By Sharon Johnson
Wednesday, March 17, 2010
As Democrats work to merge House and Senate health care bills this week, women's advocates expect further repairs will be needed on whatever law is finally passed. Three problem areas: abortion coverage, age discrimination, high costs.
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.
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.
Wisconsin Alliance for Women's Health:
Older Women's League:
Maryland Women's Coalition for Health Reform:
California Nurses Association-National Organizing Committee: