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Marcia D. Greenberger Headshot

What's at Stake for Women in Health Care Reform

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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.