By Rebecca Harshbarger
Tuesday, November 3, 2009
Health care reform promises to protect domestic violence survivors from insurance companies that consider abuse a pre-existing condition. Some advocates say what is really needed is a public plan that helps victims leave their abusers.
NEW YORK (WOMENSENEWS)--In eight states and Washington, D.C., it is legal for health insurance companies to deny coverage to an applicant with a suspected history of domestic violence.
Those states are Idaho, Mississippi, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota and Wyoming.
The National Women's Law Center in Washington, D.C., highlighted this information a year ago in a report, and the issue has gained political traction as Congress buckles down to choose a final health reform bill.
Washington state Sen. Patty Murray, a Democrat, introduced legislation to protect survivors on Oct. 1, the first day of Domestic Violence Awareness Month.
The Security and Financial Empowerment Act protects women from being penalized by insurance companies for being abused. Murray introduced the bill, which is now being considered by several congressional committees, at a time when the health care debate has triggered a larger conversation about domestic violence and health insurance.
Murray attempted to pass similar measures in the past, but a Republican-controlled Senate committee blocked her.
Five days after Murray introduced the legislation, Democrat leaders, including House Speaker Nancy Pelosi, promised to ban the practice. On Oct. 29, when Pelosi and other Democrats released the House's health care reform bill after six months of negotiations, it had a section that explicitly prohibits insurance companies from classifying domestic violence as a pre-existing condition. On a larger scale, it forbids insurance companies from discriminating against people with any pre-existing conditions.
Even if health reform succeeds in banning the exclusion of abuse survivors from coverage, that might not go far enough, said Kim Fountain, deputy director of the New York City Gay and Lesbian Anti-Violence Project, which seeks to eliminate domestic violence in same-sex relationships.
Fountain said health care reform is needed to help those in abusive relationships access insurance that can cover the multiple needs of survivors, which costs victims--not the abusers--millions of dollars in medical-related expenses.
What many victims and survivors really need is public insurance, Fountain says, since it is common for them to stay in abusive relationships for financial and health coverage reasons.
"One of the main approaches of abusers is to isolate the victim through tactics that involve getting them fired from jobs or making it impossible for them to get or hold jobs," Fountain told Women's eNews. "This creates fear and dependency, by leaving the victim with no insurance of their own."
Murray, who supports the public option, made a similar comment when she introduced her recent legislation. "We also need to look at the larger financial system and ensure that no victim ever has to choose between personal safety and economic security," she said.
The Democrats' leading House health reform bill, America's Affordable Health Choices Act, does include a public plan. Adults could purchase coverage on a new national insurance exchange, where private plans would compete with a public option. [Subhead] One Reform Bill Weaker
The three other major health care reform bills in the Senate and House ban denial of coverage due to all pre-existing conditions, whether related to abuse or not.
However, the Senate Finance Committee's health reform bill, which excludes the public option, is weaker--with a more marginal prohibition on pre-existing conditions. It says that only employees in small businesses, those with less than 100 employees, cannot be denied health care due to pre-existing conditions. Employees in large businesses could still lose coverage due to pre-existing conditions, leaving millions of Americans vulnerable.
Maya Rockeymoore is the director of Leadership for Healthy Communities, a Washington-based national program that promotes better health policy on nutrition and low-income children in the United States. "It's hard to sometimes go into the mind of insurance companies, but I suspect that they are always looking to offset their risks," she told Women's eNews. "I would assume that they do this in order to hedge their bets and reduce costs. Companies stay away from people who have had traumatic events in their life. But that doesn't condone it."
Even companies in states that don't allow insurers to exclude coverage for abuse survivors sometimes get around the law, said Judy Waxman, vice president of health and reproductive rights at the National Women's Law Center, in a recent phone interview.
"Somebody could be turned down for having had counseling or because they were in the emergency room and questioned further for being a crime victim," she said.
In addition to restricting and denying coverage, some insurers will raise the rates for victims, concerned that they are more likely to use health care facilities than those in healthy relationships.
More than a decade ago, the House Judiciary Committee found that half of the country's largest health insurers considered domestic violence as a factor in deciding whether to approve health coverage.
In 1994, then-New York Rep. Charles Schumer's staff surveyed 16 insurance companies and found that eight would not write health, life or disability policies for women who had been abused.
Many state legislatures have since passed laws to prevent insurers from using a patient's documented history of domestic violence against them. For instance, California created an insurance code in 1998 that prohibits companies from limiting or denying coverage to victims and from increasing rates for those with a history of abuse.
Waxman said some people know how to use such laws. "A woman in New Mexico knew enough when she was turned down that she called her insurance commissioner and said she had all these conditions because she was a crime victim. She was able to get the insurance. That was when someone knew enough to raise the issue with the right people."
Rebecca Harshbarger is a journalist based in New York. You can read her blog, From Kampala to New York, at www.ugandabeat.wordpress.com.
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