There has been a disturbing new development affecting women's access to abortion services in NSW and possibly other states. On June 14, a number of NSW abortion providers decided to no longer bulk-bill their clients.
For women with health-care cards, this will mean the cost of a termination up to 12 weeks of pregnancy will rise from $160 to either $480 or $520. For those without a card, the cost will rise from $190 to the same amount — either $480 or $520. The difference of $40 relates to whether a woman has an ultrasound on the day of the procedure.
Women will then have to take the receipts to a Medicare office to receive a refund of either $300 or $340.
For abortions performed after 12 weeks of pregnancy the up-front costs are even higher.
Since Medicare began, private abortion providers have had to find ways to cover the gap, as scheduled fees fall short of actual costs. To be viable, small-scale abortion providers have charged a "theatre fee" or a "counselling fee", which covers costs more indirectly related to service provision — usually for skilled counsellors. By doing this, the providers have been able to bulk bill for the abortion procedure and/or ultrasound, with other costs covered by the theatre fee or co-payment.
The Bessie Smyth Foundation, previously the standard-setting Sydney feminist abortion provider, always provided access to counselling when it was an abortion provider, yet Bessie's was also always affordable.
After Bessie's sold its abortion clinic and changed focus to be a counselling and referral service, its coordinator, Margaret Kirkby, says they became aware of the government's Health Insurance Commission (HIC) "targeting providers about the theatre fee or co-payment — even though everyone recognised that the Medicare rebate is not enough".
"The decision to stop bulk billing has come about with basically one or two major providers who have led in deciding that up-front fees are now the way to go", Kirkby told Green Left Weekly. "It avoids any possibility of the HIC challenging the arrangements and is bound to be more profitable also if concessions are abolished.
"The HIC hadn't done anything [about the fees] since Medicare was gazetted until Tony Abbott became federal health minister. But now the HIC is arguing that all other services are simply ancillary to the service and should be covered by the existing rebate. But it is not just abortion providers who bill this way, with co-payments being common in other specialties which have costly associated procedures such as opthalmology and gastroenterolgy.
"Abortion providers feel the continual scrutiny of them by the HIC is driven by the anti-abortion sentiment at the top. We can be sure that if we don't voice strong opposition that the other providers will follow suit so that they all will demand fees up-front, with women claiming the rebates later."
This is a significant attack on women's right to choose, most ironically being channelled through the very people who are trying to ensure that choice is available for women — the service providers. Kirkby warned that 'once one provider does this, the others may be thinking that they will be targetted by the HIC if they don't adopt the same approach".
"It's a grim day for NSW women", Kirkby added. "We at the Bessie Smyth Foundation have been approached by working poor women and their partners, by single mothers and others on Centrelink payments because they can't raise $160. So how are women going to raise as much as $520?
"The new billing arrangements mean that for NSW women who attend the clinics run by these providers that there is no longer a reduced rate for health-care card holders. It is considered too complex in terms of the accounting requirements.
"Already we are seeing more somewhat later abortions because women can't always get the smaller amount of cash they need at the beginning of their pregnancies. Three times our allocated budget at Bessie has already been spent on no-interest loans to assist women with the co-payment, and now that the total up-front cost is needed Bessie just doesn't have these resources. Abortion service providers also can't operate like credit providers."
Abortion, like all other medical procedures, should be fully covered by Medicare. Unless it is, women will not have a right to decide if and when to bear a child and will be slaves to their reproductive capacities.
Women seeking terminations in NSW can still contact the Bessie Smyth Foundation — phone (02) 9649 9744 — for information and referral to providers, some of whom still offer bulk-billing or discounts at the moment, and other information relating to pregnancy and abortion support.
Lara Pullin
[The author is a member of the Canberra branch of the Socialist Alliance.]
From Green Left Weekly, June 22, 2005.
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