Is Healthcare Reform Bad for Women?

Nancy Pelosi said being a woman will no longer be a pre-existing condition, others aren't as optimistic

The healthcare bill signed into law March 23 is filled with provisions meant to improve women’s health, such as improved access to preventive screenings and prenatal care. But Terry O’Neill, president of the National Organization for Women (NOW) says that limiting access to abortion and allowing companies to price health insurance based on gender adds up to an overall failure. “On balance the whole bill is bad,” says O’Neill. “It’s heartbreaking to say that, but it’s the truth.”

O’Neill cites restrictive abortion language, a loophole that will allow some women to be charged more for insurance coverage than men, and a 5-year waiting period for immigrants to purchase insurance, so damaging that the whole bill needs to be condemned. Still, others contend that as a sum total, the good outweighs the bad in this bill.

According to O’Neill these provisions are the most damaging to women’s rights:

Access to Abortion
Considered one of the most controversial provisions of the bill, tensions ran high debating how abortion will (or won’t) be covered by insurers. At the 11th hour, President Barack Obama hammered out a deal with pro-life Democrats promising that no federal dollars will be used for insurance plans that cover abortion services.

Essentially, the compromise means that anyone awarded a subsidy to purchase insurance, which is based on income relative to the poverty line, cannot purchase a plan that covers abortion. Instead, they will have to use their own money to have an “abortion rider” added to their insurance plan. Without that deal, the Democratic leadership wouldn’t have been able to wrangle enough votes to get the bill passed.

O’Neill argues that this complicated system not only stigmatizes abortion, but is a slippery slope to all women losing access to insurance-covered abortion. “This scheme is so cumbersome and unprofitable that the easiest path for insurers eventually will be to just not cover abortion,” O’Neill says.

Paying More Just for being a Woman
Right now, women trying to buy insurance on the open market often find their costs much higher than their male counterparts, with the benefits being substandard. The National Women’s Law Center (NWLC) reports that 87 percent of the individual plans currently available to 30-year-old women do not offer maternity coverage.

Healthcare reform will eliminate most—but not all—of this “gender rating.” However, says O’Neill, a loophole exists in the bill that will allow exchange-based plans to charge employers with more than 100 employees higher premiums for women, and they must decide whether to purchase coverage on the exchange or directly through a private insurer. The problem is, exchange-based plans could charge those companies higher rates based on the number of female employees they have. On average the gender rating raises the premium 50 percent.

Another federal law, HIPAA, prevents employers from charging employees more for medical coverage based on their age or gender, so the extra cost would be shared by male and female employees alike. But, O’Neill argues, the extra costs would be felt disproportionately by female-dominated professions, such as healthcare and education.

Paying More for Being Older
Those who purchase insurance through the exchange can be charged more based on their age, too. A 60-year-old could pay up to three times the premium of a 30-year-old, for example. O’Neill argues that this penalty disproportionately affects women who historically earn less than men and live longer.

“Age is not an indicator of illness,” O’Neill says. “We don’t think there should be any age rating for men or women. Everyone should pay the same price, regardless of age or gender.”

How Healthcare Reform Can Help Women
Billions of dollars have been appropriated for programs aimed at benefiting women. Though O’Neill is not convinced that the negatives outweigh the positives in healthcare reform, other experts are encouraged by the changes.

Expanded Access to Medicaid
Currently, women only qualify for Medicaid if they met certain criteria, such as being a mother with very low income, pregnant or disabled. But starting in 2014, everyone earning up to133 percent of the federal poverty level will qualify for Medicaid coverage. The NWLC estimates that up to 4.5 million uninsured women will now become eligible for Medicaid.

“Just saying, ‘If you're poor, you're eligible for Medicaid’ is huge,” says E. Kathleen Adams, Ph.D., professor of health policy and management at Emory School of Public Health in Atlanta. “I think people need to step back and look at the big picture, which is that we're really expanding coverage for millions of poor and near-poor women.”

Improved Wellness Programs
Funds have been allocated to create smoking cessation programs for pregnant women on Medicaid; increase research, education and awareness of postpartum depression; ensure no- or low cost-sharing for preventive screenings such as mammograms and educate young women about breast cancer and support young breast cancer patients.

Also, women were strongly impacted by insurers’ ability to deny coverage based on pre-existing conditions. For example, a previous cesarean section or an incident of domestic violence were acceptable reasons for rejecting applicants, according to the NWLC. O’Neill cautions, however, that the legislation is not strong enough on this issue and insurers will likely search for loopholes to get around this provision.

Improved Support Programs
Through a new Pregnancy Assistance Fund, $250 million will be available over 10 years to provide intervention services for pregnant women who are victims of domestic violence and help colleges set up support programs for pregnant students and young parents. In addition, $1.5 billion Maternal, Infant and Early Childhood Home Visiting Programs will help ensure adequate prenatal care and parenting education for families in at-risk communities.

O’Neill acknowledges that there is a lot in this bill that is good for women. But she says from a policy position, there is just too much that undermines a woman’s equal access to health insurance. The next step for NOW, she says, is fighting to repeal the Hyde Amendment, on which the abortion restrictions are based, and working to get pro-choice candidates elected to replace the staunchest pro-life advocates.

“We needed to tell the truth: Women are being very badly served by this law,” O’Neill says.

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