Insurance Assurance?

When I worked at an abortion clinic we had a laundry list of questions we asked clients when making their appointment. The standard question went like this, “do you have Medicaid, military status, or private insurance?” We spend a lot of time in this blog or in other abortion’y type news sources discussing Medicaid, abortion funds, and clients’ all-around inability to pay. But what about those who have private insurance? It was very common for women to be surprised that private insurance was an option, mainly because abortion is so completely stigmatized and compartmentalized that no one assumes it would be covered by their policy; abortion has become so moralized and fraught that we forget it is a medical procedure that deserves coverage just like an appendectomy or cardiac bypass.

Quick and dirty: Private insurance that is employer-based (as it currently stands) can and often covers “elective termination.” However, an employer can restrict this coverage and many do (back in my clinic days: Walmart and Cracker Barrel to name a few). When an employer-based policy DOES offer coverage, there is often a deductible (can be up to a few hundred dollars) or there is a co-pay (usually no more than $100, but can depend what type of facility the procedure is done in). Usually it is much cheaper to use private insurance than to pay out of pocket. However, we had a slew of clients who didn’t want to use their insurance. Sometimes they were afraid their employer would find out. Sometimes I think they just did not want any sort of official record of their abortion.

We should take a few steps back though, because using private insurance is never as simple as swiping a card. In fact, some of the smaller insurance companies we worked with were near impossible to nail down in terms of the costs that a client would have for a deductible and/or co-pay. Or, in the case of employers that only provided coverage for rape, incest, or fetal anomalies, it could take weeks before we got approval or even just a basic response for what a client needed to pay up-front. We would urge clients to call their insurance companies themselves and find out the fees but ultimately someone from our clinic needed to call and confirm the costs, which resulted in endless hours on the phone and bickering with insurance companies over whether or not someone was covered. And yes, we did sometimes encounter the lovely insurance company reps that were easy-breezy to work with and who supported abortion and you never felt like they were rolling their eyes or begrudgingly giving you info that you were legally entitled to.

I’m bringing this up because myself and a few close people in my life have recently tried to navigate the world of private insurance and come up against some significant barriers. I’ve been given three of four different quotes on costs from different sources and I’m still not entirely sure I paid the correct amount for a procedure I had. A friend received bills for services he assumed were covered because at the time of care he called his insurance company to confirm. Now, I like to think that I’m pretty literate when it comes to health insurance, yet I have become so frustrated with receiving care and the confusion over costs that it makes me want to ignore my health altogether just to avoid this HOT MESS that we call health insurance coverage.

Moving forward as we continue to fight for universal health care we must recognize that access to insurance is not enough. There needs to be education around how to navigate the system and also health insurance literacy so that all consumers maximize their benefits. Insurance companies are businesses and they are not incentivized to throw any of us a bone, in fact they will do everything they can to take advantage of us who don’t know how to use our benefits.

Injuring and insulting women: legislative edition (Or, "Hereafter Known As The No-Good-Reason Act")

You need to know about this. Chris Smith, along with several other congressmen (many of them newly elected), feel that our representatives' first priority in the new Congress ought to be the passage of "insult plus injury"-style anti-abortion legislation. Enter the "No Taxpayer Funding for Abortion Act." I want to discuss two especially stupid provisions, which this column summarizes nicely.

The tax credits that are encouraging small businesses to provide insurance for their workers could not be used to buy policies that cover abortions. People with their own policies who have enough expenses to claim an income tax deduction could not deduct either the premiums for policies that cover abortion or the cost of an abortion. People who use tax-preferred savings accounts to pay medical costs could not use the money to pay for an abortion without paying taxes on it.

I mean, this is purely symbolic for the legislators, and purely punitive for people who need an abortion! Republicans are going after tax deductions? Breezing right past that irony, let's consider: Does the fact that I can deduct my spending on medicine or a doctor's visit from my "taxable income" make me more likely to spend on those things? Not really, it just makes it slightly easier on me to afford the things I need without taking extra money from me at tax-time as though I had spent those dollars on "fun" stuff.

At my current income I don't actually have to pay federal income tax (shocker), but assume the default 20% bracket applied -- if I get to subtract, say, $500 spent on a first-trimester abortion from my total taxable income, I'll save $100 come April 15. Not enough to make me decide to have an abortion, and not enough to make me decide against an abortion if Chris Smith bans that deduction.

Another example, going further afield to tax credits, which really are a significant chunk of money credited to you directly (not just deducted from your taxable income base): if I have dependent minor children I can get $1000 taken off my owed taxes each year. Has that affected my decision to have or not have a child? Would it affect yours? Probably not; people decide to have children because they are ready to and want to, not because someone's giving them a coupon on it.

