What's at Stake for Women in Health Care Reform

Marcia D. Greenberger is the Co-President of the National Women's Law Center.

Audra, a 59-year-old African American woman living in Northeast DC, opted for an early retirement package from her employer two years ago so that she could become a full time caregiver to her ailing father. She imagined that she'd be able to find a new job before her package and health insurance ran out. But, like a growing number of Americans in our current economy, Audra has been unable to find work ever since.

This January, Audra officially joined the ranks of the 17 million uninsured women across the nation. On a dwindling income and without health insurance, it became much more difficult to manage her chronic conditions--diabetes and hypertension--which require regular medication and a strict diet. "I was at the point where I was compromising with the food, and compromising with the medicine," Audra said. "I stopped taking my blood sugar in the morning because I knew that I couldn't do anything to make it better."

Audra's plight demonstrates how much these tough economic times have exacerbated the already severe problems that more and more people face in our current health system. A new U.S. Labor Department unemployment report shows that 663,000 more Americans lost their jobs in March--raising the nation's unemployment rate to a 26-year high of 8.5 percent. For many who have lost their jobs, they've also lost their employer-sponsored health insurance benefits.

The recently-unemployed may be able to extend their health benefits through COBRA coverage, which allows laid-off workers to retain their employer-based insurance if those laid-off workers pay the full cost of that coverage. But this option is generally unaffordable. According to the consumer health organization Families USA, the average national premium costs for family COBRA coverage consume almost 84 percent of average unemployment benefits. And as health care costs climb through the roof, growing numbers of people simply can't afford coverage or health care.

In most states, insurers in the individual health insurance market (where people buy coverage directly from insurance companies) are allowed to set and raise premiums based on health status, gender, and age, refuse to cover benefits related to a pre-existing condition, or deny coverage altogether to individuals with pre-existing conditions, like Audra's hypertension and diabetes.

In our broken health care system, nearly one in five women is uninsured. Even for those who have health insurance, women are more likely than men to have health coverage that has too many gaps, including large co-pays, life-time limits, and exclusions or limitations in needed services like mental health care or prescription drugs. Since women, on average, have lower incomes than men, they are at particular risk of financial barriers to care; one in four women says that she is unable to pay her medical bills, and women are more likely than men to delay or go without needed health care because of cost.

Every woman in this country should have a guarantee of high quality, affordable coverage. Audra's story demonstrates not only why we need comprehensive reform, but some of the solutions needed.

Health care reform that results in accessible care for women means making sure that everyone has access to affordable coverage and health care, and ending unfair insurance practices - such as rejecting applicants based on health history, pre-existing condition exclusions, or setting insurance rates based on gender, health status, or age. It also means providing access to affordable health coverage regardless of employment or family status.

To meet the needs of women, health care reform must result in coverage that is affordable--meaning that it must include income based subsidies for health care premiums and all out-of-pocket expenses; elimination of annual or lifetime caps on services and prescriptions; and a strengthened and expanded Medicaid program.

Finally, reform must provide comprehensive health and prescription drug benefits with coverage for a full range of health services, including wellness, prevention, and reproductive health services.

Policy makers are finally listening to the majority of Americans who are no longer willing or able to wait for reform of our broken health care system. President Obama and key leaders of Congress have taken concrete steps towards this objective and, in last night's speech at Georgetown University, the President again affirmed his commitment to "get health care reform done this year." On Monday, Congress returns from their recess and will continue putting together a health reform proposal.

Opponents of reform are already mobilizing to defeat these efforts, drawing lines in the sand and using the same old scare tactics. But failure cannot be an option--we have too much at stake. The cost of health care is among the top economic concerns of women and their families, and fixing our health care system is key to fixing our economy and providing peace of mind for hard-working Americans.

So, what happened to Audra?

Within a month of losing her coverage, Audra was almost completely out of medicine. A friend at her church then told Audra about Bread for the City, a DC non-profit that provides free food, clothing, legal, medical, and social services to low-income District residents. Community-based health providers like Bread for the City form a critical safety net, organizing and delivering a significant level of health care and other related services to the uninsured, Medicaid beneficiaries, and other vulnerable patients.

