With all the attention paid to abortion these days, I thought it worthwhile to dig into the financial and health impact of abortion and childbirth.

First, the cost.

Women who give birth incur about $19,000 in additional healthcare costs compared to women who don’t.

And that’s for women covered by large employers’ health plans.

Second, medical debt.

Lower-income adults in the South and/or in states that have not expanded Medicaid are much more likely to have medical debt than the rest of us.

Third, coverage.

About 13 million of us will see their health insurance premiums jump in January unless Congress acts. The issue is subsidies for lower-income folks who get their insurance via the Exchanges will expire at the end of this year unless they are extended. So far, the chances for an extension don’t look promising.

Fourth, societal costs.

• Almost half of the women receiving abortions have incomes below the poverty line.
• Lives will be hugely impacted, as “the expansion of abortion access … reduced teen motherhood by 34% and teen marriage by 20%”
• Women who are denied abortions are three times more likely to be unemployed than women who were able to receive one, according to a 2018 study.
• Women who were not allowed to access abortion services had nearly a four times greater chance of living below the federal poverty line.
• And…”research shows that in 2010 the public paid just under $13,000 on “prenatal care, labor and delivery, postpartum care and 12 months of infant care.” per birth.”

Connecting the dots.

States that have or are likely to ban abortion are:

• unlikely to have expanded Medicaid,
• have much more restrictions on Medicaid coverage so far fewer people qualify for Medicaid, and
• therefore many more poor women who are forced to have children will have higher medical debt,
• will not escape living in poverty, and their child will grow up poor.

What does this mean for you?

If one is going to force people to do things, one should understand and be responsible for the consequences.

Last week I posted on Health Care Sharing Ministries, noting I’d been reaching out to the PR firm that works with theAlliance of Health Care Sharing Ministries, the PR people put out a release touting their new accreditation standards.

As I noted last week the accreditation process/requirements don’t appear to require minimum cash reserves, specific expense ratios or meet other financial adequacy minimums and the accreditation board doesn’t include individuals with actuarial or financial credentials.

In English, this is a very big deal. Unlike real health insurers, HCSMs aren’t required to have enough cash to pay your medical bills. Also unlike health insurers, members don’t have any recourse if their “ministry” decides your care isn’t worthy of their support.

This comes on the heels of a recent study that found almost a third of all Americans have medical debt; in their efforts to pay off debt respondents made a number of sacrifices and suffered substantial financial consequences: (actual study and responses from KFF)

• cutting back on household spending
• more than four in ten say they or a household member have used up all or most of their savings
• respondents reported skipping payment on other bills,
• and delaying college or buying a home, or changing their housing situation, while
• half of adults with health care debt say they have made what they feel to be a difficult sacrifice in order to pay down their debt
• One in seven adults with health care debt say they have been denied care by a provider due to unpaid bills

Here’s the truly awful thing…the least fortunate among us are in the worst shape.

I get that some people have had good experiences with HCSMs. I also know others have not, and are now among those with crippling, life-changing medical debt.

What does this mean for you?

HCSMs are no silver bullet…rather they are a “send the check in and hope you are covered if you get hurt or sick” non-solution.

It’s a measure of just how dysfunctional our healthcare system is that HCSMs even exist.

Ed note – I’ve been holding off on this post for days, hoping to hear something from AHCSM. I’ve repeatedly asked the PR firm for more details; evidently the right folks haven’t been able to respond.

I first reached out to the PR contact on June 21, 2022…three weeks ago.

Healthcare costs are about to jump again, driven by exploding staffing expenses, continued healthcare provider consolidation, and the brilliant profiteering by some of the largest (mostly for-profit) healthcare systems.

So, what’s a family to do?

A few have turned to Healthcare Sharing Ministries, a thing that looks like health insurance but isn’t. HCSMs purport to “share” health care costs among members in what might best be described as a risk-pooling framework. Almost all claim to be “Christian”, they are largely unregulated (except as charities), don’t comply with insurance regulations or laws in most states, and most have requirements that members:

• are in good health,
• make a statement of Christian belief, attend church regularly, don’t use tobacco or have sex outside of marriage and
• commit to taking care of their own health.

note there are ministries focused on other religious denominations.

So…sounds good right? cheaper healthcare is better…well, HCSMs also:

• are not legally required to pay your medical bills,
• require enrollees to do much of the groundwork to get bills paid (negotiate upfront with the provider, get all the paperwork and documentation, pay upfront then seek reimbursement)
• medically underwrite – meaning they require disclosures of pre-existing conditions and can reject applicants for medical reasons,
• can refuse coverage to anyone for any reason,
• have limits on what they’ll pay for healthcare,
• can’t guarantee healthcare providers will accept sharing ministry coverage, and
• have appeals processes that aren’t subject to regulatory oversight.

Enrollment is a bit hard to nail down; the Alliance of Health Care Sharing Ministries claims 1.5 million enrollees although it doesn’t specify the year. Other reports indicate AHCSM reported membership was “over 1 million” in February of 2019. Other sources report membership closer to that 1 million figure.

HCSMs tend to be significantly cheaper than health insurance plans, making them increasingly attractive. However, most families that buy health insurance through the exchanges get major subsidies that significantly reduce their premiums.

There have been multiple reports of individuals and families stuck with huge bills after their “Ministry” refused to pay for care. Aliera Healthcare Inc. and Trinity Healthshares, Inc are the most visible example of what can happen without tight regulation. Regulators in multiple states issued cease and desist orders after concluding the companies violated laws; Aliera was found guilty of fraud and filed for bankruptcy late last year.

Tops among concerns is this – HCSMs are NOT required to have enough cash on hand to pay medical bills. Even more concerning, they don’t have to report their finances, cash reserves, expense ratios or other data.

There’s an effort underway to “accredit” HCSMs; the process/requirements don’t appear to address this critical issue and the accreditation board doesn’t include individuals with actuarial or financial credentials.

I’ve asked the lobbying outfit that purports to represent HCSMs for details on the financial portion of that accreditation process. So far they’ve been less than forthcoming.

What does this mean for you?

be very careful.

Once again children have been killed.

Yesterday’s slaughter of little children cut me to the heart, coming the day after I spent hours watching our granddaughter. Hours of delight, wonder, love, joy and promise.  Sitting together in a swing as she munched on goldfish, picking dandelions, working on puzzles and learning more colors, doing nose kisses and picking out her outfit for the day (rain boots, shorts, and a favorite shirt, with a pretty awful ponytail (as it always is when grandpa does it)).

I cannot imagine the heartbreak suffered by families in Uvalde Texas, nor can I imagine how this reverberated among parents of kids killed in Sandy Hook Connecticut a decade ago, ripping open wounds painful beyond measure. That’s awful indeed – what’s worse – if that’s possible – is there have been dozens of mass shootings this year alone.

Look at your kids, your schoolyards, your sports fields, your graduation ceremonies and school plays and imagine the impact of a Uvalde/Sandy Hook/Buffalo/Laguna Woods/Milwaukee/Brooklyn/Sacramento.

If we do not do something about gun violence, some of you, dear readers, may come to understand all too well the heartbreak and utter devastation suffered by families victimized by gun violence.

Make no mistake, this butchery would not happen without grandstanding by vote-seeking pols, lax background checks, wildly inadequate mental health care, incredibly permissive concealed carry laws in some states and easy access to guns, many of which serve no purpose other than killing people.

What does this mean for us?

We are failing to protect children, loved ones, parents and family. This is a national disgrace. 

Note – I am a gun owner and hunter. Family members are first responders, former law enforcement and national security.