I know taxes are a drag, so we don't have to keep discussing, but you see the gist: this ban's purpose can't logically be to make people less likely to choose abortions -- it's only to injure them for it by taking out an extra $100 of their taxes (or more, depending on their income bracket), and to insult them by refusing to acknowledge that their abortion counts as a health-related expenditure. (Just like tampons and pads and menstrual cups don't count, either. Just like breast pumps don't count, either. I discern a fucking pattern.)

The Smith bill also would take certain restrictions on federal financing for abortions that now must be renewed every year and make them permanent. It would allow federal financing of abortions in cases of "forcible" rape but not statutory or coerced rape, and in cases where a woman is in danger of death from her pregnancy but not of other serious health damage. It would free states from having to provide abortions in such emergency cases.

FYI, as Sady Doyle notes, "70% of rapes are 'non-forcible.' Rapists consciously seek out people and situations where they’ll have to use a minimum amount of 'force'."

Currently I work in a state that doesn't provide any of its own funds for abortion coverage but supposedly abides by federally-funded Medicaid's mandate to cover abortions in cases where a pregnancy resulted from rape. Even the old-timers at my work say that they have never seen Medicaid cover a procedure, even when the rape was "forcible" (all rape is forcible, obvi, since that's the opposite of consensual, but by this Smith really means there must also be beating), even when prosecution occurred, even when the pregnancy was DNA-matched to the perpetrator. Many clinics don't bother trying to bill Medicaid anymore, so the state is passively stripping women of even the limited rights they supposedly have. Abortion patients whose pregnancies are a result of rape, even patients who do have Medicaid, overwhelmingly are already paying for their own abortion care (and often struggling to do so). And women who can't pay for their own abortion care overwhelmingly are already bearing their rapists' children. Doesn't that warm your Republican heart*? (Oh, a few Democrats too!)

So this provision, too, isn't going to prevent women from choosing abortion. If the federal government reverses decades of painstaking progress in legal thought, jurisprudence, and goddamn human rights, it isn't going to make women who were raped but just not beaten too feel that they deserve to remain pregnant any more than they did before. It's just going to bring written law more in line with the outrageous reality of states already not understanding rape or supporting rape survivors; add to the stigma of patients who choose abortion outside of the few 'acceptable' reasons (e.g. "I can understand it in cases of rape, but this wasn't even 'real rape'"); and in the process possibly fuck up criminal justice even worse than it's already fucked up.

Sorry, y'all: every time I tell myself I'll try not to rant, something comes up that just makes my brain start bleeding out my eyeballs.


*Update: also h/t Sady, these dudes aren't even in touch with their own supporters - in a November poll, "71% of American voters who voted for a Republican candidate opposed the Smith bill."

Update 2: Sorry, I should have included a What You Can Do!  The same post I linked above provides a handy-dandy link to your representatives' contact page and helpful hints (for a sample call, see rabbleprochoice):

Click on this, and it should take you to a page where you can find out exactly who your rep is, and what their contact information is. Look that person up on Wikipedia, to get a sense of who they are, if you don’t already know. Then, CALL THEM. Be polite; be professional; do not threaten or use violent or abusive language under any circumstances. Explain to them that their constituents don’t support this bill, explain how and why it’s a bad bill, and let them know that if they support or fail to oppose this bill, they can expect that to impact them in a very bad way when it comes to the matter of keeping their jobs.

Transition

Doing some research at work on contraceptive prevalence in some developing countries to appease a lazy donor (duh, measuredhs.com), and we decide to give them some abortion data as well. The reasoning: if our programs increase contraceptive prevalence, then it also reduces abortion prevalence. Since the DHS doesn't capture abortion data (unclear on why; political issues?) we find some Guttmacher data. Initially I was concerned that this info might confuse our donors; since ab laws have been relaxed in many places over the last decade, abortion prevalence might increase and lead them to believe horrible things about contraception and the ineffectiveness of our programs. And it's not easy to talk a donor down from a ledge.

But check it! Worldwide, ab prevalence has actually gone down. From this particular data I can't say why, but of course we'll speculate that it has to do with increases in method use, especially long-term methods (IUDs and such). But read further: though overall abortion rates have fallen, rates of illegal/clandestine abortions have stayed the same!

ACK!

So the situation is actually pretty bleak. Because the most relaxed laws occur in the most developed countries, the women at greatest risk for complications from abortion are not granted access. This report mentions 19 countries have reduced restrictions, many in the developing world, but with the same access barriers and so on that have existed forever. God bless pro choice de jure.

