I’ve talked many times now about the different standards applied to the proximity of taxpayer funds to abortion and the proximity of private premiums to abortion. Of course, from a moral perspective, there is really no difference, and yet the widespread funding of abortion by private health insurance seems a matter of small concern. Guttmacher claims that 87 percent of employer-based plans covered abortion, while 13 percent of abortions are billed directly to insurers (this excludes people who seek later reimbursement from insurance companies). Until a few weeks ago, abortion was covered by the Republican National Committee’s plan, but nobody cared until the current healthcare reform bill pushed this issue into the limelight.
Nobody cared. But they should care. Because the dirty little secret is that insurance companies love covering abortion, because it saves them a lot of money on childbirth costs. In fact, as Tim Noah notes, “For health insurers, the true cost of abortion coverage is less than zero, because hospitals and doctors charge less to perform abortions than they do to tend pregnant women before, during, and after childbirth”. To put this in stark terms, a profit-making insurance company striving to appease shareholders by minimizing “medical loss” has every incentive to encourage abortion and discourage childbirth.
And yet, this is not on the radar of the pro-life movement. It was never on their radar. They didn’t care when Medicare Advantage allowed private insurance companies to cover abortion. Despite the hullaballoo over the healthcare reform bill and abortion, this bill represents the first attempt at the federal level to regulate what insurance companies can and cannot do when it comes to abortion. States can prohibit them from coming to the exchanges with abortion plans. Every person must have an option that excludes abortion – an option, I must point out, that is not available to people on employer-based plans. And those that choose an abortion plan must remit a separate payment that covers the gross cost of abortion (not the saved money from childcare costs) into a segregated abortion fund. (Realistically, how many will choose this option? How many companies will ever bother offering?).While imperfect, this is the first step towards getting the insurance industry out of the abortion business.
Why does nobody seem to care about this? Why has the pro-life movement been asleep at the wheel for decades? One reason is that it remains aligned with that variant of liberalism which emphasizes individual rights and is distrustful of using the government to enforce collective decision-making. In this view, the market is good, and government is bad. Individual responsibility embodies virtue, dependence on others embodies vice.
Applied to health care, Jonathan Chait puts it this way: “Democrats propose to shift resources from the rich and the healthy to the poor and the sick. Republicans want to do just the opposite. Republican health care plans reflect the party’s increasingly widespread belief that good health, like other forms of prosperity, is a matter of personal responsibility.” Of course, he misses the religious dimension – this is Calvinism in action. It is not the Catholicism that sees a clear role for the state in collective decision-making and views healthcare as a basic human right.
And so, the pro-life movement was been in bed with big business, including the abortion-loving insurance companies. After all, one must not disturb one’s allies on the right! Here’s the bottom line: If a private insurance company covers abortion in normal times, no big deal. But if a private insurance company covers abortion during a government-sponsored attempt to insure 30 million more people, then it must be opposed at all costs.
I know we have been through this before, but I will say it again. It is absolutely not true that no one cared and that it was not on the radar of the pro-life movement. How do you explain why some states prohibit any private plans from covering abortion? In some states where the pro-life movement could not pass such laws, they have managed to pass laws at least prohibiting state employee plans from covering abortion.
Moreover, I know that dioceses and Catholic institutional employers have been concerned about it for decades, actively trying to purchase plans that do not cover abortion.
Because the dirty little secret is that insurance companies love covering abortion, because it saves them a lot of money on childbirth costs.
I really don’t like this argument because it completely misunderstands the purpose of insurance and requires assumptions that are ultimately wrong. To make the insurance companies virtuous instead, we could claim that insurance companies hate death, because then they have to pay out life insurance claims. So, supposedly insurance companies should have incentives toward promoting perpetual life. But, if everyone has perpetual life, they won’t need life insurance. Since insurance companies cannot both be working toward perpetual life and working against it, it follows that they have very little interest in any particular life in question. And it turns out that in nearly all insurance contracts, the company doesn’t really care about the underlying event. What the insurance company cares about is that the average potential cost band narrows as the number of claims increases. In other words, while 1 pregnancy may cost between $3,000 and $100,000, the cost of 100,000 pregnancies will average out 97 out of 100 times to between $8000 and $8500 each, to pick numbers out of the air. I forget off hand the variability of pregnancies per year with comparable populations based on the legality and availability of abortion, but I don’t believe there is actually all that much variability. If there was, the result would be lower premiums and not higher insurance company profits, because pregnancies per year over a large population are very predictable. Bosses on the other hand have been known to fret over the number of women they have of child bearing age.
