First, there was last week’s news that the U.S. ranks thirtieth in the world when it comes to infant mortality. American infant mortality rates are more than twice as high as infant mortality rates in such countries as Japan, Norway, and the Czech Republic. Dr. Alan Fleischman, medical director for the March of Dimes, told The New York Times that a recent report issued by the CDC’s National Center for Health Statistics was an “indictment of the U.S. health care system.” The smallest and most fragile babies, he said, were often born to poor and minority women who lack health care and social supports. No surprise here.
Then came a big surprise from the House of Representatives. To get a bill passed, the House made a deal that would prevent government subsidies from being used for abortion services. Those subsidies are the crux of health reform, and people with low and moderate incomes will need them in order to buy the required insurance. Insurers offering policies through the government’s proposed brokerage service, called the Exchange, could offer a policy that does cover abortions. But if they do, they also must sell a policy identical in every way except that it doesn’t cover abortions. Women who take the subsidies would not be able to buy the policy offering abortion coverage. A public plan option could not cover abortions either, unless a woman’s health was in danger or the pregnancy resulted from rape or incest.
These women could use their own money to buy abortion coverage offered as a policy “rider.” Think of it as protection against an unplanned pregnancy. But it’s hard to know in advance whether you’ll have one, so what’s the point of shelling out cash for the rider? If women of modest means—the ones most likely to give birth to preemies—want to terminate a pregnancy, they may not have the money to do that, and the federal government won’t help. Does that suggest more premature babies who come bundled with a lot of costly medical problems?
The argument, I guess, is that armed with a new health policy, albeit without abortion coverage, women may have a shot at better prenatal care that would be effective in preventing premature births. That assumes that the policies will cover maternity services. Increasingly, policies sold in the individual market do not.
The trend these days is for insurers to sell stripped-down policies that omit expensive benefits like maternity care. Take the Tonik policies, created by insurance giant WellPoint. An ad for three types of Toniks sold by Anthem Blue Cross in California, which operates under the WellPoint banner, lists some of the benefits, but it explicitly says maternity coverage is not among them.
These policies are aimed at the young invincible crowd that doesn’t get sick and apparently doesn’t have babies. If they do, their budget-priced Toniks won’t do much good. Companies like WellPoint are pinning their business strategies on such policies, and it’s a good bet they are eyeing the new prospects who will buy through the Exchange as fresh bait.
What should the media be exploring? After refusing to allow coverage for abortions, will Congress let insurers off the hook for subsidized maternity coverage too, and not require them to provide it? That indeed is a key question for legislators, especially considering all that lobbying by WellPoint and its brethren. Last week, WellPoint sent a letter to members of Congress protesting that the House bill would prohibit the company from selling individual coverage outside of the Exchange. If that provision sticks, it could blow apart WellPoint’s business model, which is based on selling cheap policies with few benefits. Congress may have to choose between WellPoint’s ability to make money and a woman’s need for maternity coverage. This is a thread of the abortion story that so far has been overlooked.Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.