Because most philosophies that frown on reproduction don't survive.

Monday, August 27, 2012

Did RomneyCare Reduce Abortion?

There's a claim being made that Obama's Affordable Care Act will significantly reduce abortions, despite the concerns voiced by the US Catholic Bishops about the ACA funding abortions, on the theory that providing people with a guarantee of contraception and pre-natal care will reduce the "need for abortion."  The original basis for this claim is, so far as I can tell, a 2010 article by Patrick Whelan, the president of the Catholic Democrats, published in the New England Journal of Medicine. This article states:
The number of abortions in Massachusetts in 2006, the year before the new law was implemented, was 24,245, including 4024 among teenagers. I obtained data from the Massachusetts Department of Public Health for each of the two subsequent years.... In 2007, the first year of Commonwealth Care, the number of abortions fell to 24,128, and in 2008, it fell to 23,883 — a decline of 1.5% from the 2006 level. The number of abortions among teenagers in 2008 fell to 3726, a 7.4% decline from 2006. These decreases occurred during a period of rising birth rates, from 55.6 per 1000 women 15 to 44 years of age to 56.9 per 1000 in 2006 and 57.2 per 1000 in 2007 (the latest year for which data are available from the Massachusetts Department of Public Health), and an increase in overall population (in 2008, the Massachusetts population surpassed 6.5 million for the first time, and it was nearly 6.6 million in 2009, according to the Census Bureau). The abortion rate thus declined from 3.8 per 1000 population in 2006 to 3.6 per 1000 in 2008. Overall, since 2000, the number of abortions in Massachusetts has dropped by 12% (from 27,180 to 23,883) and by nearly 36% since 1991.
Now, as you can see from the quote, the claim here is already a little dubious. Dr. Whelan would like to attribute the last couple years drop in abortions to RomneyCare, but he of course has to admit that abortion had fallen much more in the years before, without the benefit of universal health care.

A couple days ago, Brian Fung of the Atlantic published a piece in which he appears to have updated Dr. Whelan's data using the same rough estimation methodology: getting the raw number of abortions per year from the Massachusetts Department of Public Health and dividing it by the total Massachusetts population (men and woman of all ages). Based on this update, he reports that the raw abortion rate (number of abortions divided by total population) has further reduced to 3.14 in 2011, giving a total reduction in the raw abortion rate of 17%.

Commonweal reported on the Atlantic piece writing:
Writing for The Atlantic, Brian Fung reports, “As the number of insured has gone up in Massachusetts, new state data show a corresponding decline in the number of abortions performed there since 2006.” Since passage of “Romneycare”, Massachusetts’ abortion rate has dropped 17%.

Then Vox Nova writer Mornings Minion piles on, citing the Commonweal piece and writing:
With this in mind, I thought I would share the results of two interesting new studies.

The first shows that abortion rates in Massachusetts dropped by 17 percent after the introduction of Romney’s healthcare reform. Given that the Affordable Care Act is almost identical to the Romney plan, and has some explicit pro-life measures and protections that the Romney plan did not have, we might expect the same outcome at the national level in the years ahead.

The second study tries to estimate the impact on abortion rates from overturning Roe v. Wade. It finds that the most likely outcome is that 31 states ban abortion, and that the overall abortion rate falls by 15 percent. If only 17 states banned abortion, the rate would only fall by 6 percent. In the most optimistic scenario – all but four states banned abortion – the rate would still only fall by 29 percent. That’s basically the best we can hope for.

Is this claim remotely believable?

The obvious question is: Is the decline in abortions in Massachusetts sufficiently unique to suggest that it is Massachusetts's universal health care system which is responsible for the recent decline. Determining this is made difficult by the fact that rigorously calculated data on abortion rates is not available from reputable sources like the Center for Disease Control or the Guttmacher Institute for years past 2008. However, I took a look at the change in abortion rates for a number of states from 2005 to 2008 according to the Census Bureau (2006 was not reported). The results I got showed that Massachusetts had declined in real abortion rate (the number of abortions per 1000 women aged 15 to 44) by 7.24% between 2005 and 2008. This was more than the US average, which was up by 0.86%. However, it was similar to the decreases in a number of other states:
-8.85% in Alaska
-8.96% in Mississippi
-7.15% in Maryland
-10.71% in Nebraska
-7.25% in North Carolina

Other states saw large increases:
+37.06% in Delaware
+15.37% in Kentucky
+36.59% in Louisiana
+22.22% in Pennsylvania

I picked one of the states that had performed similarly to Massachusetts from 2005 to 2008 that I was able to find data online from (Nebraska) and compared their change in raw abortion rate to that in Massachusetts. The result is very similar: Nebraska (not known for its universal health care coverage) saw a 22% reduction in its raw abortion rate from 2006 to 2011, and a 19% reduction in total abortions over those same years. The raw rate dropped from 1.66 per 1000 in population in 2006 to 1.29 in 2011.

Although each article in the above cited sequence offered stronger claims that 'researchers think' there's a link between Massachusetts's health care law and the reduction in abortions in that state, that belief seems to be based on no more than wishful thinking and interviews with low income Massachusetts residents who say they're "delighted" to have access to subsidized contraception. There certainly appears to be no evidence from the data cited to suggest that RomneyCare has reduced abortion in Massachusetts, nor is Massachusetts unique in its declining abortion rates. The claim that ObamaCare will somehow reduce abortion more than overturning Roe is, obviously, hard to prove one way or the other, since any model of what a post-Roe US would look like would be highly speculative. But at the very least, we can say that there is no real foundation for the belief.

1 comment:

Anonymous said...

The embarrassing thing is that Morning's Minion is trained as an economist, and he knows darn well that what he's putting forth as a causal model would get him laughed out of any economics seminar.