Well said, especially: “Why has the pro-life movement been asleep at the wheel for decades? One reason is that it remains aligned with that variant of liberalism which emphasizes individual rights and is distrustful of using the government to enforce collective decision-making. In this view, the market is good, and government is bad. Individual responsibility embodies virtue, dependence on others embodies vice.”
This libertarian link is very important; I’ve often been struck by this watching the Tea Partyers. Moral relativism, anyone? Well, I’m sure Michael Novak could come up with a rationalization.
Ctd – I’m sure some have focused in it, but it seems small scale. I mean, to count a victory as a Catholic institution not providing abortion in its healthcare plan is a pretty low bar!
What about the rights of everybody in employer-based insurance to opt out in matters of conscience, as is proposed for the individual insurance market on the exchanges?
Why did the pro-life movement support the private insurance companies liberalizing abortion provisions in Medicare Advantage?
Please. You didn’t care about this issue until the healthcare debate began (unless there was a post I missed). There are a lot of aspects to abortion support, and this wasn’t one that was really noticed. There are many possible reasons for that. While the right-leaning nature of the current pro-life movement is certainly one possibility, that the focus of the pro-life movement has been on the legal/political process and not on healthcare until this debate is a very plausible (and more charitable) possibility.
Instead of pointing fingers at each other for why this wasn’t an issue before, why don’t we just continue to make sure it remains an issue for the pro-life movement (an issue that I would point out requires condemnation BOTH of insurance and government plans that fund abortion).
Moreover, I know that dioceses and Catholic institutional employers have been concerned about it for decades, actively trying to purchase plans that do not cover abortion.
ctd,
Has it ever been suggested (prior to discussions on this blog) that any employee whose employer provides abortion coverage, and requires the employee to pay part of the premiums, must opt out of their employer-provided insurance rather than contribute money toward abortions?
I was not counting the action’s of Catholic institutions a “victory.” I only noted that it is evidence that the issue has not been ignored.
North Dakota, Kentucky, Idaho, Oklahoma, and Missouri, by the way, have comprehensive bans on abortion coverage in private policies. Other states of degrees of prohibitions.
When did the “pro-life movement” “support” liberalizing the abortion provisions in Medicare Advantage? The fact that certain members of Congress who purport to be pro-life allowed it to happen is not the same as the pro-life movement supporting it.
Then way does the pro-life movement not exert the same pressure on the remaining 45 states as it does at the federal level on healthcare reform?
And, by the way, the National Right to Life Committee was fully supportive of the Medicare Advantage bill, because they were under the bizarre impression that rationing happens in traditional Medicare, but not in the private sector! They let their blindness to ideology take precedence over their supposed opposition to “federal funding of abortion”.
You guys really don’t understand how employer driven health insurance works. Most companies are self insured. Meaning they pay an insurance company for access to a network and in some cases billing. They then decide what to charge their employees for this sevice based on union contracts, market conditions, recruiting,… Along with the price, the company decides on what coverage to offer, using the same decision points. When a claim comes in the company pays it out of the pool it allocated for employee health insurace. Most companies will then reinsure any overage with a reinsurer. Meaning that if total claims for a year over say $1,000,000 then they make a claim against the reinsurer.
Your target in this case really needs to be companies that offer abortion coverage. That is the employer. And if you want to be self righteous about it, ask Catholics to quit any employer that offers abortion coverage. But the nearness to evil is even further removed in the business health insurance self insured model, since the premiums go to the company to offer insurance, not pooled in some bank account with other employees to pay for abortions.
This attack against pro-lifers is really a stretch. Why is your ire and self righteousness not against Democrats for failing to pass a Stupak like amendment in the Senate? That is all they would need to do to get the USCCB and pro-lifers on board.
That’s a fair point, Kevin, but I think it is more accurate to describe it as negotiation between the insurance company and the entity being insured (the whole point of the Exchanges is to improve the bargaining relationship between the 2 sides). So, yes, the company might be to blame, but it’s certainly in the interests of the insurance company to cover abortion as well as childcare costs.
Can you direct me to an insurance company promotion of abortion?
Again, I wish that instead of this tired “hypocrisy” argument, you pushed this as a positive for health care reform — it give us a single pressure point to stop the coverage of abortion.
Kevin’s point underscores it — isn’t it better that we can lobby for a pro-life health care than all of us have to quit our jobs?
Let’s go for win-win.
North Dakota, Kentucky, Idaho, Oklahoma, and Missouri, by the way, have comprehensive bans on abortion coverage in private policies.
Which would be nullifed by the Republican plan to allow sale of insurance policies across state lines. And the Pro-Life objection to this GOP proposal is where?
John, as a friend of mine said yesterday, we’ve already won. The fact that we are debating Stupak vs. Nelson, and the that the latter is the worst outcomes tells us we have won.
