A Note on PA SB3

A bill in the Pennsylvania State Senate (SB3) would make it illegal for any health insurance plan offered in one of the Pennsylvania health exchanges set up via the Affordable Care Act would not cover abortion or post-abortion complications.
Just to provide some background, here is the state's legal definition of abortion and complications:

18 Pa. C. S. A. 3203
Definitions
Abortion: the use of any means ot terminate the clinically diagnosable pregnancy of a woman with knowledge that the termination by those means will, with reasonable likelihood, cause the death of the unborn child except that, for the purposes of this chapter, abortion shall not mean the use of an intrauterine device or birth control pill to inhibit or prevent ovulation, fertilization or the implantation of a fertilized ovum within the uterus.

Complication: Includes but is not limited to hemorrhage, infection, uterine perforation, cervical laceration and retained products. The department may further define complication.

Here are the requirements that must be met for an exception in the case of rape or incest:

18 Pa. C. S. A. 3215
(a) Limitations. – No hospital, clinic or other health facility owned or operated by the Commonwealth, a county, a city or other governmental entity (except the government of the United States, another state or a foreign nation) shall:
(1) Provide, induct, perform or permit its facilities to be used for the provision, inducement of performance of any abortion except where necessary to avert the death of the woman or where necessary to terminate pregnancies initiated by acts of rape or incest if reported in accordance with requirement set form in subsection ©.
© (2) When abortion is performance in the case of pregnancy caused by rape which, prior to the performance of the abortion, has been reported, together with the identity of the offender, if known, to a law enforcement agency having the requisite jurisdiction and has been personally reported by the victim.
© (3) When abortion is performed in the case of pregnancy caused by incest which, prior to the performance of the abortion, has been personally reported by the victim to a law enforcement agency having the requisite jurisdiction, or, in the case of a minor, to the county child protective service agency and the other party to the incestuous act has been named in such report.

There are three things I’d like to point out about this.

The first is that it would be very easy for an insurance company to restrict coverage of some procedures entirely as opposed to restricting them only in the case of post-abortion complications. Take, for example, dilation and curettage. This may be done post-abortion but it is sometimes also done after a miscarriage (see info at MayoClinic). It is also sometimes done after a full term birth if pieces of the placenta are left in the uterus. A D&C might also be done in the case of fibroids, heavy uterine bleeding, and other gynecological circumstances (see emedicine). What proof would a woman who had had a miscarriage have to provide to show it was a spontaneous miscarriage and not an abortion? Would doctors refuse to do a D&C for other reasons to avoid tangling with insurance companies over the use of the procedure?

The second is that minors have to report a case of incest and the identity of the perpetrator to a county agency worker. That’s going to be difficult for a young teen whose father or other family member has been abusing her for years. The same concerns come into play for rape victims. What if the woman doesn’t know the identity of her rapist? There have been several serial rapists in the Philadelphia area in recent years. I don’t think those guys left a business card. How much pressure will insurance companies put on women to provide a name before coverage will be provided. Note also that incest reports much be made by the pregnant woman herself but no such requirement is listed for rape. One other matter – there is no requirement that the accusations by name be confirmed by DNA testing. In cases where a woman is personally threatened with violence there will be a strong temptation to avoid further violence by providing a fake name or, even more unfortunate, the name of an innocent man.

The third is that there is no provision for expectant fathers to pay for prenatal care, in cases where an abortion is denied. Finding insurance that will cover all necessary or recommended prenatal care is difficult, and good care can be expensive. In a he said / she said case where the woman says she was raped and the man says it was consensual, who will decide if she can get an abortion? Will she have to wait until the court case is finalized? Can he be forced to pay half of the prenatal and birth expenses while the legal system goes through? If a woman can’t get an abortion when both she and the man involved want one, you might see more cases like those in which the man involved wants the woman to get an abortion and she doesn’t. Philadelphia’s Latoyia Figueroa was in that situation and her boyfriend killed her to avoid becoming a father.

Should you have any concerns about this bill, let your state senator know, especially if he or she is among the sponsors: INTRODUCED BY D. WHITE, SCARNATI, PILEGGI, ARGALL, YAW, ROBBINS, BROWNE, ERICKSON, GORDNER, KASUNIC, VOGEL, TOMLINSON, FOLMER, SMUCKER, ORIE, ALLOWAY, PIPPY, CORMAN, BRUBAKER, EICHELBERGER, RAFFERTY, WAUGH, MENSCH, WARD, PICCOLA AND YUDICHAK.

I think a better way to decrease the number of abortions is to work towards providing good low cost prenatal care and child care, contraceptive education, and make it harder for businesses to fire or otherwise discriminate against pregnant women and working mothers.