Health Insurance and Abortion
It seems often the case that a heated political debate causes people to suddenly focus on issues which had previously been essentially ignored. One recent example of this in Catholic circles has been the way in which the debate over the Stupak Amendment to the House health care reform bill suddenly focused scrutiny on the question of abortion coverage in health care insurance.
To recap briefly: From the beginning, one of the concerns that many pro-lifers had expressed about “government health care” was that it would result in government funding for abortion. As the various reform bills coalesced, it became clear that no “government health care” per se would be offered, but rather an exchange on which private health insurance plans which fit specific government-set criteria would be offered. Given this situation, pro-lifers (and in particular, pro-life Democrats, who clearly had the prime say here since Republicans were unlikely to support the bill either way since they saw its overall structure as detrimental to the common good) insisted that one of the stipulations for the private health insurance policies offered via the exchange (and qualified for government subsidy for lower and middle-income Americans) be that the plan not cover abortions.
Pro-choice Democrats of course hated this provision. Some progressive Catholics also seemed eager to explain why the bill would be just fine even without Stupak, doubtless in order to avoid a situation in which pro-life advocates (backed by the bishops) successfully made the case to conservative Democrats that supporting a bill without language similar to the Stupak amendment was unacceptable for Catholics and other pro-lifers. The primary argument that surfaced was, “Most private insurance policies already cover abortion, so even without Stupak’s language, the status quo does not change. More people just get health care, and that’s good, right?”
The extent to which abortion is abetted by private health insurance is a semi-open question. Planned Parenthood on the one hand reports that 80% of health insurance policies cover abortion in at least some circumstances, but on the other hand that only 40% of abortions are actually paid by via insurance.
Obviously, even 40% of abortions is a huge number, and not something that the pro-life movement should ignore. Some progressive pro-lifers have latched hard onto this point in recent weeks. On several occasions, recently, I’ve seen progressive-leaning Catholics make the point that, “The pro-life establishment has long ignored that big business is funding abortions through big insurance. If they truly cared about life, this would be their primary focus rather than the supreme court and congress.”
There are various considerations here, and for lack of a better approach I’ll list them off separately.
– I don’t think it’s accurate to say that pro-lifers don’t care about “big insurance” funding abortions. The primary political focus of the pro-life movement has been working to legally restrict abortion, both via small steps in the interim and via larger ones that would be made possible through the overturning of Roe v. Wade. Obviously, if abortion was legally restricted as a medical practice, the fact that health insurance used to pay for abortions in some circumstances wouldn’t do anything to make them more legal. So if pro-lifers won on the legal front, it would take an end run around any insurance coverage of abortions. In the non-political arena, pro-lifers are primarily occupied with pro-life crisis pregnancy centers and with clinic protests and sidewalk counseling. All of these are certainly as applicable to someone planning to use insurance to pay for an abortion as otherwise, so it’s hard to see how one can accuse them of neglect here.
– The fact that insurance had been little discussed in regards to abortion before this particular health care reform bill made it a national issue probably has a lot to do with the cultural understanding of abortion out there. Most of us, I imagine, have as some time heard some co-worker or classmate talk about getting a woman pregnant and “giving her money to take care of the situation”. When people think about the abortion issue, it’s often in terms of this kind of situation, and the idea of insurance doesn’t really come into the stereotype. This is probably compounded by the fact that the demographic which procures the most abortions (single people in their teens or early 20s with lower or middle incomes) is the group of people least likely to have their own insurance.
– The question of abortions paid by insurance vs. abortions paid in cash probably also ties very closely to another of the issues relating to abortion in America which is not necessarily discussed a great deal. There are two worlds of abortion: Voluntary abortions are essentially the “I don’t want to have a baby right now” variety. They spring from “surprise” pregnancies and are (like any other strictly optional procedure) generally not going to be paid for by insurance. This is the area in which the pro-life movement seems to be gaining increasing traction as painful experience teaches society that abortion is not a painless get-out-of-pregnancy card. The much more difficult battle for pro-lifers, however, is against so-called “therapeutic” abortions, where there is either some real or likely medical problem with the unborn child or where the pregnancy represents an unusually high health risk to the mother. These situations are much more likely to be covered by insurance, the abortions often take place in hospitals rather than at abortion clinics, and many people who oppose abortion “in most circumstances” will get all wishy-washy about these situations.
– I don’t see why it’s unreasonable for pro-lifers to ask for one of the regulations placed on insurance policies in a government regulated “health care exchange” be that the policy not cover abortion. Many other groups with strong ideas about what insurance should or should not cover had already entered the mix to try to mandate what policies on the exchange should cover, what percentage of care they would pay for, what the maximum you would have to spend on “your share” of medical expenses per year would be, etc. It’s not as if no one else was seeking to control what sort of insurance would be offered on the exchange, and while these questions were open, I think it’s entirely appropriate for pro-life legislators such as Stupak to seek to ban abortion coverage from those policies.
– Now that the issue has achieved this prominence, I think it would be a mistake to simply drop the question. While getting private insurers to change their policies to exclude abortion would clearly not be easy (since there are dozens of insurers offering a plethora of policies, each with different coverage restrictions) I think pro-lifers should indeed seek for ways to encourage insurers to offer abortion-free policies, and Catholics business owners to select those policies. There might also be a chance of achieving this effect through regulation. Health insurance is a very highly regulated industry, with all states having laws about what must be covered by different types of health care plans. Seeking to have abortions specifically classified as not being necessary medical care would strongly encourage insurers to skip covering abortion as a cost savings measure.