Why would it matter that Medicare Advantage Plans allow coverage for aboution? I’ve been in the Medicare Market for 30 years, and have never known of a Medicare recipient to need an abortion.
George, Medicare covers disability as well as the elderly. And here is an example of Medicare Advantage covering abortion.
Employers, i.e. mostly self-insured plans*, are not regulated under the Exchange. It is very rare for an employer to recover under aggregate insurance, which is what Kevin is referring. Employers mostly recover when employees hit what are referred to as specific deductibles that can be from $15,000 to over $100,000. And then there are lasers and other fun things to add complications. Self-insured plans subscribe to networks in their own right; they don’t get access through the re-insurer. What this has to with MM’s post escapes me, though this gives me an opportunity to show that I do know what I’m talking about.
* I haven’t looked at how fully-insured plans are effected by the exchange. If I were to speculate, I would guess they would be treated like their self-insured brethren. If your company employs over 300, they are almost always self-insured. If they employ under 100, they are almost always fully-insured.
The idea that the prolife movement may have some shortcomings is not in any way a valid defense of the current health care insurance reform proposal(s).
The pro-life movement is admittely far from perfect. It is not omnisicient. It does not always think through every implication of every policy. It is certainly at times influenced by the other political concerns of its members.
That does not mean it has been actively giving a pass to pro-abortion policies. Rather, it may have made some mistakes in being too lenient and trusting of both government and business in the past. That should be all the more reason for skepticism of the current government notion.
For my part I want no part of paying for anyone’s abortions, contraception, embryonic stem cell anythings, artificial conceptions, or any of that stuff. I don’t want my taxes going to it, I don’t want my pay or benefits going to it, and I don’t want anyone else being made to pay for or do those tings. I consider it a grave violation of human rights and dignity to be forced to pay for these things by the state, and I find being arm-twisted into it by a business to be equally unpalatable.
In any case, I for my part remain against this latest attempt, and while I do have pro-life arguments, and moral arguments, as part of my reasoning, quite frankly I am against it for economic, fiscal, financial, constitutional, and logistical reasons as well.
To my mind the current conscience protections are not sufficient for health care workers and health care entities. I also do not see sufficient conscience protection for others involved, so as the customers.
I also think that eventually this plan will be used as a vehicle for expanding morally objectionable policies. I strongly suspect it will be used both as justification and mechanism for things that every true Catholic would object to. Admittedly this is a slippery-slope type argument, but such predictions are sometimes correct.
In any case, I see much that can be improved about the current system of health care and health care insurance. I just happen to think that the current proposals are among the worst ways of doing it. Quite frankly I think I would be more comfortable with a straight forward government take over of health care and single payer system. At least that idea has some logical consistency, some hope of transparency, some slight accountability, and might actually work. The current proposal is illogical (it often as not works against its own goals), it is not at all transparent to the average citizen, the perfect formula for shifting blame, and it probably won’t work as advertised anyways.
- As I wrote a little while back it hardly seems fair to say that the pro-life movement has been actively ignoring private health insurance in regards to abortion when their primary focus has been on restricting (and eventually banning) abortion entirely. Obviously, if they succeed in this, then any insurance coverage of abortion becomes null. They’re simply taking a different approach. Also, short of encouraging employers to demand plans which don’t cover abortions (which as ctd points out Catholic organizations have led the way on) and seeing to ban private insurance coverage of abortion (which has been achieved in several states) it’s a lot harder to influence what’s covered in private policies than it is in a Federal program to set criteria for an insurance exchange. Which is why, obviously, this came up now.
- I don’t think your suggestion that insurance companies “love” abortion because it’s cheaper than birth makes a whole lot of sense. Insurance companies don’t have to make their profits by digging in their heels and refusing to pay for procedures that people want. They can also (and do) raise rates as people’s usage patterns change. So if starting tomorrow the abortion rate fell to zero, it might result in slightly higher insurance rates next year, but I don’t think we’d see insurance companies begging people to abort. (Indeed, I would challenge you to provide links to examples of insurance companies pressuring people to abort.) And indeed, in the long run, insurance companies make money because of enrollees. If they kill all the enrollees, they make no money. Population growth is in their favor. This doesn’t make them virtuous, but this “insurance companies are eeeeeeevil” routine doesn’t make a whole lot of sense.
I have been in the insurance industry for almost 20. Not one time have I ever seen a plan that covered abortion. Who is writing this article? I have come across hundreds of benefit packages and again have never seen it covered. Where are you getting your information from?
American press has already been caught in a lie by stating that 90% of private insurance companies cover abortion.
Abortion seems to be the political topic of the past 40 years. Why does almost every political decision seem to revolve around this barbaric procedure? Lord have mercy in the USA.