A Belated Debate Over Abortion Funding? : Insurance: Talk of including abortions in a national health care package has incensed opponents. But what the government is considering is already a widespread practice.

By BETTIJANE LEVINE

April 22, 1993 12 AM PT

TIMES STAFF WRITER

Anti-abortion activists went on tactical alert a week ago at news that the Clinton Administration’s proposed national health care package would include coverage for elective abortions.

“Any plan that puts abortion into the national health care system will . . . force (House) members from the undecided column into the opposed column,” said David Kush, a spokesman for abortion opponent Rep. Christopher H. Smith (R-N.J.).

“We would strongly oppose any mandate . . . that compelled employers, health care providers and citizens to collaborate in abortion on demand,” agreed Douglas Johnson of the National Right to Life Committee.

Fighting words.

But an informal survey of major private insurance companies confirms that abortion is already a firmly entrenched benefit. To offer it in a national health care plan would simply continue what already exists in plans that many Americans tap into every day.

What’s more, most health care experts now believe that abortion must be part of a broad spectrum of female reproductive health services, all taken in context if the health of women is to be maintained--and health care costs contained. (More women enter hospitals to have babies or to care for reproductive problems than the total number of men who enter hospitals for any reason, a recent survey revealed.)

And employers, insurance companies and ordinary citizens may already “collaborate” in abortion on demand, analysts say.

According to figures from the Alan Guttmacher Institute, a nonprofit public education group, more than 50% of all pregnancies among American women are “unintended;” one half of those pregnancies are terminated by abortion. And nine out of 10 abortions take place in clinics or doctors’ offices.

Who pays for all this? In California and 11 other states, Medicaid-eligible women can terminate pregnancy with costs paid by state funds. Nationwide, private insurance--through either group or individual policies--pays for much of the rest.

But nobody knows exactly how many abortions are paid for by private insurance, probably because the issue is such a political hot potato and no one wants to keep tabs.

Said Richard Coorsh, of the Health Insurance Assn. of America: “Nobody knows the extent to which employers offer reproductive rights coverage.”

Each employer designs a plan based on what is affordable and wants to offer to employees, Coorsh said. So most plans differ from one another.

But the HIA, which represents about 270 of the major commercial insurance companies in the United States, takes regular surveys of employers. “We simply don’t ask questions about (abortion) and those kinds of things,” Coorsh said.

One insurance industry executive, who did not want his name or his company’s name used, explained that “covering abortion is far less expensive than removing abortion coverage. That’s because the cost of pregnancy is much more than the cost of an abortion.” If a pregnancy is difficult, and a baby with medical problems is born, the costs for both mother and child skyrocket, he said. “Remove abortion, and there will be an increase in the cost of premiums.”

Robin Weiner, with the Los Angeles consulting firm of Foster Higgins & Co., said her company does a health survey every year, “the largest of its type in the country.” But the survey does not ask about abortion and there are no statistics on the procedure, she said, “because abortion isn’t something we want to raise an issue over.”

Weiner, who has analyzed cost claims data from 50 major insurance companies for the past five years, said she has never seen “anything jump out” relating to abortion. “Female reproductive care is a whole category in itself--I’ve looked at the data and the most costs occur due to cancer and hysterectomies. Abortion and sterilization” are not expensive problems.

In fact, many health-insurance industry analysts say if you strip politics from the issue of abortion, it becomes a non-issue.

Unlike many experimental drugs and newfangled medical procedures over which doctors and insurance firms continuously wrangle, both of those groups agree that abortion is safe, proven, cost effective and worthy of insurance coverage.

At Blue Cross of California, spokesman Michael Chee said “abortion is not a social or political issue for us. We are completely and emphatically neutral on the issue.”

And yes, he added, Blue Cross does offer coverage for elective abortion under both its HMO and PPO plans.

In the PPO plan, the benefits for abortion are calculated the same as they are for normal delivery or Cesarean section; that is, 80% of the expense is covered after a $2,000 deductible is met. (In 1989, the average cost for a first trimester abortion in the United States was $250.)

A Blue Shield spokesman said: “Elective abortion is a covered benefit in all group plans that we underwrite. It’s also a covered benefit under our HMO for groups and individuals. Medical necessity is not a condition of coverage for elective abortions under either group plans or our HMO for groups and individuals.”

At Pacificare Health Systems, Inc., one of the nation’s major managed health care organizations, a representative said termination of pregnancy is part of the family planning package, which includes coverage for vasectomy, tubal ligation, insertion of IUD and insertion of Norplant device.

And Ruth Dunker, Kaiser Permanente’s manager of benefit development and government programs, said her organization offers “a wide range of family planning services, including artificial insemination, abortion, vasectomy, and infertility treatment.”

Dr. Reinhold Ullrich, an obstetrician/gynecologist and past president of the Los Angeles County Medical Assn. said, “I know certain aspects are controversial, but I think they should definitely be covered. If you consider that birth control prevents an unwanted pregnancy, you’re saving money” as well as pain by providing coverage for birth control.

And the same goes for abortion, he said. “Think of the total cost involved; abortion is certainly less expensive than carrying an (unwanted) child to full term and the total cost of delivery and raising the child. Most insurance companies have come to recognize that a dollar spent here saves a lot of money down the line.” Ullrich said that from his observations, most private insurance does cover elective abortion these days.

Many health care analysts believe that the number of abortions will automatically shrink if a national health care plan finally offers what they consider necessary: unbiased coverage of pregnancy prevention counseling, drugs and devices along with various surgical procedures.

Right now there are too many inequities, biases and quirks in both public and private insurance systems, the analysts say. For example, insurance firms often pay for surgical sterilization, regardless of whether it is for therapeutic or elective reasons. But many of these same firms do not cover diaphragms, oral contraceptives, IUDs and Norplant.

And in Hawaii, the state’s employer-mandated insurance program pays for the cost of sterilization and abortion, but not for contraceptive services and supplies. Or, for that matter, for preconception counseling and care. Other quirks analysts point to are in the structure of public assistance programs. Medicaid, for example. offers free family planning services and a free Norplant insertion in all the states. But only for indigent single mothers. An indigent married woman may not qualify.

But the evening-out of health care that might occur with the Administration’s proposed national plan doesn’t impress abortion critics.

Rep. Smith, the New Jersey Republican, still believes “Congress has an obligation to stand up for the rights of conscientiously opposed taxpayers. Let’s keep the taxpayers out of the grisly abortion business.”