Sunday, September 09, 2007

Not so easy on Healthy Wisconsin and abortion

Seth Zlotocha and Cory Liebman from One Wisconsin want to get all over Wisconsin Right to Life for its claim that the Senate Democrats' "Healthy Wisconsin" plan will require the state to pay for lots of abortions. They claim that the state health plan pays only for "therapeutic abortions" which they define, without citation other than to the unsupported assertion of some Democrat legislators, as being somehow being limited to those "necessary to the life of the mother" or necessary to "preserve the health of the mother." (Whatever these mean.)

This struck me as odd. Seth is a bright guy, but I know and have worked with the good people at WRTL. They are very professional and very careful. They take great pains to be accurate. Could they have flubbed this one?

No. WRTL is all over this. The state's standard plan covers all legal abortions. Of course, we don't know if that will be the "Cadillac" that HW seeks to emulate. The state also has HMO options providing the uniform schedule of benefits that Seth cited (he must use an HMO). The uniform schedule says it covers services "such as" "therapeutic abortions." I think its reasonable to read that as a limitation. But the term is not defined and, of course, can be defined in a way that is tantamount to no limit at all by construction to cover mental health, small risks of minor consequences or the abortion of babies with Down's Syndrome or similar maladies.

What has actually happened? The state is apparently claiming it has no idea how many abortions it pays for.


Seth Zlotocha said...

The point that WI RTL makes is that Healthy WI would cause abortions to "skyrocket," and this contention is based on the argument that HW would follow the state health plan to grants state employees virtually unrestricted access to abortion coverage. The clear implication is that HW would cover all abortions in the state.

In fact, here's what the RTL press release says: "The numbers of abortions in Wisconsin can be expected to increase dramatically and Wisconsin taxpayers will be forced to reimburse abortionists for virtually all abortions performed in the state."

Is that an accurate statement? I'd say it isn't even close.

The HW plan or the WHP would follow the tiering system for state employees, which is something Russ Decker even confirmed recently. The Standard Plan is a Tier 3 plan that runs state employees $290 more per month than Tier 1 options, which is easily enough to pay for one or more elective abortions each year out-of-pocket. In other words, you're not going to get people opting for this coverage just to get abortions on the state dime.

And the percentage of people opting for the top tier coverage is certainly important for the argument RTL is trying to make. After all, the word "skyrocket" is key to the sensationalism the group is trying to generate, and if a small percentage of people even get that level of coverage, it pretty clearly deflates the RTL argument.

I'll check this week about how many state employees opt for Tier 3 coverage, but my guess is it's less than 20 percent. If that's the case, do you suppose RTL would consider adding that as a caveat to its press releases? Seems to me it'd be pretty pertinent to the point it's trying to make, and if they're truly approaching this as professionals rather than polemicists, then I imagine they wouldn't have any trouble mentioning it. To get the ball rolling in the direction of clarity and professionalism, I'll add an update to my post explaining that the Tier 3 plan does cover all legal abortions.

As for the definition of "therapeutic abortion," it's highly unlikely that you're going to have doctors forging justifications or private health plans willing to accept them on a widespread basis. But if RTL and others are concerned about it, they should simply lobby to have an explicit definition added to the legislation rather than trying to drum up opposition to the plan as a whole using misleading claims. (And those misleading claims can have an impact on public opinion.)

Seth Zlotocha said...

According to ETF figures, 2.6 percent of active state employees -- or 1,773 of 69,413 -- had the Standard Plan in 2006. The other 97.4 percent of state employees only have access to coverage of therapeutic abortions.

Rick Esenberg said...


Why do you think that doctors would have to "forge" justifications for therapeutic abortions? You keep assuming - in fact, asserted - a narrow definition that does not exist. Lots of things can be therapeutic.

As for whether abortions will increase dramatically once the state starts to pay for them, I suppose it could be that we won't get more of what we choose to subsidize.

You are certainly right that a more limiting definition can be crafted. (I checked out Marquette's plan and, as you'd suspect of a Jesuit school, it has one.) Maybe, had the Senate Dems done something other than drop an unvetted plan in the budget bill, WEL would have worked to get one. Maybe it still will, although you and I both know that, for now, HW is DOA. Doyle doesn't want it.

