In speaking out against a bill that would make sure no pregnant person could be denied medical coverage due to their pregnancy, a health insurance lawyer unintentionally made a great case for a national, single payer health program.
Shawn Donahue is an attorney at Blue Cross & Blue Shield of Rhode Island and last Tuesday he spoke at the House Corporations Committee meeting to oppose a bill that would ensure “no pregnant applicant for medical insurance coverage would be denied coverage due to her pregnancy.”
I want to stress at the outset that Donahue seems like a decent man, and I sensed that he was somewhat uncomfortable speaking out against this bill.
“No one believes in the importance of pre-natal care more than Blue Cross,” said Donohue, “We’ve invested in it.”
That’s true. “Getting early and regular prenatal care is one of the most important things you can do for the health of both you and your baby,” says Blue Cross on its website. The site contains a wealth of information and advice on healthy pregnancies. But we don’t have to assume that Blue Cross is promoting neonatal care out of any sense of public service. Healthy pregnancies are cheaper for insurance companies. An insured baby, with proper neonatal care, is less likely to have expensive health problems going forward.
The importance of prenatal care is underscored by the health risks associated with not having such care.
“Women in the United States who do not receive prenatal care have an increased risk of experiencing a neonatal death… Lack of prenatal care is associated with a 40 percent increase in the risk of neonatal death overall…” says the Guttmacher Institute, citing a study, “Black women are more than three times as likely as white women not to receive prenatal care, and regardless of their prenatal care status, their infants are significantly more likely to die within their first 27 days of life than are infants born to white women.”
Other risks from not receiving adequate prenatal care include low birth weight for the infant, and pre-eclampsia, a form of organ damage, that affects the mother. From a human perspective, this is terrible and unnecessary. From the perspective of an insurance company, such health problems are expensive.
Yet, said Donohue, speaking for Blue Cross at the Rhode Island State House, “The only way insurance works is if you purchase it when you don’t need it so it’s there for you when you do. If you allow people a special enrollment period, whether they’re diabetics, cancer patients or pregnant people, they won’t buy it until they need it.”
The Affordable Care Act (ACA or Obamacare) mandates that Rhode Islanders buy private insurance on the state run health insurance exchange, HealthSourceRI. “If you’ve missed the open enrollment period,” said Donohue, “ you’ve broken the law and now you are penalized for that, and the penalties start to grow.”
Donahue is talking about financial penalties of course, but the real penalties from a societal point of view are dead babies, or babies and mothers with terrible health outcomes. Suddenly the financial penalty for not complying with the ACA mandate seems rather small and meaningless, doesn’t it? But more to the point, it’s exactly these negative health outcomes that Obamacare was supposed to address.
“We don’t let people buy insurance on their way to the hospital in an ambulance,” said Donahue. I would say that having to worry about financial issues during a medical emergency is a major system failure, and further, these gaps in care for vulnerable Americans expose the weaknesses in today’s for-profit health insurance industry, of which Blue Cross & Blue Shield of Rhode Island is a big part.
According to Physicians for a National Health Program (PNHP), “Single-payer national health insurance, also known as ‘Medicare for all,’ is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands. Under a single-payer system, all residents of the U.S. would be covered for all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs.
“The program would be funded by the savings obtained from replacing today’s inefficient, profit-oriented, multiple insurance payers with a single streamlined, nonprofit, public payer, and by modest new taxes based on ability to pay. Premiums would disappear; 95 percent of all households would save money. Patients would no longer face financial barriers to care such as co-pays and deductibles, and would regain free choice of doctor and hospital. Doctors would regain autonomy over patient care.”
On the national scene Bernie Sanders has championed single payer, calling it Medicare for All. “Health care must be recognized as a right, not a privilege,” says Sanders, “Every man, woman and child in our country should be able to access the health care they need regardless of their income. The only long-term solution to America’s health care crisis is a single-payer national health care program.”
State Representative Aaron Regunberg has introduced, for the second time, a bill to bring the benefits of a single payer health insurance program to Rhode Island. His bill would “act would repeal the ‘Rhode Island Health Care Reform Act of 2004 – Health Insurance Oversight’ as well as the ‘Rhode Island Health Benefit Exchange,’ and would establish the Rhode Island comprehensive health insurance program.”
His bill deserves our support.
Ahead of yesterday’s finance committee votes in both houses of the General Assembly approving RhodeWorks, the truck toll plan, a press conference was held at the Greater Providence Chamber of Commerce (GPCC) featuring some of Rhode Island’s most powerful political, business and labor leaders. They were there to present a unified message in support of the tolls, despite vocal opposition.
One prominent Rhode Island business owner, whose business has “been a member of the Chamber for almost as long as there’s been a Chamber” told me that contrary to GPCC President Laurie White‘s claims that this issue has been discussed with membership, he was never consulted about the plan, despite his business’s dependence on trucks for shipping. In fact, he said, “I didn’t even hear about this meeting until I heard about it on the radio this morning!”
As I said before, RhodeWorks is inevitable. The legislation has been fast tracked not because there is a sudden, urgent need to fix our roads and bridges; the need for this repair is decades old. The legislation is being fast tracked because the necessary arrangements between the various parties involved have been carefully worked out, but in an election year, meaning that the sooner elected officials put this issue in their rear view mirror the better. Several legislators are going to be challenged for their seats because of their votes on this.
