'Free' Abortions for Everyone in Oregon
Anchoring abortion access to the insurance market won't make it more affordable. But it will result in a lot of legal drama...
A measure on its way to Gov. Kate Brown requiring health-insurance plans to include "free" coverage for elective abortions and an array of other pregnancy-related services for all insured, regardless of their gender identity, is certain to reverberate far beyond the state of Oregon.
The bill, sponsored by state Rep. Julie Fahey (D-West Eugene), is a response to Republican shenanigans in Washington, which could soon end Obamacare's provision that health insurers cover a list of preventative services with no deductibles or co-pays.
Fahey's measure would ensure that many of these services—such as cervical and breast cancer screenings and birth control—remain mandatory benefits under Oregon insurance plans and add abortion and vasectomies to the list.
It would also set up a fund for covering abortion procedures for undocumented immigrant women, who are not eligible for state-funded health coverage otherwise.
"In some states such as New York, abortions are cost-free if they're deemed medically necessary," ABC News reports. "The Oregon bill is unique, however, in that patients would have access to the procedure for virtually any reason, at any time."
The Hill called the bill "a rare bright spot for abortion rights advocates at a time when opponents have advanced restrictions in other states."
I disagree.
The goal of the reproductive-freedom movement is ensuring safe, widespread access to things like contraception, abortion, and maternity care. And, in theory, the Oregon measure does that. But it does so by acting on the same authoritarian impulses abortion foes are so fond of, guaranteeing inevitable and lengthy legal battles from folks who feel their conscience rights are being abridged.
The bill contains some exemptions for churches and religious non-profits as required by federal law. Insurance companies with religious objections can also apply for a waiver. But the category of people who oppose abortion for religious reasons extends far beyond religious institutions and insurance-company execs.
As with Hobby Lobby and the Obamacare contraception mandate, there will certainly be owners of private, for-profit companies who object to providing employee health-care coverage that funds something they find morally abhorrent.
I don't find abortion morally abhorrent. I share in the liberal fight to not just keep abortion legal and clinics open but also to ensure that anyone who needs to terminate a pregnancy can afford to do so. But we have got to get beyond this idea that securing this access must involve mandates and government funding. Inevitably, such requirements will interfere with civil liberties, stymie innovation that could bring better and cheapter care to more people, and drive up the cost of care for everyone.
If we are securing abortion access even for those who can't afford it, why not go at it directly, instead of through sixteen layers of bureacracy? Making every health-care plan include abortion coverage doesn't just rile religious objectors and raise insurance costs (which will be passed on to plan recipients indirectly), it ignores some of the most vulnerable populations.
Not only undocumented immigrants who may lack health insurance coverage altogether. Homeless women, women fleeing violent partners, teen runaways, drug addicts, and others who are unlikely to be insured are also likely to be targets of sexual violence and to have unintended pregnancies. How is a health-insurance mandate going to help them?
Abortion providers will no longer have an incentive to keep costs as low as possible or find innovative models for care because they can count on insurance reimbursement and don't need to deal directly with patients about the expense.
Rather than requiring one-size-fits-all insurance plans, we'd do better to look to places like Carafem, which opened in the D.C.-area in 2015 and offers first-trimester, pill-induced abortions, along with other gynecological and sexual-health services.
The company advertises directly to patients via ads on the Metro and in other high-visibility spaces, and its website is up front about all costs—which are similar to those at Planned Parenthood. Without vast amounts of government funding, Carafem manages to provide the same services at the same prices and avoid the attention of anti-abortion protesters.
Harnessing the twin engines of the market and charitable groups devoted to helping low-income, uninsured, and undocumented patients could do a world more for abortion services than the government imposing "access" on the insurance industry.