Joe Davidson for the Washington Post: D.J. Feldman was 11 weeks pregnant last year when she learned that her child had anencephaly, a fetal defect that left the baby with almost no brain. It is always fatal.
Feldman, a 41-year-old federal lawyer, and her husband had been trying for two years to have a baby. Sadly, her doctor "made it very clear I wasn't to continue this pregnancy," she said.
An abortion was medically necessary. She had little choice.
But after the jolt of the diagnosis and the emotional pain of the procedure, Feldman was in for another shock -- sticker shock. She thought her health insurance policy through the Federal Employees Health Benefits Program (FEHBP) would cover the $9,000 cost of the abortion. It didn't.
For Feldman, unlike many women who have abortion insurance coverage through private-sector employers, abortion coverage provided through her employer -- the U.S. government -- is illegal. The law says that "no funds . . . shall be available to pay for an abortion" under FEHBP. Exceptions are made for pregnancies that are the result of rape or incest, or that endanger the mother's life.
Feldman's case is instructive. Congress is considering a ban, like the one in federal employee health plans, against federal funding of abortions as part of the effort to reform the nation's porous health insurance system. After hot debate last month, the House approved the Stupak-Pitts amendment, which would prohibit abortion coverage in government-subsidized health insurance, with exceptions for rape, incest and the mother's health.
Feldman's health was in jeopardy. The minority of babies with anencephaly that are carried to term -- dying shortly after birth -- cause complications such as "dysfunctional labor and postpartum hemorrhage, which can increase the risk for the mother," Feldman's doctor wrote in a letter to her insurance company.
The doctor warned that the complications for a woman of Feldman's maternal age from giving birth to a child with anencephaly "are especially serious . . . and could be life threatening."
Despite the doctor's plea, the Office of Personnel Management refused to make Blue Cross/Blue Shield pay.
"The fetal anomaly presented no medical danger to you, the mother," OPM wrote to Feldman. "Consequently, we cannot direct the [insurance] Plan to provide benefits for the services in dispute."
Feldman was able to negotiate the fee down from the $8,898 she was billed as an individual, to the $5,000 the Blues would have paid. Federal and insurance company officials do not discuss individual cases.
For privacy reasons, Feldman, who lives in the D.C. area, doesn't want her full name or agency printed. She has lobbied against the Stupak amendment and the law that places restrictions on the health coverage of federal employees. Those restrictions also apply to others who use federally funded health programs, including poor women on Medicaid, patients in military hospitals and Native Americans who use the Indian Health Service. Federal law even prohibits the D.C government from using its local funds for abortions, though the House has voted to lift that ban.
"People don't want their tax dollars to pay for abortion," Rep. Bart Stupak (D-Mich.) said in an interview, citing a recent Washington Post-ABC News poll showing that 61 percent of those surveyed support a ban against using public subsidies for abortion coverage. "Many pro-choice members [of Congress] support no tax dollars for abortion," he added.
Stupak said that individuals would be able to buy supplemental abortion policies. But that coverage isn't always available. The Government Employees Health Association, better known as GEHA, for example, doesn't sell supplemental abortion policies.
With Democrats running the White House and Congress, abortion rights advocates thought that now would be the time to change the law. "This has been the first time in eight years to have the punishing restrictions removed from federal employees," said Nancy Northup, president of the Center for Reproductive Rights.
She and others are encouraged because the ban has not been included in a Senate appropriations bill, though it remains in similar House legislation.
"Abortion is basic health care for women, and federal employees should have coverage," said Vicki Saporta, president of the National Abortion Federation.
But the Stupak amendment has been a blow to abortion rights forces. It's a clear signal that the House, at least, is in no mood to mess with the bans against federal funding.
Nonetheless, "I'm hopeful it will be changed," Feldman said.
© 2009 The Washington Post Company
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