(or, what I do when I’m bored on a Saturday morning)
Insurance, n.: coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril.
There has been a lot of talk lately about what has been dubbed the Rape Insurance law in Michigan, which recently went into effect. The law came about because sincere pro-lifers did not want to be party to abortions through paying their money into an insurance pool that covered them. The idea was to separate the insurance pools for pro-life and pro-choice supporters. Those who believe in supporting choice for others, or who believe they would/could make that choice for themselves, could elect to purchase the abortion coverage rider, and those who believe it is wrong in any circumstances would be comfortable that their money was not paying for any abortions. This is not a bill having anything to do with insuring against rape. It discusses insuring against the need for an abortion.
There are some gray areas. Situations where the mother’s life is in danger are in one possible gray area where even some on the pro-life side believe a woman should be able to have a life-saving abortion. Situations involving miscarriage are another: A procedure known as a D&C is commonly used when a woman is diagnosed as miscarrying, and some have classified this as a kind of abortion and used that classification to deny service or payment. As far as I can tell, the “rape insurance” bill covers the first gray area with an specific exemption when the mother’s life is in danger. I have not been able to find any evidence that it covers the second gray area mentioned above, but the only reports I’ve seen are from opponents of the law claiming that it “could” prevent payment for medically-necessary D&C procedures; without evidence, I have to discount that claim. So the only thing left to discuss at the moment is what everybody generally considers an abortion: ending an established pregnancy that does not appear likely to end on its own and does not threaten the mother’s life.
We’ve defined the bill; now let’s define insurance. What we call “insurance” when it comes to health care today really isn’t. The “insurance” we now all are required to carry is more of a health maintenance plan, a payment plan, a way to distribute all health care costs among the population. Insurance, on the other hand, is like a bet between the insured and the insurance company: the insured is betting that they will require expensive medical care, and the insurance company is betting that they will not require this expensive medical care. If the insured is right, they get back more in payments for health care than they paid in premiums. If the insurance company is right, they never have to pay more for that health care than they received in premiums. Both parties are in it to make money, essentially.
Remember that nobody who has not bought into the insurance pool is covered for any procedure whatsoever. You can’t say that your premiums are going to benefit another person who can’t pay because that person has to pay, or they aren’t in the pool. So I just had to wonder: would it be worth it to me purchase the rape insurance rider, so that my health insurance would pay if I needed or desired any procedure resembling an abortion? (Assuming that I felt this was a path I could ever take, of course.)
The only cost I’ve seen so far suggests that the rider would be 32 cents per month, or a total of $153.60 for a 40-year reproductive life from 12-52 years of age. (Since there would never be a need for an abortion before menarche or after menopause, obviously purchasing the rider during these periods of life would be a losing proposition for a woman.) This would provide insurance coverage for an abortion equivalent to other insurance coverage. With my own health insurance plan, this means that I would pay 100% for an abortion before meeting my deductible, 10% if I have met my deductible but not my out-of-pocket cap, and 0% if I have met my out-of-pocket cap for the year. We usually meet the deductible by April, and about half the time we hit the cap before the end of the year. Depending on when my need for abortion would occur, 25% of the time I would pay 100%, 63% of the time I would pay 10%, and 12% of the time I would pay nothing at all.
The average cash cost of an abortion in Michigan, pharmaceutical or surgical, appears to range from $300-$700, so I’ll take the median of $500 for my calculations. With my insurance coverage, I might have to pay all of that $500, or only $50, or nothing at all. Assuming my abortion need would be equally likely to occur at any time of the year, my statistically-probable cost for the abortion is $156.50.
Statistics say that I have a 25% chance of being raped at some point in my life. Only half of my life includes reproductive years, though; any rapes occurring outside that 40-year span could not result in a pregnancy. In addition, there are only about 5 possible fertile days in each menstrual cycle, and each sex act during a fertile period has only about a 25% chance of resulting in a pregnancy. Assuming that I never use birth control, and discounting any time that I spend actually pregnant, postpartum, or in lactation-induced amenorrhea (which for me this life was actually a total of 6 years), that leaves me with 2400 fertile days over an 80-year (29,200-day) lifespan, or 8.2% of my life. I have about a 0.5% chance of suffering a rape that results in a pregnancy.
I’m going to discount right here the possibility of having a pregnancy where the baby was sure to die after birth. I have disabled children already as well as children who had a pretty good chance of dying at birth, and I can’t personally imagine not giving any child every possible opportunity to beat the odds. That’s not to mention that I just don’t participate in most of the testing that would result in that kind of in-utero diagnosis. So I’m going to save myself the math on this one.
So, I have 0.5% chance of needing a procedure that is likely to cost me $500 without insurance and $156.50 with the insurance. The insurance will cost me $153.60 over my reproductive lifetime, which means that if I need this procedure once, I will likely pay $310.10 for it with the insurance coverage, possibly as much as $653.60 if I need it at the wrong time. If I choose not to purchase the additional coverage, and I instead place that 32 cents into a savings account every month like the one I currently have, I would have $156.71 at the end of 40 years (boy, do interest rates suck these days!).
I have to say, that’s a tough call. I have very, very, very little chance of personally requiring an abortion, and I can’t see a circumstance where the cost of the abortion would be prohibitive, especially knowing there are places that operate on a sliding scale or payment plans for times in my life when cash was tight. The odds are in my favor that I will come out ahead by not purchasing the rider, and the insurance company has a strong incentive to offer this rider because they are likely to come out ahead on anybody who purchases it, especially considering that anti-discrimination laws and people who just don’t pay attention mean that the rider will probably be purchased by more people incapable of getting pregnant that by those who are. Recent reports state that most insurance companies were not planning on providing this rider as of the time the law went into effect; however, I suspect that most were simply waiting to see if the law was going to be killed before going into effect, so they could save themselves the paperwork and programming to implement the special rider. I can’t see most companies forgoing this opportunity to make more money, so I expect most companies will be adding this rider to their available policies very soon.