The Washington Post had an interesting article this morning examining the consequences of requiring insurers to collect a separate premium for abortion coverage. It turns out that when people need to send in a separate check for their abortion coverage, nobody really wants it:
In North Dakota, where insurers can cover abortions if customers pay a separate premium, the state’s largest provider says it sells no abortion policies because no one has asked to buy one. […] “There’s not a lot to tell. We have no member who elected to have abortion riders,” said Denise Kolpack, vice president of Blue Cross Blue Shield of North Dakota, which covers about 80 percent of the North Dakota market. “We would be legally bound to provide an offering, but we have no groups that have requested it.” Similar policies are in place in Kentucky, Missouri, Idaho and Oklahoma. “It is rare that we hear in the market that an employer would request a rider for this coverage,” said Anthem Blue Cross and Blue Shield spokesman Tony Felts, whose territory includes Kentucky.
Part of the problem is that most women either don’t know that their plan doesn’t cover abortion services or don’t think they’ll ever have an abortion. Women don’t ask, and carriers don’t tell. After all, we always assume the best. A young, strapping, blogger purchasing coverage in the individual health insurance market doesn’t think he needs cancer coverage at 24 until he is diagnosed with melanoma and has to pay out of pocket for his treatments. In the same way, a young woman in North Dakota thinks she’s playing it safe by sticking to the pill and so she doesn’t bother to ask if her insurance carrier provides abortion coverage and may not be the wiser until the need arises.
In some ways, this kind of structure undermines the purpose of insurance — which we purchase to protect ourselves from life’s little surprises — and could even discourage insurers from offering abortion coverage. After all, the abortion language in the Senate bill no longer guarantees that at least once carrier in the exchange will provide abortion coverage and some health care wonks have argued that the extra administrative burden of processing a separate payment may encourage carriers to opt out providing abortion services. Plan that offer abortion services within the exchange may attract a very small clientele (because of the problem described above) or even worse, appeal to sicker women — both of which would increase costs for the carrier and dissuade plans from offering abortion services.
All of this would disadvantage poorer women. An abortion in the first trimester carries a price tag of some $400 dollars — a relatively pricey, but not prohibitive procedure for middle class women. Poorer women who don’t ask about their plans’ abortion coverage provisions, however, or can’t find affordable abortion coverage within the exchange, may be priced out their right to choose.