With all the resource allocation and funding for ab in the states, what is the prognosis for that kind of support in the rest of the world? My org is not allowed to; which orgs are? Does anybody know of prospects for abortion access overseas? Is it too much of a hot button issue? I'm so confused. So many countries' women are dying and they don't care! How is it that the world has managed to (for the most part) get on board with HIV/AIDS within a decade, but has taken centuries to do so for ab? If you ask me HIV is as tricky an issue as ab, by which I mean it's not tricky at all. Give people things so they don't die.

SOUNDS PRETTY GOOD TO ME!

If I were Miss America, I wouldn't wish for world peace. I'd wish for world abortions.

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IN OTHER NEWS:

I just received an email stating the following:

"New rule from Dept. of Health and Human Services: women with pre-existing conditions like breast cancer, AIDS and diabetes will be banned from buying insurance coverage for abortion in
high-risk insurance pools. They won't even have the option to buy coverage with their own money. Outraged? So am I."

WHAT IN TARNATION?!?!?!

End the madness!

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ALSO!

As long as I keep getting distracted at work by checking email and IMDB and other distracting sites, I found the following while reading the Wikipedia entry for Nick Cannon (don't ask):

"Cannon's music video for Can I Live? reveals that he was almost aborted by his mother, but she panicked in the abortion clinic and decided to have the baby."

Sigh. I love when people talk about this stuff as though it's an argument for abortion banning. Not that this entry was explicitly anti-choice in any way, but it reminded me of other instances in which "My mom almost aborted me and etc etc" comes into the discussion. Remember when it's "pro-choice" and not "pro-strapping-women-to-tables-and-forcing-things-between-their-legs"? Why would we not want women to have babies if they want to have them? Ack ack.

Education Sunday.

I decided to post an excerpt from a paper I wrote. In case you didn't know the specifics, now you do.

On March 24, 2010, President Obama issued an Executive Order that prohibits the use of federal funds for abortion services (except in cases of rape, incest or life endangerment of the woman).[1] This provision continues the ban on federal funding of abortion that was set in place more than 30 years ago by the Hyde Amendment. Proponents of the Hyde Amendment assert that it is their democratic right as policy leaders, to express their opinion and be able to exert their beliefs in the health care debate.

Currently, six million women of reproductive age obtain health care coverage through the Medicaid system.[2] Federal bands on funding for abortion services have severely restricted access to safe abortion care for thousands of low-income women who depend on the government for their health care. Poor women especially, are unable to exercise their constitutional right to choose abortion when public funding is restricted. An estimated 18-35% of Medicaid-eligible women carry their pregnancy to term because they cannot afford an abortion.[3] While Medicaid does not allow federal funding for abortion, it does provide funding for childbirth.[4] Medicaid insures one-fifth of the nation’s children and pays for one-third of all childbirths.[5]

Under current health care policy, the federal government is willing to pay for some of poor women’s reproductive health but not all. In turn, the Hyde Amendment is negatively impacting poor women’s lives on the basis of policy leaders moral and ethical beliefs about abortion. Should Congress members and policy leaders be able to put their moral beliefs above the health and well being of its citizens? Low-income women often face serious hardship when trying to raise funds for abortion services. Many women use money they should have spent on rent, food, bills and clothing for their children. A significant amount of women resort to pawning household items, and some resort to theft and prostitution in a desperate attempt to have a legal, medical procedure.[6] The 1983 AGI study found that Medicaid-eligible women wait on average 2-3 weeks longer than women with economic means to have an abortion. As a woman gets farther along in her pregnancy, the cost of the abortion starts to rise, and it becomes more difficult to raise the necessary funds, creating a vicious cycle.

The Hyde Amendment is a discriminatory policy that targets poor women, who are disproportionately women of color. Women who are not covered under the Nation’s Medicaid system, are either not enrolled in the program, undocumented citizens, or not eligible under the Federal Poverty Income Guidelines. Women who can afford to pay for an abortion on their own, ranging from approximately $300-$500 for a first trimester procedure, are mostly unaffected by the Hyde Amendment’s restrictive policy. An estimated 18-35% of Medicaid-eligible women carry their pregnancy to term because they cannot afford an abortion.[7] There is a huge disparity between impoverished women and middle/upper class women. In 1983, AGI researchers found that “nearly 60% of Medicaid recipients said that paying for an abortion caused serious hardship, compared with only 26% of non-Medicaid-eligible women.”[8] Although Roe v Wade gave women the constitutional right to have an abortion, they are unable to exercise this right when access and affordability of services is denied. The Hyde Amendment makes real reproductive “choice” a privilege for those that can afford it, rather than a constitutional right guaranteed by the Supreme Court.[9]

---

[1] Raising Women’s Voices. (March 30, 2010). Health Reform and Reproductive Health: Positive and Negative Effects. Available: http://www.raisingwomensvoices.net/storage/RWV%20on%20Health%20Reform%20and%20Reproductive%20HealthFINAL3.30.10.pdf.

