The state of Oregon recently passed a new law that requires all health insurance plans to cover abortions.
The move was praised by pro-choice advocates as a significant step forward for reproductive rights as it ensures everyone has access to an abortion, even if they are of lesser means.
Conservatives and pro-life groups oppose the measure, and the bill was ultimately passed on a party line vote in the Oregon Senate, with all Republicans voting against it.
At first glance, the issue appears to fall along the usual battle lines in the abortion debate–with a near-zero possibility of either side changing anyone’s mind.
But in fact, the question at stake here is a more interesting one.
It does not matter whether you or I personally believe abortions are immoral or whether they ought to be illegal.* What matters is that some people sincerely do hold those views.
The issue raised by Oregon’s new law is whether it is appropriate for the government to force people to pay for things they deem immoral.
Why Everyone Pays
Before moving on to that philosophical question, it’s worth explaining briefly how the new law works–and why all Oregonians will ultimately pay for it.
As noted above, one part of the law requires health insurance plans to fully cover abortions so there is no out-of-pocket cost to the patient at the point of service. In this way, abortions become free to patients with health insurance.
Of course, the abortion itself still costs money. The doctors doing the work won’t suddenly switch to doing all abortions pro bono. They will still be getting paid. It’s just that now all of the fees will come from the insurance companies.
All things equal, this has the effect of raising the average cost of claims per policyholder for the insurance companies. And since most insurance companies aren’t known to be in the charity business, they will want to maintain their pre-existing profit margins. The insurers achieve this outcome by raising premiums to offset the new costs.
In the absence of the Affordable Care Act, it’s likely that these premium increases would be very targeted–with premiums rising for women of child-bearing age but staying relatively constant for everyone else. However, the Affordable Care Act restricts insurers’ flexibility to tailor pricing based on the expected costs of the insured. Most relevant for this case, men and women cannot be charged different rates.
As a practical matter, this means men (and to some extent, older women) who have no need for abortion coverage will ultimately end up paying for it anyway, in the form of higher premiums.
To be fair, the new law does create federally required exemptions for religious organizations, similar to the Affordable Care Act. This allows certain employers to object to paying for abortion coverage in their health plans on religious grounds. In these cases, they’re allowed to get a unique policy that doesn’t include such coverage.
However, employees working at these institutions are still entitled to abortions at no cost. When one of these employees seeks an abortion, the state government–which is to say, the taxpayers–will step in to foot the bill for their abortions, according to The Huffington Post.
A second component of the new law allocates additional taxpayer funds to provide abortions and other reproductive health services for undocumented immigrants and people who are uninsured.
Given the controversial nature of abortion, it may seem surprising that tax dollars would be explicitly spent to pay for the procedure. However, this approach is not new in Oregon. In fact, the state’s Medicaid program currently provides coverage for abortions for poor individuals under pre-existing law.
Thus, the bottom line is that Oregonians were already required to pay for some abortions as part of Medicaid. Under the new law, they will have to pay more, as health insurance customers and taxpayers, in order to cover all abortions in the state.
Policy and Morality
The question here is whether government policy should force people to pay for things they find immoral. In this particular story, the potentially immoral activity is abortion. But the question applies in many other situations as well.
Should a Hindu person, whose religion considers cows sacred, be forced to subsidize the slaughter of cows and consumption of beef?
Should an anti-nuclear environmentalist, who believes the nuclear industry is destroying the planet, be forced to subsidize nuclear power plants.
Should a Palestinian-American, who objects to the Israeli government’s occupation of the West Bank as immoral, be forced to contribute foreign aid to Israel, thereby abetting the occupation?
Under the status quo, all these types of people above really are forced to pay for the things they find immoral through taxation. This indirect method makes it more difficult to notice, but the end result is the same as if the Hindu paid money straight to the butcher or the Palestinian advocate gave the Israeli government a piece of their salary.
Notably, all of the subsidized activities above could still readily occur without resorting to coercion. Cows would still be killed and beef would still be purchased by paying customers without agricultural subsidies. If nuclear power proved to be economical, investors would still build new nuclear energy plants to earn a profit. In the case of Israel, individual Americans could choose to donate to Israel’s defense. And even without any US aid money, Israel’s security against outside forces–the ostensible goal of US foreign aid–is still assured given its military dominance in the region and its not-so-secret nuclear weapons arsenal.
There is a voluntary option available for abortions too. If people believe everyone should have access to abortion, then they can donate to organizations that are already working to achieve that goal.
In all of these cases, there is a voluntary and consensual alternative that is readily available. But instead, the government forces innocent people to pay for things that violate their conscience. Is this really how policy ought to work?
Or, put another way, do you want to be forced to pay for things you find immoral?
If the answer is no, then it does not really matter whether we find merit in the specific moral objections raised.
If people have a right not to be coerced to pay for things they find immoral, then that right extends to everyone–even people we disagree with.
*For what it’s worth, this author is of the opinion that abortion should be legal. But as mentioned, that’s not really relevant to the discussion at hand.