The RNC is dropping abortion coverage from hits heath insurance. Is that saving them any money?
The Republican National Committee has decided to be as heartless with its female employees (and the female family members of its employees) as Republican politicians want to be with women receiving federally-subsidized health care. Â Having for years offered normal health insurance that includes abortion coverage, the RNC has now decided to penalize unwanted pregnancy by telling its insurer not to pay for abortions.
That raises an interesting question. Â How much, if any, money is the RNC saving by doing so? Â Since abortions are cheap compared to perinatal care and delivery, denying coverage could actually add to total costs. Â So inquiring minds want to know whether Cigna will be lowering its rates when it offers its employees the inferior coverage demanded by the Religious Right.
Author: Mark Kleiman
Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out.
Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken)
When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist
Against Excess: Drug Policy for Results (Basic, 1993)
Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989)
View all posts by Mark Kleiman
24 thoughts on “What happens to health insurance rates when abortion coverage is excluded?”
Your analysis fails to factor in the value of fetuses saved and of the acts of saving them. For one who see that value as 0, abortion coverage is a clear winner, but for one who sees it as very high, abortion kills a lot of value and discouraging it is one form of crime control. I'm generally pro-choice, but pro-lifers have the right to put a high value on fetuses in their cost-benefit analyses…
…but I agree that that value determination (and the resulting premiums increase) shouldn't be forced on the public.
Steve has a very good point. Though I do not think that Mark believes fetuses have no value.
I would like to counter Steve's point with this: In reality the value of what is here and now is more substantive than what may become of a fetus in the future. As a fertile, child bearing age woman, I believe that that my value here and now ought to be held in at least a marginally higher regard than the hypothetical value of an as of yet non-existent being. Moreover, I'd like to be given the benefit of the doubt in my fitness to make the best decisions for myself and my family's health and future. All of the arguments I hear from the anti-abortion camp give me credit for neither.
Steve, the post is about actuarial consequences, which are not the same as moral consequences.
You should thank them for the chance to get an empirical answer to your speculations on this subject. Arguments can be made either way, real world data is required.
Though… I doubt you'll endorse the Stupak amendment if it turns out refusing to cover abortion is cost effective. Why would you expect Republicans to repudiate it if that refusal turned out to be a bad deal financially? Neither side is basing their position on the financial bottom line here.
Steve, "…but I agree that that value determination (and the resulting premiums increase) shouldn’t be forced on the public."
Nor should no-bid contracts for mercenaries who defraud the peoples' government of gazillions of dollars, but there you go-
Brett, you're correct that neither side is basing its arguments on practicalities. Maybe the bottom line would be more reasonable; esp. considering dwindling resources.
I must say health care is as personal as it gets, and I'm comfortable with people making their own choices for their own bodies and lives. The disregard and disrespect shown to women by this argument is astounding to me. Anti-Choice politicians who vote for militarily attacking other countries are really the greatest of hypocrites in my view. I think it must be more of a control issue regarding women.
Brett, all sorts of bad policies reveal interesting facts about the world. That alone isn't a reason to thank their authors.
It's true there are people whose views are settled, & can't be changed by this consideration or any other. But that's not a reason to go mute on the subject. Advocates of all sorts still try to persuade, & they're probably not wrong to. This is because, in addition to the fixed camps, there are people at the margin who still are open to persuasion. And beyond the political calculus, there are other reasons we'll want to know about consequences.
Of course the point that Brett and his fellow advocates of forced childbirth want to ignore is obvious to the rest of us: that if denying women coverage for abortion services doesn't save money, then the claim that offering such coverage amounts to spending the taxpayers' money on abortion falls apart. Instead we have a situation where public money is being spent to force women to carry unwanted pregnancies to term.
If refusing to subsidize abortion is "forced childbirth" then surely refusing to subsidize child-rearing is "forced abortion." I'm guessing Mark doesn't think that so perhaps he'd like to start over and try thinking clearly.
And it simply is a mistake to believe that two outcomes with the same actuarial outcome can't result from very different payment streams. Mark so loves abortion that he's not thinking clearly at all.