Dad29 said...

No question that the term "therapeutic" can be mis-used.

As to "skyrocket": maybe, maybe not. But when the money's there, along with the legal justification(s), it cannot be said that HW is DIS-couraging abortion.

Anonymous said...

"Virtually all" is key here, no?

Is Rick defending this RTL claim or not?

Anonymous said...

". . . 'necessary to the life of the mother' or necessary to 'preserve the health of the mother.' (Whatever these mean.)"

And what the heck do you mean by that? Not enshrouded sufficiently in legalese? Reads clearly to me and anyone, I would imagine, with a grasp of basic English.

But no need to worry your lawyerly head about this, as it's doctors who can tell whether a pregnancy is killing or impairing the health of a woman -- for example, impairing her ability to have a healthy pregnancy and baby in future.

That ought to be something WI RTL would support, it would seem. So is that your problem with it -- that it's up to doctors to decide matters of health and not lawyers, WI RTL, or . . . what the heck do you mean by this?

Seth Zlotocha said...

So is that a "probably not" on expecting RTL clarifying its press releases to explain that over 97% of state employees only have access to coverage of therapeutic abortions? So much for taking great pains to be accurate.

And, even though there’s nothing in the uniform benefits policy to define “therapeutic,” there are regulations and incentives in place to ensure that there is adherence to a generally accepted medical definition of “therapeutic abortion.” Private health insurance companies have auditing policies in place to ensure that sufficient medical documentation exists to back-up billing codes. Those insurers have strong financial incentive to scrutinize bills to make sure they meet the therapeutic threshold for abortions. Such protections still would be in place under Healthy WI, the WHP, or any other universal plan that would follow the coverage outlined in the state’s uniform benefits policy.

Granted, this is just an anecdote, but my wife works closely with the bill coding unit at Columbia Hospital in Milwaukee, and based on her conversation with the manager of that unit, the vast majority of abortions are coded as elective specifically due to the fact that coding them as therapeutic raises red flags for insurers who demand a high level of documenation to support the code.

But, in the end, if all RTL wants is a more explicit definition of "therapeutic," then that's what it should lobby to get. Your attempt to cover RTL's needless and harmful (in terms of the public debate) sensationalism by diverting attention to how HW was added to the budget and Doyle's feelings about it is just that -- a diversion.

Rick Esenberg said...

"Health" exceptions are rather malleable. Sometimes they are limited, as in MU's plan, to abortions that are "medically necessary" due to "complications of pregnancy." Sometime they are limited to physical health. Sometimes they include mental health. So, when I say "whatever that means," I am saying that the precise meaning of the phrase Seth used in not clear.


Please refer me to the definition of "therapeutic abortiuon" under the state's plan. The one that is in all those regulations? I have read that there is not one, but maybe you know something that the rest of us don't. Part of the problem here, of course, is that when Sen. Lazich asked the state for more information, she was apparently told that it did not exist.

Seth Zlotocha said...

As I've explained, Rick, a definition doesn't necessarily need to exist in the state's uniform benefits policy for the procedure to be regulated.

In addition, I repeat the first and last paragraphs from my last comment.

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Amy said...

"Theraputic" HAS been misused...just look at George Tiller in Kansas.

He's performed PBAs on women who were concerned - and I quote - that they "wouldn't be able to attend rock concerts" and "wouldn't be able to play sports." These were otherwise healthy, normal pregnancies.

He cited these as "mental health" issues.

And tell me that therapeutic wouldn't have a definition as broad as the Pacific.

Seth Zlotocha said...

Tiller's case involved two docs allegedly breaking the law by unjustifiably signing off on late-term abortions. That's a separate case than filing questionable therapeutic abortion claims with a private health insurance company that has a strong financial incentive to avoid paying for questionable claims and the auditing authority to protect those incentives.

Besides, did Tiller get away with it? After all, the question isn't about whether some docs will try to stretch the definition, it's whether they'll be able to get away with it and do so on a widespread enough basis to justify RTL claims that abortions will skyrocket under a health reform plan that requires policies to meet the coverage outlined in the state's uniform benefits policy.