Thursday, August 06, 2009

On Health Care Reform and Abortion

There is perhaps no more divisive nor explosive issue than abortion, and we take no official stand on the morality of it. But as we've written over the years, we are most definitely proponents and advocates of the concept of "medical necessity" and the role it plays in risk management, of which insurance is a useful tool.
Contrary to previous reports, it now appears that the current proposal would, indeed, mandate coverage for abortion. Currently, the Hyde Amendment prohibits the use of public funds for that procedure; one supposes that there'll have to be some kind of legislative sleight-of-hand to get around that.
There's a more important consideration, though, which is whether there is ever a circumstance where abortion is "medically necessary." There are likely some obscure, rare circumstances (besides "the mental health of the mother") where this may be the case, but it's unlikely to be applicable in many cases. Absent medical necessity, it appears that this provision represents another mandated benefit, the cost of which will be borne by people who not only don't need it, but whose faith and convictions prohibit it.
The medical issue most relied upon by those who favor abortion is the mental health of the mother. We'll leave it to others far more qualified to speak to the validity of that argument, but we can look to how mental health benefits are currently covered for guidance in that area. The Mental Health Parity Act requires that certain benefit levels be covered under certain forms of insurance. For the most part, these apply only to group plans; individual plans, regulated at the state level, have much lower policy limits for Mental and Nervous. And, even on the group level, certain restrictions may be applied (for example, only in-network providers may be used, or the number of visits may be limited). So there's precedence for restricting benefits attributable to mental health.
Perhaps the larger issue will be the Law of Unintended Consequences. For example, those providers who choose to accept Medicare or Medicaid patients must adhere to the dictates of those programs. They can't balance bill, and they have to provide the services required by the programs. If a Public Plan becomes reality, those providers will have to decide whether or not to accept patients covered under that plan, which would apparently now include abortions. I can think of more than a few providers that might have significant issues with that.
And there's this: in its current form, it appears that while the Public Plan would cover abortions, it couldn't use federal funds, only whatever it takes in in premiums. I can think of a few more Unintended Consequences to that, as well: there may well be those who might choose the PP, but for the fact that they are opponents of abortion, and don't want to see their own dollars going directly to pay for someone else's abortion. And what about "partial birth abortion?" There is no medical justification for this procedure, and one wonders how (or if) it will be covered.
The other issue is one of utilization: when something's covered, it generally gets used. For example, the reason that maternity coverage on individual plans is so expensive (when it's available at all) is because carriers know that it has a 100% utilization rate. That is, everyone who buys that coverage ends up using it. By contrast, not everyone ends up with a broken wrist or cancer. So will abortion coverage (a related and elective procedure) also result in over-utilization, and hence significant rate increases?
Time will no doubt tell.
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