We don't have to analyze "forced to" idioms from scratch; there's a large body of work on the subject. It's not of one voice, but there's at least a rational argument that there are circumstances under which refusal to subsidize something can sensibly be said to force a person to forego it. So we needn't conclude that anyone's head-over-heels for obstetric procedures has affected his reason.
It's true that refusing to subsidize something doesn't always amount to forcing the otherwise-subsidized person to forgo it. If I don't subsidize Lloyd Blackfein's holiday vacation, I don’t force him to stay home. We don't want to say that any time I choose an option, if it comes w/ a cost, then the cost is forced on me. But in normal usage we also don't restrict "forced to" to cases governed by (successful) threats or in which there's only one eligible option (in which case it’s unclear whether the person can be said to act at all). We'll often want to say a person who lacks any minimally acceptable means of obtaining something is forced to forego it. This applies to abortion as to other things.
There remains the problem of what is minimally acceptable. Most people would agree that if I decline to intervene to prevent the destruction of everything you hold dear unless you do X, there's a sense in which you're forced to do X. But there's bound to be disagreement about some cases. (I suspect what's minimally acceptable will always be relative to a culture.)
On refusal to subsidize child-rearing: the less imperfect analogy might be refusal to subsidize necessary obstetric care. Second, a person who can’t afford to give birth may also be unable to afford an unsubsidized abortion, & a person can't be forced to do what she can't do. Third, again, if the people who’re denied a child-rearing subsidy have the money to raise a child, they’re not forced to forgo one, including by abortion. But fourth, it’s at least arguable that a woman who lacks any minimally acceptable means of giving birth, but is afforded the option of abortion, is forced to take it. What conditions are minimally acceptable is a separate question.
The literature is large, but the only thing at hand is GA Cohen's fairly old article, “Are Disadvantaged Workers Who Take Hazardous Jobs Forced to Take Hazardous Jobs?,” in History, Labour & Freedom (Clarendon 1988).
Sorry, I accidentally subjected Lloyd Blankfein to the indignity of having his name misspelled in a blog comment. Also, "head-over-heels for" in the 1st paragraph should be "head-over-heels love for," as in Kleiman's fiery love for abortion.
"I must say health care is as personal as it gets, and I’m comfortable with people making their own choices for their own bodies and lives."
The problem with abortion, of course, it that at some point in the fetal development, you're talking about women making choices about somebody else's life. I happen to think the leadership of the pro-life movement are somewhat nuts about where they draw that line, but not significantly more nuts than the people who insist on drawing it after birth.
Furthermore, with abortion, you're looking at a point libertarians have been making about government health care for years: With government funding comes government control. Government control over, yes, something that's as personal as it gets.
What, you thought that control would always be exercised in ways YOU liked, against people who wanted things YOU disapproved of? Nah, you can forge the government into a sword to use on your enemies, but only at the cost of your enemies occasionally picking it up and having a whack at you.
I know that the forced-this vs forced-that argument is a wonderful philosophical discussion, but has anyone noticed that the people who are opposed to (even indirect) subsidies for abortion are also typically opposed to subsidized care for infants (except by a stay-at-home parent with a high-earning spouse), Head Start, S-CHIP, public education and pretty much every other subsidy for adequately raising children that you can name? So in the real world the argument is moot or worse.
(Oh, and Brett: do you actually know of anyone who insists on drawing the line on consideration as a separate patient/person after birth? This sounds like yet another attempt at false equivalence by someone who knows or cares diddly about late-term terminations.)
Thomas, try to read more carefully before you accuse other people of not thinking clearly. I didn't say that the Stupak Amendment constitutes "forced childbirth." But its advocates all want to criminalize abortion. In the case of military women overseas, they've managed to write a law that doesn't allow them to spend their own money – money they earn defending the rest of us – on abortion in military hospitals. Forbidding a woman to have an abortion means forcing her to carry to term.
