Another Likely Effect of Roe’s Reversal: Higher Healthcare Costs

Carrying a pregnancy to term and giving birth are among the most risky activities, from a health perspective, that most women are likely to experience. During pregnancy, potential complications include gestational diabetes and preeclampsia (a dangerous rise in blood pressure that can be fatal for both mother and baby). During or shortly after childbirth, eclampsia (seizures resulting from preeclampsia), cardiomyopathy (a form of heart disease), amniotic embolism (when amniotic fluid enters the mother’s bloodstream), sepsis (extreme reaction to an infection bacterial infection) and respiratory distress May occur. This is only a partial list. The risk of dying in childbirth is significant, especially in the United States, where maternal mortality rates are shockingly high: the United States is the worst of rich, developed countries by this metric, and fifty-fifth of all countries , just behind Russia. .

“With Roe’s reversal and subsequent state laws banning abortion, we’ll see that some people will seek abortions in different states or through different means,” said Joelle Abramowitz, an economist at the Institute for Social Research in Washington. ‘University of Michigan. who studies how health policy affects people’s life decisions and well-being, told me. “But some people won’t. And that means we’ll see more births, and those births are going to lead to more birth-related deaths. We know we will see that.

The Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade, has sparked the start of a period of chaos, as some states rush to implement laws banning or restricting access to abortion and other states try to determine if they can protect a civil right which Americans have enjoyed for nearly fifty years and which has provided part of the foundation for the full participation of women in society. Many of the new laws will be challenged in court, which can take years to materialize. In a time of great uncertainty for women who are pregnant or who may become pregnant one day and for those who care for them, as well as for healthcare providers, regulators, employers and health insurers, a One thing seems clear: the cost of health care for women is almost certain to rise.

This is partly because some women with health complications that could have terminated a high-risk pregnancy will no longer be able to do so. “We could see higher costs associated with caring for these pregnancies and an increased risk of them becoming fatal,” Abramowitz said. “Thus, we could see more complicated and risky pregnancies carried to term.” All insurers, whether private companies or public plans such as Medicaid, consider factors such as age, gender, health status and geographic location when calculating the cost. intended for the insurance of a particular population. Cori Uccello, actuary and senior health researcher at the American Academy of Actuaries, a nonpartisan organization that provides expertise on health insurance financing to policymakers, said that going forward, lack of access abortion for many women will also be a factor.

Uccello noted that it is too early to understand what the full effects of the legal changes will be; it remains unclear to what extent available abortion pills will remain where surgical abortions are not, and whether laws banning abortion will include exceptions for cases where a woman’s life is in danger. Still, she says, she was thinking about different ways the Supreme Court’s decision could affect the insurance market. The first focused on how insurance coverage for abortion services might change. Prior to the Dobbs decision, Uccello said, abortion coverage was quite limited and varied from state to state; private insurers would likely reassess their benefits in the future, but because these companies had previously spent so little on abortion care, costs for privately insured patients were unlikely to change much.

The most important issue concerns health expenditure on maternity and newborns, both of which are likely to increase. Health insurance plans are required to cover maternity care, so any reduction in the number of abortions will lead to increased insurance costs, even if the insurance plan would not have covered the abortion (abortions are much less complicated, and therefore less expensive to cover, anyway, and they are statistically much safer than pregnancy and childbirth). “If they’re more likely to be high-risk pregnancies, they’re likely to be more expensive. If newborns are likely to have health complications, the costs will be higher,” Uccello said. “We don’t know exactly how that will turn out, but it’s a possibility that it’s not just more births, but more complicated births.” There could also be costs for mental health care, physiotherapy and other services that are not always associated with pregnancy, but are directly related to it.

Many insurance companies are not allowed to charge women more than men, so higher costs would be reflected in the premiums paid by all pool members. “Premiums are unlikely to be affected right away, as the legal and regulatory environment is not going to stabilize for some time, and it will take some time for insurers to understand how these changes will evolve,” added Uccello. “But over time, premiums can be affected by changes in healthcare spending.”

This also has implications for taxpayers. A study by the Kaiser Family Foundation and the Peterson Center on Healthcare found that pregnancy, childbirth and postpartum care cost an average of $18,865, with C-section births costing an average of $26,280. Nearly half of childbirths in the United States are covered by Medicaid, so if these costs increase, the burden on taxpayers will also increase. “Of course, individuals bear some of these costs, but some are also borne by the insurance, or by the provider itself, and ultimately they are passed on to other insured persons through premiums. higher. And in the case of people on Medicaid, through taxes,” Abramowitz said. “So we see everyone bearing those costs.”

Abramowitz said that in the best-case scenario, medical providers would focus more on pregnancies, deliveries and postnatal care for high-risk patients, including investing more in equipment and technology. She also sees another potential silver lining: It would be great, she said, “if some people switch to more effective birth control methods.” ♦

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