Health Reform 'Fix It' Threatens Abortion Care

(WOMENSENEWS)–"Fix it" measures that might emerge this week from congressional Democrats working to join the House and Senate bills on health reform worry Sara Finger.

"It would be a travesty if health care reform resulted in the most significant restrictions on access to abortion coverage in 30 years," said Finger, chair of the Madison-based Wisconsin Alliance of Women’s Health, an independent network of organizations in the state.

Bracing for the possibility that a reform bill will spread to most women the same kind of abortion coverage restrictions that have faced low-income women under Medicaid since 1976, Finger predicts that women’s groups will continue their advocacy efforts on their various concerns–abortion coverage, age discrimination and coverage for low-income women–after Congress finishes voting this month.

"The race for bringing about affordable comprehensive coverage for women is a marathon, not a sprint," she said. "The lap at the federal level is done and now we move on to the states."

Anne S. Kasper, chair of the Maryland Women’s Coalition for Health Reform in Bethesda, also expects unfinished business to be left this month. She sees the Senate bill as a "good starting place in reforming a failing health system."

Kasper says the bill eliminates gender ratings that force women to pay up to 40 percent more for the same coverage as men.

"It also prohibits insurance companies from denying coverage based on pre-existing medical conditions like heart disease and diabetes, as well as previous Caesarean sections and even domestic abuse," she said.

Reconciliation Politics

Because no Republicans in Congress support the Democrats’ plan for overhaul of health care, Democrats are planning to pass the final bill with a simple majority instead of the 60 votes usually required to pass major bills in the Senate.

But first the House and Senate must merge the bills to prepare it for a full vote by Congress.

Under a so-called reconciliation process, the House is expected to first approve the Senate’s version in a vote that is expected this weekend. Then Democrats in both chambers will pass another bill that "fixes" the provisions that the House objected to in the Senate bill and President Obama would sign that bill into law.

The health reform bill, which has been stuck in Congress for nearly a year, is expected to come up for a final vote by March 24.

Pro-choice groups, including the National Organization for Women, Planned Parenthood Federation of America and the Wisconsin Alliance of Women’s Health, are adamant that the restrictions on abortion coverage in the Senate bill be eliminated in the "fix-it" bill.

The major restriction in the Senate bill is a requirement lobbied for by Nebraska Democratic Sen. Ben Nelson that says no federal subsidies can be used to help fund abortion services. Such funding must only be derived from premiums paid to private plans. Pro-choice advocates fear this administrative requirement will be so burdensome that insurers that currently provide abortion services as part of reproductive health care–now in the majority–will stop doing so.

House Bill More Restrictive

The Nelson provision permits abortion coverage if a woman writes two separate checks to her insurance company. Anti-abortion activists in the House, led by Democratic Rep. Bart Stupak, want the "fix-it" bill to be even stricter. Stupak is advocating for a cumbersome requirement that will require women who want abortion coverage to purchase a separate rider.

Democratic leaders have resisted the pleas of pro-choice groups to remove the administrative barriers imposed on insurance providers in the Senate bill. They claim that changes could cost them the support of party members who oppose abortion, which they need to reach the 216 votes to pass the bill in the House.

A major defect of both the House and Senate bills is the age discrimination that will be allowed, says Natale Zimmer, health policy director of the Older Women’s League, or OWL, a Washington-based advocacy group for middle-aged and older women.

Insurance companies will be able to charge middle-aged consumers twice as much as younger customers. A 58-year-old policyholder, for example, would pay about $5,900 a year compared to $2,965 for a 24-year-old.

"Insurance companies justify age ratings because they say older policyholders require more treatments than younger people do," said Zimmer. "But these ratings are a subtle form of discrimination that prevents many older women from obtaining coverage. Women generally earn less than men do and are more likely to work for small companies that don’t provide insurance."

In 2008, nearly 17.6 million women–one out of seven in the United States–lacked health insurance.

Requirement Downside for Women

The Health reform bill requires individuals to buy insurance or pay a penalty. To help individuals shop for policies, states will establish exchanges where consumers can compare policies.

"Women will still have difficulty obtaining affordable insurance," said Geri Jenkins, co-president of the California Nurses Association-National Organizing Committee, an Oakland-based organization of more than 86,000 registered nurses in 50 states. "In the past 13 years, there have been over 400 mergers involving insurance companies, leaving one or two large companies to dominate the market in most states."

The lack of competition, Jenkins said, allows companies to raise premiums to outrageous levels and impose co-pays and deductibles that cause Americans to skip needed care. Viewing that as a critical problem, the California Nurses Association will continue to advocate for the establishment of a single-payer Medicare for all systems in the states.

Another contentious issue in the fix-it bill is the level of Medicaid reimbursement to the states. Medicaid is available to low-income individuals and families.

"Medicaid has been a lifeline for women in the recent recession who lost their jobs and employer-provided insurance," said Zimmer of the Older Women’s League. "Without it, many low-income women would have been without insurance."

In 2008, 850,000 additional women sought Medicaid coverage compared to 2007.

The Senate bill expands Medicaid eligibility and provides federal funds to pay the cost of reimbursement. But because some states like Wisconsin and Massachusetts already cover an expanded pool of low-income people, they would not receive money.

"We hope that the final text of the health care reform bill will fix the reimbursement formula, so that all states will be repaid up to a certain level," said Finger. "This would ensure that Wisconsin and other states won’t be penalized by going above and beyond the federal mandates."

Sharon Johnson is a New York free-lance writer.