Mark, I was too charitable. You were just falsely attributing views to Brett that he doesn't hold. See his post at 3:46. And you were falsely attributing the same view to others who support the Stupak amendment. Your latest isn't particularly helpful: forbidding a woman to have an abortion IN A MILITARY HOSPTIAL means forcing her to carry to term? Really? You'd be better off pursuing the equivalent-actuarial-value-means-no-subsidy nonsense.
K, there's nothing imperfect about the analogy between child-rearing costs and abortion. A poor pregnant woman under the current law has three choices: abortion, adoption, and raising the child. Those three are the choices faced, and so it seems to me that if we want to discuss costs and subsidies and forced choices we should actually examine the options presented to the woman, and not insist on some ridiculous framing focused on "necessary obstetric care", as if it's a natural kind and not just a subset of the costs of the decisions in our social context. The fact is that those who worry so much about the costs of abortion and the need to subsidize it to preserve a woman's autonomy generally don't give a damn about autonomous decision making that doesn't lead to abortion.
Thomas, it's in their nature that our analogies, like ourselves, ordinarily aren't perfect. Yours isn't; mine isn't. If a woman can't afford an abortion, either on her own or w/ a subsidy, she has to give birth. But if adoption is an option, she may not have to raise the child. If a woman can't afford to raise a child, either on her own or w/ a subsidy, she doesn't have to abort. As you say, she can abort or give birth. So your talk of "forced abortion" at 10:47 is unpersuasive. This is a simple point.
I would've thought these people of whom you speak who'd afford poor women access to abortion but not to the care incident to childbirth are a bit of a straw man. I certainly don't know any, least of all here. But I take your word for it if you have someone specific in mind, & am happy to join you in grappling w/ anyone who wouldn't insure a woman's access to the health care incident to childbirth, whether or not they'd afford her access to abortion.
K, yes, a woman who can't afford to raise a child has the choice of abortion or forced abandonment. Do you mean to suggest that Mark's interest in her autonomous decision-making is therefore vindicated?
As for the "health care incident to birth" bit: First, it's a bullshit formulation. A dodge. Second, if you're looking for an example, look no further than Mark, who favors a health care bill where abortion would be free and delivery of a child not, and where delivery of a child would result in significantly higher health insurance premiums for an extended period of time. Those positions, remember, are required so that a woman can make an autonomous decision. What a joke.
Thomas, I'll try to put this charitably: at the very least, we're speaking past each other. What I meant to suggest is that your 10:47 argument isn’t persuasive. I’ve already expressed myself on the subject as clearly as I can. I do not mean to suggest that Kleiman requires vindication, & certainly not by me.
I don't see why you need to be charitable, now that Thomas has decided to pretend that adoption = abandonment. You couldn't get much more dishonest.
Brett, adopting Mark's and K's framework, it's hard to see how that some cases of adoption aren't just cases of forced abandonment, and I'm not sure what's dishonest about that. Some women have constrained choices–that's the point of Mark's post. Some women surely find adoption to be a meaningful and even agreeable (if perhaps tragic) choice, but surely that's not every case. Some women who choose adoption would surely prefer to raise the child, and, to the extent that the decision is a result of their lack of alternatives they must feel that they're being forced to abandon their child.
K, You say you don't find my 10:47 argument persuasive, which is fair enough, but I'd note that I've revised it in light of your very fine suggestion, and so please read it to include 'forced abandonment' as well. I thought you might respond with a defense of the particular subsidies and penalties Mark favors–an argument that a woman who lacks the "minimally acceptable means" to raise a child but would wish to if she had them should be given a free abortion, or should pay for a substantial portion of the child birth and then be forced to place the child for adoption, and that the bare fact of the existence of the first of these alternatives is necessary and sufficient to say she has an autonomous choice in deciding whether to bear and raise a child. I was hoping you were some sort of magician, I guess.
What's dishonest about that is that "abandonment" conventionally means something like stopping your car on a busy intersection, tossing the baby out, and driving off. Not going through a formal process which results in substitute parents, and has the kid reliably cared for at all stages.
You could as honestly describe it as "abandonment" when parents send their kid off to summer camp.
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