposal in Newsweek.  http://www.newsweek.com/id/226262.  This was placed in order for a Senate staffer (who prefers to remain nameless) to pass it along to Senator Nelson and have it not be this staffer’s idea, since this staffer was pro-choice.  The original essay was intended as a compromise.  It contained, in addition to the prima facie pro-life separate check requirement, a pro-choice offset:  an observation that insurance companies might charge less for the basic policy to people who procured the abortion coverage on the theory that avoided live births would more than offset the cost of abortions.  And that, therefore, the abortion coverage could very well be cost-neutral even while federal funds were segregated. 
However, Senator Nelson not only rejected that portion of the compromise, but he actually wrote language specifically prohibiting insurance companies from doing exactly this, even though the only mention of it as a possibility was in that one essay.  Hence the likelihood, as mentioned above, that insurance companies will simply discount the abortion rider itself in order to encourage its use.
The Inconvenience Factor
In a nutshell, a red herring.  Commentators have made a big deal of the “separate checks” but in reality this check will probably paid once a year.  If it is collected monthly, it will probably be by credit card, automatically, just like Netflix.
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