From Friday, people can switch health insurers again. Which insurance you choose should not matter for the basic package – after all, the care in it is reimbursed for everyone. That is regulated by law. But the practice turns out to be different. Health insurer Pro Life, a subsidiary of Zilveren Kruis Achmea, does not pay for abortion. Pro Life writes on its site because of the Christian philosophy, not wanting to pay for “medical activities that have the aim of ending life or radically changing one’s life”. In addition to abortion, it also does not pay for, among other things, euthanasia and IVF where donor sperm is involved.
Although the insurer has not paid for such care for years, GroenLinks asked parliamentary questions about the issue on Monday evening, after there was a fuss about the insurer on Twitter over the weekend. The party wants clarification about the “misleading” and “discriminatory” policy of Pro Life.
Striking amendment
Abortion, euthanasia and many IVF treatments are therefore included in the basic package. Only makes Pro Life use of an amendment that was adopted in 2004 when the Health Insurance Act was being discussed. It states that insurers may offer ‘model contracts’ that exclude ‘certain highly controversial performances’. At Pro Life, pregnant women can only be reimbursed for an abortion if their own life is in danger.
The amendment was submitted by André Rouvoet of the ChristenUnie and former SGP leader Bas van der Vlies, who died on Sunday. Thanks to the support of the VVD, PvdA, D66 and SP, among others, that amendment received a majority at the time. It is a striking amendment because the Health Insurance Act is about equality in access to care.
The Pro Life Health Insurance has been around since the 1980s and has been part of Zilveren Kruis Achmea since 2015. Pro Life shares a financial reserve with that insurer, and they also purchase healthcare together. Pro Life Health Insurance has more than 116,000 policyholders.
A spokesperson for Zilveren Kruis points out on behalf of Pro Life that approximately 90 percent of abortions take place in clinics. These are paid for through government subsidies. An abortion in the hospital is done through the health insurer. And that is not reimbursed at Pro Life.
Corinne Ellemeet, Member of Parliament for the Green Left, is surprised about Pro Life’s policy: “As an insurer, they are not at all about abortions in an abortion clinic. But does a sixteen-year-old girl from the Bible Belt know that too?”
It is indeed questionable whether insured persons at Pro Life know whether they can undergo an abortion through a clinic. On its website, Pro Life mainly makes room for anti-abortion times. For example, anonymous women are interviewed. One person says she became depressed because of her abortion. “Abortion gives you life,” says this woman, who has undergone it. “In retrospect, I am ashamed that I even thought about the option of an abortion,” said another.
A pregnant woman who wants an abortion and is insured with ProLife can always switch health insurance, says the spokesperson for Zilveren Kruis. Normally this is only possible at the end of the year, but in such a case Zilveren Kruis offers an exception. “This happens at most once a year,” said the spokesperson.
Euthanasia is also excluded from reimbursement in the Pro Life Health Insurance policy. However, there is a reimbursement for palliative sedation (the administration of medicines in the last phase of life that makes the patient sleepy). Pro Life also does not reimburse gender reassignment, copper IUDs and the morning-after pill.
Not an everyday operation
According to the 2004 amendment, in order for an insurer to deviate from the reimbursements from the basic package, the medical procedure must not only be ‘highly controversial’, but it must also not be too mundane and common, such as a visit to the general practitioner. In the law this is called ‘deviating slightly from the basic package’.
With the amendment André Rouvoet wanted to make it possible for Pro Life (and other health insurers) to exclude certain care ‘for ethical or philosophical reasons with a separate agreement’.
There is a potential problem with the amendment, says health lawyer and assistant professor of health law Bastiaan Wallage. “Now it mainly concerns abortion and euthanasia, but the law does not define what exactly is ‘strongly controversial’ or ‘slightly deviating from the basic insurance’.”
In theory, an insurer can therefore also decide to offer basic insurance in which addiction care or gastric bypass is not reimbursed, because it would be contrary to the philosophy of life of certain groups not to drink alcohol or eat healthy, adds Wouter Koelewijn. lawyer and university lecturer in health law. “Increasing differentiation in the basic package due to principles of principle would put the ax into the roots of solidarity in our health care system.”
In 2015, Khadija Arib (PvdA) also asked parliamentary questions about Pro Life. The then health minister Edith Schippers (VVD) defended the insurer at the time by stating that “the choice of an insured for the Pro Life policy is a conscious choice”. Arib does not know why her party ever supported Rouvoet’s motion. She thinks that Pro Life is crossing a line with this. “Health insurance is for everyone, but this is very much based on anti-abortion. There should be no incentive to choose an abortion, that’s just the woman’s responsibility,” she says.
A version of this article also appeared in NRC in the morning of November 9, 2021
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