By Jennifer Zahn Spieler
Tuesday, March 21, 2006
Washington state just passed a law protecting abortion clinics from losing insurance after they are attacked, but it's too late for one clinic in the state. Nationwide, small, independently owned clinics are searching for new insurance options.
OLYMPIA, Wash. (WOMENSENEWS)--On Jan. 9, 2005, the Eastside Women's Health clinic here was hit by arson.
The fire started on the roof and destroyed much of the building's interior, but spared patient records. Over a year later, the case remains open; no arrests have been made.
The owners of the independent, private clinic, Nancy Armstrong and Shelley Pacheco, managed to reopen within weeks in a nearby trailer while the clinic was being renovated.
But then they got hit by more bad news. West American Insurance Company said it was canceling their policy--for $1,600 a year--since its underwriting manual prohibited covering abortion providers.
"When the fire first happened, the underwriters went to our broker and said, 'We didn't know they did abortions. We're not paying for this.' Well, it says clearly on our application that's what we did," Pacheco said.
West American is a subsidiary of Ohio Casualty Group, headquartered in Fairfield, Ohio. The company refused to comment on the circumstances of Eastside's cancellation.
It also declined to comment on Washington state's March 7 passage of a law forbidding insurers from pulling coverage from a health-care facility following arson or malicious mischief.
"My bill discourages the terrorists because they see that arson won't cause a clinic to lose insurance," said Rep. Brendan Williams, the bill's chief sponsor, whose state legislative district includes Olympia.
California in 2003 took a similar stand when it added a reference to reproductive-health services to a law preventing insurers from canceling or not renewing the policy of a religious, educational or nonprofit institution that was the victim of a hate crime.
The Washington law came too late for the Eastside Women’s Health Clinic in Olympia.
West American has paid most of Eastside's approximately $500,000 claim, but Armstrong and Pacheco were left scrambling to find new insurance to stay in business. They were quoted an annual premium of $120,000 for a medical malpractice, general liability and property insurance package.
"And that was when we finally got a quote," Armstrong said. "We went for a while when nobody would even talk to us."
If they agreed not to provide abortion services, the premium dropped to just over $18,000; still significantly more than what they had been previously paying. Unable to afford the six-figure premium, Eastside--which performed approximately 400 abortions a year--ceased providing them last fall. The clinic still offers primary adult health care services to about 500 patients a month, many of whom are low-income.
"What is sad are the people who have called us since we stopped doing abortions and they're just breaking down on the telephone, sobbing and crying and saying, 'What am I going to do?'" said Pacheco.
Eastside Women's Health now refers patients to other clinics for abortions, including out of the county. A spokesperson for Sound Choice Health Center in Olympia, Wash., who spoke on condition of anonymity, said in some areas of western Washington there can be up to a one-month wait for an abortion procedure because of the shrinking pool of providers.
As of 2000, 87 percent of U.S. counties had no abortion provider and in the Midwest and South, the figure is over 90 percent, according to a report by the New York-based Guttmacher Institute. The report found that the overall number of U.S. abortion providers has been declining. In 1982 the nation had 2,900 abortion providers, which fell to 1,819 in 2000.
While unclear how many of these providers are independently-owned clinics, the report indicates that more abortions are performed in clinic settings than in hospitals. Independent clinics can be nonprofit or for-profit.
Last year Planned Parenthood, a network of more than 850 clinics across the country, became self-insured for property and liability coverage. It was already self-insured for malpractice.
Eleanor Bader, co-author of 2001's "Targets of Hatred: Anti-Abortion Terrorism," says a possible solution to the insurance crisis for the independent clinics is for Planned Parenthood to insure them as well.
Calls to Planned Parenthood over the past few days to see if it was considering extending insurance beyond its own clinics were not returned.
But the real key, Bader says, is for all clinics--private, chain, nonprofit--to be willing to work in concert with each other rather than being competitive.
One subset of independent clinics has discussed the idea of cooperative insurance. These are 14 nonprofit health centers that in 2005 formed the Consortium of Feminist Abortion Providers, said Raquel Castellanos, executive director of Blue Mountain Clinic, a consortium member in Missoula, Mont.
Amie Newman, communications director for Seattle's Aradia Clinic, says the cooperative insurance idea is "tabled for now," but will most likely be revisited by the consortium at a later date.
The National Abortion Federation, based in Washington, D.C., is also discussing the possibility of creating some type of property and liability insurance pool, which they have already done for malpractice insurance. "We're looking into it," said President Vicki Saporta.
In deciding how to insure themselves, clinics consider a mix of options including protection for buildings and contents; medical malpractice; and general liability, which protects against claims for injury or damages not related to medical malpractice. If a clinic leases rather than owns its office space, it may decide not to insure the contents. Some clinics may skip medical malpractice insurance.
Steven Emmert, executive director for the National Coalition of Abortion Providers, says creating some kind of cooperative property-liability insurance for independent clinics is much more difficult to accomplish than for malpractice because of the perceived differences in risk.
"Malpractice insurance is easier because you're pooling the risk and abortion is one of the safest procedures there is," Emmert said. "With liability insurance, you're putting all the high-risk people in one pool and nobody's going to want to touch that."
The question is whether the risk is real. Extreme forms of violence against clinics have decreased in the last few years, according to the National Abortion Federation. In 2005 the only arson attacks in the nation were on Eastside Women's Health and Presidential Women's Center in West Palm Beach, Fla. Between 2000 and 2005, there were a total of 12 incidents of arson against abortion providers. By comparison, from 1994 to 1999 there were 48 such incidents.
A U.S. Supreme Court ruling in Scheidler v. National Organization for Women handed down on Feb. 28 lifted a 20-year-old injunction protecting women's health clinics from violent anti-choice protestors. The court ruled that federal racketeering statutes can't be used to bar protests outside clinics because the federal Freedom of Access to Clinic Entrances (FACE) Act of 1994 has been enacted in the interim to prevent attacks.
Saporta doubts the court ruling will embolden attackers. "There is no license for those who oppose abortions to commit acts of violence against clinics," she said.
Karen Kubby, executive director of an Iowa clinic, agrees. In addition to FACE, she says the existence of local "bubble ordinances"--which create buffer zones around clinics to protect patients and staff from protesters' harassment--mean the ruling won't jeopardize clinic safety.
Jennifer Zahn Spieler is senior reporter for The Sitting Duck, an independent newspaper in Washington state.
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National Abortion Federation:
National Coalition of Abortion Providers:
The Alan Guttmacher Institute: