Capps Keeps On Digging

Data Confirm Large Payouts For State Employee Abortions

By Paul Chesser

RALEIGH-Rep. Russell Capps (R-Wake) unearthed more data last week regarding the funding of abortions by the state employee's health insurance plan.  Capps and other legislators are calling for a closer look at the Teachers and State Employees' Major Medical Plan.  Their goal: eliminate use of state funds for abortions.

During the last three years, the Teachers and State Employees' Major Medical Plan allowed payments of almost $2.75 million for abortion procedures for state employees.

"I was shocked at the numbers," said Capps.

According to Gordon Daughtry, director of program services for the plan, providers performed 111 medically induced abortions in 1999 alone at a cost of $125,451. That worked out to an average of $1130 per elective abortion. Such services can be performed at abortion clinics for as little as $250.

"It's clear that those payments are very high," said Barbara Holt, executive director for N.C. Right to Life.

From 1997 to 1999, the plan allowed charges of $2,749,567 and paid claims of $2,010,198 for abortion procedures. "Allowed charges" are equivalent to what the abortion provider received from the insurance plan and patient co-payments and deductibles. "Paid claims" are what is sent to the provider by the health plan.

Abortion classifications include procedures that result from pregnancy complications such as hemorrhaging and miscarriage.

In an effort to specify which abortions were considered "elective," the state plan reported 430 procedures performed at facilities classified as "clinics" or "physicians offices" during the three years. Almost $350,000 in charges were allowed for those procedures. However, it cannot be determined for sure that those procedures were all elective.

North Carolina pays $188 monthly for each employee's medical benefit premiums, and the employee is responsible for paying any dependents' coverage. The abortion figures cited are for all employees and their dependents enrolled in the state plan. The plan is self-insured.

In addition, state employees have the option of forgoing the state's self-insured plan in favor of HMO options. The HMO's do not provide claims data to the state plan because the plan does not oversee the HMO programs. Numbers of abortions paid through the HMO's remains unknown.

Lawmakers have expressed their intent to address the problem in the next legislative session.

"It is the legislature's position not to fund abortions," said Rep. Michael Decker (R-Forsyth). "We have to address this in the next assembly."

That may not be easy. North Carolina law states that benefits must be paid for "accidental bodily injury, disease or pregnancy." The statutes elsewhere define pregnancy as "includ(ing) resulting childbirth, miscarriage or abortion."

By far, the largest abortion provider for the state employee medical plan during the last three years was the Raleigh Women's Health Organization. The clinic performed 119 of the procedures – almost 28 percent of the total abortions performed by clinics or physicians. Indeed, the organization's website home page contains information and a price list for elective abortions.

It is almost impossible to precisely separate the numbers of elective abortions from other procedures such as miscarriages. The problem lies in the coding system used by the health insurance industry. The current procedural terminology, or CPT, does not distinguish one from the other, and therefore one "cannot infer intent," according to Daughtry.

"Any count I have for abortion procedures is an undercount," said Daughtry.

Capps is concerned with the ambiguity in classifying procedures, and wants to make sure doctors aren't "getting by with classifying these as miscarriages." He said he wants to find out where the money is going also, making sure all providers are licensed by the state.

Until 1994 the state maintained a $1.3 million state abortion fund for low-income citizens, when over 4,500 abortions were paid for. The legislature limited that fund to cases of rape, incest, and saving the life of the mother in 1995, and only one abortion has been paid for from that fund since then. Holt said the legislature should align the employee insurance plan with that policy.

"The legislature should at least be consistent with what they've done the last five years and limit the plan to rape, incest and life of the mother," said Holt, who only supports abortion to save the mother's life.

The new data has fueled the pro-life position.

"We're certainly going to try to get abortion removed whether it's one or 100," said Nancy Lischwe of LifeTree, a state pro-life organization based in Cary. LifeTree initiated the original investigation of the state health plan.

"We don't think the taxpayers should be paying for abortions," said Lischwe.

Paul Chesser can be contacted at paul.chesser@thetriadworld.com.

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