[2] Boonstra, H., A. Sonfield. “Rights without Access: Revisiting Public Funding of Abortion for Poor Women.” The Guttmacher Report on Public Policy. April 2000: 8-11.

[3] Fried, M. (2007) “Hyde Amendment: The Opening Wedge to Abolish Abortion.” New Politics. 11(2): 82-85.

[4] Annas, G. J. “Abortion Politics and Health Insurance Reform.” The New England Journal of Medicine. December 31, 2009: 2589-2591.

[5] Weil, Alan, "There's Something About Medicaid," Health Affairs (Jan/Feb 2003).

[6] Boonstra, H., A. Sonfield. “Rights without Access: Revisiting Public Funding of Abortion for Poor Women.” The Guttmacher Report on Public Policy. April 2000: 8-11.

[7] Fried, M. (2007) “Hyde Amendment: The Opening Wedge to Abolish Abortion.” New Politics. 11(2): 82-85.

[8] Fried, M. (2007) “Hyde Amendment: The Opening Wedge to Abolish Abortion.” New Politics. 11(2): 82-85.

[9] Boonstra, H., A. Sonfield. “Rights without Access: Revisiting Public Funding of Abortion for Poor Women.” The Guttmacher Report on Public Policy. April 2000: 8-11.

Mad about Michigan

Man oh man, has my home state gone bananas.

First, Bart Stupak is at it again! Blubbering like a baby, he condemns the new health plan for not telling women how to spend their money. The new version goes so far as to require insurance companies to itemize everything in their plans so abortion costs can be isolated. I wonder what the individual costs are for prostate exams and treatments. Actually, I don't really care. Men have the right to healthy prostates. None of my beeswax. As far as the ladies out there who might be screwed insurance-wise, start saving! Start making a list of your best friends and how much they're good for should you need to ask. Everyone else, start donating to local funds to help said women! Stupak, you are dumb. Also, get a haircut.

In other news, the pro-choicer who shot and killed an anti is heading to trial, and jury selection is beginning. Trouble is, the anti who was killed was so obnoxious that it is becoming difficult to find a neutral jury/jury members who didn't actually know the anti. Oops. Now at the end of the day, a murder is a murder, and I do not condone murder of even the most detestable of human beings. I am not pro-death (honest). But it just goes to show that being a jackass doesn't pay. I especially enjoy this little morsel:

"A barber, Jim Corrin, 63, once asked Pouillon, a regular customer, why he didn't display two pictures of happy children on his sign instead of just one accompanied by an aborted fetus."

Jim, you ask an important question with a simple answer. You see, antis do not actually care about people. They would rather use their Saturday mornings to scream at people than feed the hungry or read to children. But as far as I know, flies still prefer honey to vinegar.

And that's the latest from the Mitten State.

Ways To Get Screwed By A Pentagon, Henry Hyde, World Wars, and Other Violent Artifacts of the Twentieth Century

[As a promised follow-up to this post.]

I'm visiting home this week and won't be back for months, and I can't safely stay pregnant in Afghanistan much longer. Can you see me before Sunday?

They'll ground me if they find out I'm pregnant, but the Air Force is my last chance out of the dead-end town I'm graduating from. How early in my pregnancy can I have an abortion?

My fiance just left for a second tour, and I can't imagine going through this without him. Where can I find an abortion provider and someone to talk to?
(OR: My fiance was just killed while serving, and I can't imagine going through this without him. Where can I find an abortion provider and someone to talk to?)
(OR: My fiance was just killed while serving, and I can't imagine not having his child in five/six/seven months. Where can I find prenatal care and someone to talk to?)

I'm an Army brat -- we travel around with my mom a lot -- so I don't know this town too well or have a lot of friends I could ask for help. Where's the closest abortion clinic, and will it be OK if I ride the bus there?

We're on my husband's TriCare plan, but they're denying coverage for my abortion even though the pregnancy is shutting down my kidneys. Is there anyone out there that helps with this sort of thing?


(I sure hope so, five or six weeks from the start of your last normal period, here, here, here, you'll probably need a friend to drive you home and may need to check out parental consent laws in your state, and yes thank god but they need our help.)


"Back to the status quo" update in the last two weeks: Military higher-up to reverse official policy punishing pregnancy. OK, now how about you combat that parallel de-facto punishment system too? Reproductive justice in tiny, endless shuffles...