My Body, My Choice…. Until the Market Tells You Otherwise

My Body, My Choice…. Until the Market Tells You Otherwise

Last week, New York State legislatures, to thunderous applause, enacted a new law rolling back the state’s current limitations on abortion. Previously, women in New York could only obtain abortions after 24 weeks if the mother’s life was in danger. The new law puts no gestational age limit on a woman looking to obtain an abortion as long as it is a danger to the mother’s health. Not only does this allow for full-term babies to be aborted, but changing the legal term from “life in danger” to “danger to health” makes the law incredibly subjective. What constitutes health? Are we talking physical health, mental health, financial health? Clearly the term health, in this context, is difficult to define.

There are other nefarious elements of New York’s new abortion law that are outright absurd and diabolical. Prior to the Reproductive Health Act, only physicians could provide abortions, but the new legislation allows licensed nurse practitioners, physician assistants and licensed midwives to perform the procedure now. Many states also mandate that late-term abortions must be approved by two physicians as a safeguard for the doctor and patient; however, New York does not. It’s astounding really. Leftists will refuse to read a conservative blog because it isn’t “peer-reviewed” but they think it’s totally fine to get a late-term abortion without a second opinion, from a midwife they found on Craigslist. Furthermore, the law Gov. Cuomo signed repealed section 4164 of NY’s Public Health Law, which mandated medical care for any baby born alive during an abortion. In other words, New York abortionists will now be adding the finest in Chinese medical devices to their operating rooms… a bucket of water.

But enough of the repugnance of the new law. Whether you find it abhorrent or advantageous, immoral or moral, there will be serious market consequences to increasingly lax abortion laws. The market doesn’t discern between good or bad behavior, it simply provides goods and services to facilitate behavior. Look no further than the thriving illegal drug market where users can obtain marijuana, cocaine, meth, heroin, etc. Pornography is available on demand, prostitution is completely legal in some jurisdictions, and despite law makers best efforts, illegal weapons are not hard to come by. The free market does not discriminate against commerce the public deems good or evil, it just gives them what they want. However, sometimes a new good or service can come at a very high cost. Not necessarily to the suppliers, but to the buyers. 

The highly controversial practice of assisted suicide gained national attention in the 1990s when Dr. Jack Kevorkian aided over 40 patients in committing suicide. Since then, six states (California, Colorado, Oregon, Vermont, Hawaii, Washington) and Washington DC have legalized assisted suicide/euthanasia. While constituents and lawmakers argued over the morality of such legislation, insurance companies were discovering a very profitable/cost saving service. In the states where assisted suicide is legal, some insurance companies have stopped offering to cover expensive treatments for terminally ill patients and instead are only offering coverage for the lethal drugs used in assisted suicide. Effectively, leaving dying patients with two options, pay out of pocket or kick the bucket. 

Those in favor of legalizing options for suicide reason that it is compassionate to spare a terminally ill person the months/years of pain and suffering before their inevitable death. But they never foresaw the profit incentive that would encourage death. Proponents for assisted suicide essentially take the “my body, my choice” route, not realizing that that position might actually reduce choice.

As with the market’s response to the cost savings element of assisted suicide, abortion will be no different. How long until the health insurance companies start covering abortions for babies with birth defects rather than the treatment for said birth defects? How long until the 20-week scan (the lengthy ultrasound that can detect fetal anomalies), is the do or die moment for the unborn? Why would insurance companies not incentivize mothers to abort babies with birth defects by simply refusing to cover treatment for the birth defects once they are born? 

Conditions that incur huge medical expenses to treat after birth and that carry low survival rates will be prime for insurance companies to prefer termination. For example, hypoplastic left heart syndrome is a rare heart condition where the left side of the fetal heart does not develop. According to the CDC, 1 out of every 4,344 babies is born with the condition. It is fatal without treatment. Infants born with the condition must undergo heart surgery within two weeks of birth, another surgery between four and six months of age, and again between 18 and 36 months. Medicine and follow up treatments are required for the rest of their life and a possible heart transplant may be necessary. That’s an enormous expense for any insurance company. Doctors already encourage mothers with this fetal anomaly to terminate. Why would an insurance company with the financial incentive not do the same?

Congenital heart defects, like hypoplastic left heart syndrome, are the most common type of birth defect. Additionally, heart defects are the leading cause of death in birth defect-related deaths. Eliminating gestational age limits for abortions puts these babies at the most risk of abortion. They will not be alone. How will insurance companies in states with no gestational term limits react when fetal testing discovers other birth defects like progeria, fragile X, spina bfida, Phenylketonuria (PKU), or any other abnormality that incurs costly medical treatment post birth?

Additionally, as medicine continues to make remarkable advances, more fetal abnormalities will become detectable at earlier and earlier stages of pregnancy, making abortion more attractive to insurance providers.   

With the precedent now set in suicide coverage versus treatment coverage, we have now approached the slippery slope for the same practice to be employed in regards to abortion. Fortunately, there are some hurdles insurance providers have to overcome. In total, 29 states restrict abortion insurance coverage, 11 of which restrict coverage for private companies and providers on the health insurance exchanges. Other states only put restrictions on the exchanges or insurance for public employees. However, that leaves 21 states with no abortion restriction for insurance providers. And of course, legislation is subject to change. 

Of the now eight states that allow full-term abortions on perfectly healthy babies (Alaska, Colorado, New Hampshire, New Jersey, New Mexico, New York, Oregon, Vermont) and the District of Columbia, precisely none of these states including the District, restrict abortion coverage for private insurers, health insurance exchanges, or public health plans (with the small exception in Colorado, DC, and New Hampshire that limit only the public funding option to life endangerment, rape, or incest).

This makes the states with the most progressive abortion laws the most vulnerable by providing a loophole to insurance providers operating in these states to start refusing coverage for birth defect treatments and instead only opting to cover abortions. Furthermore, without the ability to purchase insurance across state lines, expectant mothers in these states are at the mercy of their already limited choices of insurance providers operating in their state. The combination of a completely unrestricted pro-choice movement and a severely limited insurance market within the states has the potential to terminate thousands more pregnancies in these states, and possibly not by the mother’s choice.     

The only ways to ensure that expectant mothers will not be susceptible to this perverse incentive is to either enact legislation barring all insurers from providing abortion coverage in states where no legislation exists or to completely unleash the free market, allowing citizens to purchase across state lines. 

If the latter is done, the former may not even be necessary. On a national level, support for abortion has largely remained in a deadlocked split 50/50. It’s hard to fathom insurance companies taking the risk of ostracizing half the market by employing the ‘abortion instead of treatment coverage’ approach. Then again, who could have predicted that the insurance companies would have been so brazen and cruel to refuse potentially life-saving treatment and condemn customers to death? By limiting competition within the states, insurance companies have the ability to run rough-shod over customers. If there is only one provider on the health exchange, insurance providers have no obligation or incentive to supply better coverage, they need only to look out for themselves. And particularly in New York, where a single medical professional can encourage and provide abortions with no oversight from a second party, the minimal cost of the abortion paid for by insurance companies ends up being very profitable (several thousand dollars’ worth) to the abortion provider. 

What we have here now is a dangerous precedent. The lack of insurance competition within the states provides insurance companies refuge from rival companies who will provide illness/ birth-defect treatment. The tactic has already been used against our terminally ill and could be used against the unborn. What the pro-choice movement has not realized is that it may be your body, it may be your choice, but without economic choice, pro-choice is just a fallacy.

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