It Can Get Pretty Expensive to be a Rape Victim

It is beyond traumatic to be raped, yet sexual assault continues unabated. It also continues to stigmatize victims, and too often authorities question whether or not the victim is in whole or in part responsible for the inducing the crime. We add additional societal cruelty to the mix by requiring victims to pay for some or all of the medical care or forensic investigation they need. In the post Roe v Wade repeal, there are nine states that deny women a right to an abortion even in cases of rape: Alabama, Arkansas, Kentucky, Louisiana, Missouri, Oklahoma, South Dakota, Tennessee and Texas. You’d think that after passage of the federal Violence Against Women Act (VAWA), treatment for rape victims would be easy and automatic. It isn’t. As the Kaiser Family Foundation points out in this excerpt (11/1/22), even getting a simple rape test kit, which is supposed to be free, often results in charges to the victim.

• Sexual violence is a public health concern that affects every community and often has lasting impacts on health and well-being.

• While the intent of the Violence Against Women Act (VAWA) is to guarantee full coverage for rape kits or forensic exam services to survivors of sexual violence, some people are still charged for rape kit services. There are several reasons that that could be happening:

• The exam is conducted by an individual who the state does not recognize as a provider of covered Medical Forensic Exams (MFEs). These are typically provided by Sexual Assault Nurse Examiners (SANEs).

• Hospitals’ billing services may not know that the services should not be charged to the victim and send a bill to them for services provided.

• Finding a place to get a rape kit from a provider specially trained in MFEs can be difficult in some places. Only a fraction of hospitals in the US have a trained forensic examiner such as a SANE. This makes it especially difficult to get an exam from a trained provider in rural communities. In addition, there is no government sanctioned national database of SANE providers making it difficult for victims who do not interact with law enforcement or a rape crisis center to know where to go.

• The scope of services required to be performed along with the forensic exam and evidence collection vary by state. Many services that are considered to be the standard of care, outside of the forensic exam and evidence collection process and performed by a provider at the same time or on the same day as a forensic exam (such as medication, x-rays or MRIs), are not subject to the VAWA coverage requirement.

• KFF analysis of a sample of private insurance claims from large employers found that two-thirds (66%) of privately-insured women who likely presented for a rape kit after a sexual assault were charged out-of-pocket costs for some services which are typically included in the minimum standard rape kit services as defined by the US Department of Justice. Women who were charged cost-sharing for services often included in the MFE spent an average of $347 dollars out of pocket.

• Despite the intention of the VAWA to provide no-cost rape kits to all survivors of sexual violence, some survivors still face out-of-pocket charges for minimum standard rape kit.

As Samuel Dickman, a physician, researcher and the chief medical officer of Planned Parenthood of Montana, points out in the June 21st Los Angeles Times, while victims in red states get hit the hardest, even residents of blue states pay for their care after rape: “In the summer of 2021, a woman seeking an abortion came to the Texas clinic where I worked as a physician. She’d been raped and was 15 weeks pregnant. I was the first medical provider she had seen since being assaulted. She told me she hadn’t gone to the emergency room after her rape because she was uninsured and afraid of racking up a huge medical bill… It was not the first time I’ve heard such a story.

“Immediate medical care after a rape — usually delivered in emergency rooms — is essential to the health and recovery of victims of sexual violence. In many ERs, specially trained nurses perform forensic exams to collect evidence for use in a prosecution if the attacker is ever caught. In most cases, the federal Violence Against Women Act — a law that’s supposed to protect survivors of sexual violence — pays for the forensic exam through state-run victim compensation funds.

“But a forensic exam is far from the only medical service rape victims need. They need medications to prevent serious sexually transmitted infections such as HIV, and sometimes they need repair of injuries such as vaginal or rectal lacerations. They often need mental health treatment and usually need emergency contraception to prevent pregnancy.

“Since the federal law doesn’t cover the full range of necessary services, getting them can be financially catastrophic for victims. As my colleagues and I reported in a study in the New England Journal of Medicine, victims of sexual violence are often expected to pay for at least some of their care out of pocket, and that presents a powerful disincentive for women to seek care at a time they desperately need it.

“We analyzed more than 35 million ER visits and identified 112,716 survivors of recent sexual assaults in 2019. More than 17,000 of the victims we identified were expected to pay out of pocket for their ER care; they were charged an average of $3,673. Even privately insured survivors paid, on average, 14% of the total costs of their ER care (more than $900), because most private coverage carries copayments and deductibles, and many ERs are ‘out of network.’ These are steep costs for most people, but particularly for the low-income women and girls who most frequently suffer sexual assaults…

“‘Rape exceptions’ were once the norm in antiabortion states, and even in today’s brutal post-Roe environment, a few Republican lawmakers can’t stomach forcing rape survivors to carry the pregnancy for nine months. The abortion bans in Idaho, West Virginia and Mississippi include nominal exceptions for rape survivors. But to obtain an abortion in those states, victims are typically required to report the crime to police and prove they have received rape-related medical examinations.

“Those innocuous-sounding requirements hide a hard truth. For many survivors, getting medical care after rape comes with an impossible price tag. Knowing they can’t afford a $3,600 medical bill, they won’t seek care at all.” Red state abortion bans are cruel in so many ways. They proselytize inadvertently pregnant women, many without financial means, to have those unwanted children… and do not provide a penny in support for that child once born.

We live in a cruel country where greed and religious fundamentalism trump common sense, where unwanted children are expected to grow up and become normal contributors to society. Young medical students and residents are shying away from careers in red states, where they might face criminal prosecution for practicing their craft. Many who support those abortion bans support the death penalty and ownership of assault weapons that have no legitimate purposes other than being able to kill the largest number of human beings in the shortest possible time.

I’m Peter Dekom, and it hard to understand how those opposing abortions believe that we live in a much better post-Roe v Wade time.