Audra was fortunate enough to get an appointment, where she received free medical services, including her medication, and a monthly supply of groceries to help her manage her diet. She was then enrolled in DC HealthCare Alliance, a program that provides a range of healthcare services to uninsured individuals and families with incomes up to 200% of the federal poverty line, or $21,660 for a single person in 2009.

Audra found a temporary solution to the challenges she faced as a single, uninsured low-income woman, and is fortunate to live in a jurisdiction where she qualifies for a publicly-sponsored insurance program. But for too many women in America, this help isn't available - they lack access to even temporary solutions, and they go without the care they need. And Audra can't count on this help lasting for as long as she needs it.

Audra, along with millions of Americans, simply can't afford to wait for meaningful reform that will bring a guarantee of quality, affordable comprehensive health care for us all.

Comments

[kjo46]

I am cynical enough to believe that the opponents of health care reform have a Big Picture in mind-- social darwinism. The poor and uninsured will stop getting health care altogether and will die off. The ones who can afford astronomical insurance rates will continue to feed the coffers.

[ka8uet]

kjo46, I agree with you. The powers that be (the rich and the corporations) have decided that there are too many poor people. The quickest way to get rid of them is to send them to war. The second quickest is to deny them health care. We have for a long time rationed health care in this country based on income. This is still the policy.

[Aimee Stern]

One option for women with no insurance or gaps in theirs is a new free service that can help them price shop for healthcare. Healthcarebluebook.com lets you search for the service or treatment you need in your market area and will tell you the average price health plans pay their doctors and other providers for that service. With that baseline price in mind, you can call multiple facilities and figure out the best price. The ranges in pricing for the same service in the same market and even in the same health plan can be thousands of dollars. So it pays to learn how to shop around.

[Primadonna]

There are more women than men in our ranks ... perhaps its time to put a call out for women of all ages ... mothers, sisters, daughters ... to come together in unison and demand single payer healthcare for us all ... our sons, our brothers and our fathers ... as we give life with heart to all.

HR 676, sponsored by Congressman John Conyers is before the House now. This bill proposes single-payer universal healthcare for all.

[DebbieKat]

I've been bugging my congressman about co-sponsoring this bill for quite some time. I wish there was more progress on HR 676.

[DebbieKat]

We need universal single payer health care. Nothing less will do. Too bad this administration is planning to just like the rest and placating the insurance industry who are a bunch of sharks earning bonuses on the backs of the sick. What a disgusting industry. They'd rather give huge bonuses and salaries to their execs while preventing people from getting life-saving treatment. I wonder how these people sleep at night.

[historymatters]

Real health care reform will never be achieved as long as private insurance companies are allowed to set the tone of the debate (either themselves, or through their bought-and-paid-for politicians in DC).

Continuing to rely on the employer-based health insurance system also is a huge mistake. It limits people's ability to change jobs if they need to, and it puts a horrible burden on American businesses trying to compete in a global economy. Health care costs have gotten so out of control. If we keep things as they are, American businesses will never be able to compete effectively against companies based in countries with single-payer or national health care. That will mean an inevitable and continuing decline in the standard of living for the vast majority of Americans.

[Susan Phelps]

I could not agree more with the article and with this comment. We must make it an ethical and moral priority to separate access to healthcare from employment. What's more, if we must compromise and keep insurance companies, then I believe they must become nonprofits.

[GregBloom]

Thank you, Marcia, for this great column. As a Bread for the City representative, who happened to meet Audra during her first visit to our medical clinic, I'm happy to say that she just recently found a new job, and started this week! It's a temporary position at the moment, and so she still does not have benefits. But she will be able to catch up on rent (our legal department helped her negotiate with her landlord during her long stretch of unemployment). Plus, Bread for the City will still be here to provide her medical care while she works to achieve full-time status.

You can read more about Audra's story, including her own words about the experience here on our blog: http://tinyurl.com/dkqv7k

Of course, Audra is very fortunate to have made it through a difficult period of unemployment with our support, and with the insurance of the DC Health Care Alliance. But every day, we have to turn away many more people who need care, even those who are eligible for DC's great affordable insurance option, since we just do not have the capacity to treat them all. Strong leadership from the public sector is needed as soon as possible.

Greg Bloom
Bread for the City
www.breadforthecity.org

[Robin Reed]

We need health care reform *now*. We can't wait any longer!