Not that Republican challengers are offering anything better. As Sam Bell pointed out yesterday, the Republican plan seems to be privatization, which means private businesses will take over our roads and bridges and charge whatever tolls they want to for profit, or their plan is cutting the budget, denying important social services to families in need. (Not to worry, though: Senate President Paiva-Weed promises that she and Speaker Mattiello will continue to cut the budget, cut taxes and cut services. More on this in a future article.)
The cost of RhodeWorks will be passed onto consumers. Ocean State Job Lot raised a stink over the weekend when they put their expansion plans on hold, threatening as yet unrealized jobs, but after this all pans out, Job Lot will not lose out on any profits: They will simply raise the price of their goods. This means that we are not imposing a user fee on businesses as much as we are coming up with yet another regressive tax that will affect the poor and middle class more than the rich, which is just the way our political leaders like it.
The General Assembly is expected to pass RhodeWorks today, and Governor Raimondo will sign the legislation asap. In the meantime, you can watch the full press conference below.
Laurie White, Greater Providence Chamber of Commerce (GPCC) President
RI Governor Gina Raimondo
Providence Mayor Jorge Elorza
Peter Andruszkiewicz, Blue Cross & Blue Shield of Rhode Island CEO and President
Scott Wolf, Grow Smart Rhode Island Executive Director
Lloyd Albert, AAA of Southern New England Senior Vice President
Michael F. Sabitoni, Rhode Island Building and Construction Trades Council President
House Speaker Nicholas Mattiello
Senate President Teresa Paiva-Weed
Woonsocket Mayor Lisa Baldelli-Hunt,
Central Falls Mayor James Diossa and
Lt. Governor Dan McKee were in attendance but did not speak.
Thousands of HealthSource RI subscribers lost medical coverage for abortion this year, and most had no idea this was happening.
Under new policies mandated by Governor Gina Raimondo, insurers must now offer one plan that does not cover abortion at every level in which they offer a plan that does. As a result of the Governor’s actions and a minor change in the law that allows insurers to re-enroll subscribers into new health plans if their previous plan no longer exists, 9,000 out of 32,000 families have lost this crucial coverage.
Raimondo made two decisions earlier this year that lead to this crisis. First, she settled the Doe v. Burwell lawsuit when she didn’t have to. Doe, who chose to remain anonymous because of his HIV+ status, claimed that he was unable, due to his religious beliefs, to contribute money to any health plan that covered abortion, and that his needs as an HIV+ man meant that waiting until 2017 for the one plan that does not cover abortion mandated under federal law was not practical.
Doe was represented in his lawsuit by the conservative Alliance Defending Freedom (ADF) and supported by both RI Right to Life and the Roman Catholic Diocese of Providence. It was far from certain that Doe and the ADF would win the suit since HealthSource RI was operating fully in accordance with Federal law and accommodations had been offered to Doe.
But Raimondo caved, and caved hard. After settling a case she did not have to, she went further than existing federal law and submitted legislation mandating that insurers offer multiple plans that omit abortion coverage. Every insurer was forced to offer a plan at every tier of coverage. Federal law mandates that at least one plan on a state exchange offer no coverage for abortion. Raimondo insisted on what amounts to nine plans.
All insurers on the HealthSource RI exchange had to roll out new plans. Two insurers decided to modify existing plans as well, which meant that many health plan subscribers had to be moved to whichever new plans were deemed most similar to their old plan. Whether or not the new plan covered abortion was not a consideration.
According to the Providence Journal, “Out of HealthSource’s three insurers, two mapped subscribers into plans with limited abortion coverage — Blue Cross & Blue Shield of Rhode Island and Neighborhood Health Plan of Rhode Island. United Healthcare did not.”
Now, 9,000 families are without abortion coverage, unless they change their enrollment by December 23. Many more people, when looking at the new plans on offer, may switch into plans that do not cover abortion – not because they are anti-choice, but because some of the anti-choice plans might appear to be cheaper.
Figuring out which plans are cheaper is a difficult, if not impossible task. There is the monthly fee to consider, but there are also differences among plans in terms of deductibles, medication costs and co-pays. Ultimate cost may depend more on usage than monthly contributions. Figuring out how much a family saves by choosing an abortion free plan may be an exercise in futility, even though the law requires such plans to be cheaper, if only by a few cents.
Nobody plans on having an abortion, so abortion coverage is often not a big consideration when choosing a healthcare plan. Those who may find themselves most at risk of discovering they are suddenly out of pocket for abortion expenses are young adults covered under their parent’s healthcare plan until age 26. Others at risk include couples who might want to have a baby, but encounter a crisis at a late stage. Costs associated with additional testing and termination of a nonviable late term pregnancy can be in the tens of thousands of dollars and require a hospital stay.
As a result, some families will face the kind of financial ruin that Obamacare was instituted to prevent.
This is the kind of information that may have been revealed had Raimondo introduced her legislation openly, as a bill submitted to the General Assembly to be debated and commented on by the public. Instead, the governor slipped these changes into the budget as an eleventh hour amendment and with as little fanfare as possible. It worked: the measure passed with little outcry.
Just before Governor Raimondo signed the budget into law, mandating the changes that have resulted in thousands losing abortion coverage, Barth Bracy, executive director of RI Right to Life, said, “Due to the complexity of Obamacare, and its implementation in Rhode Island, neither the media nor our opponents at Planned Parenthood and in the pro-abortion caucus of the General Assembly, yet appear to understand the extent of our victory.”
I guess now we do.
If Governor Raimondo is truly a pro-choice candidate, she has a strange way of showing it. No recent RI governor has been nearly as successful in stripping families of their reproductive rights.