Will Health Care Reform Help – or Hurt – Women?

Kay Steiger

Both candidates want to fix our nation's broken health care system. How will women fare under John McCain's plan? Under Barack Obama's?

In August this year, the infamous "Harry and Louise" ads of
1993 returned. This time, Harry and Louise weren’t complaining that the government would take away
their options
on health care. Instead, they called for health care reform and
worried about skyrocketing costs. Health care reform remains a top domestic
concern, and the candidates for president have proposed very different ideas
of how to correct rising medical costs. The two different plans would affect
women in very different ways.

Push Toward the Individual Market vs. Expansion of Federal Benefits

Republican presidential nominee Sen. John McCain’s plan
promotes the individual health care market. Currently, Americans pay for
employer-sponsored health care premiums with pre-tax income. McCain’s plan
would require workers to pay for insurance out of post-tax income; his plan
would offset this by extending a tax credit of $2,500 for individuals and
$5,000 for families. This tax credit can either be applied to a person’s
employer-sponsored plan or to one on the individual market. Additionally,
McCain calls for opening up options by allowing people to purchase health care
plans from providers in other states.

But this push to the individual market isn’t optimal for
women. According to a report
recently released by the National Women’s Law Center,
women have a hard time finding equitable coverage on the individual market,
often paying more and getting less. Right now about two-thirds of women get
coverage though an employer, 16 percent of women get coverage through public
programs like Medicaid, and just 7 percent of women currently get coverage
through the individual market.

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Of women who bought insurance on the individual market, the
NWLC report found that they pay more in monthly premiums at almost every age
than men–6 to 45 percent more for women aged 25 and 4 to 48 percent more at age
40. How can this be legal in the individual market and not in employer-sponsored
coverage? Courts have ruled that Title VII of Civil Rights Act applies to
employer insurance coverage. Only ten states prohibit such discrepancies in
individual market premiums, and two states limit it.

McCain’s plan to allow the purchase of insurance across
state lines could allow some women to purchase coverage in a state where the
insurance industry is regulated against discrimination by gender on the individual
market. However, this is unlikely to happen in practice, since insurance plans
in states with non-discrimination policies are likely to be far more expensive,
and many health policy experts believe that if insurance companies can insure
individuals regardless of their state of residence, the companies would
relocate to the least regulated states, much like the lax financial regulations
in South Dakota and Delaware are magnets for credit card companies.

Frighteningly, too, for women the list of pre-existing
conditions that can lead to a legal denial of health care coverage is
long.  Insurers in nine states and the District of Columbia are
legally allowed to deny coverage to survivors of domestic violence. Insurers
can classify it as a pre-existing condition and deny coverage; other such
conditions include diabetes, a family history of breast cancer, or even
pregnancy. Recent research
even shows that some women can be denied coverage for having had a c-section.
This is largely exclusive to the individual market because the Health Insurance
Portability and Accountability Act (HIPAA), which was enacted by Congress in
1996, prevents employers from denying coverage for pre-existing conditions for
more than 12 months. No such limit exists on the individual market.

On the individual market, women also often struggle to
obtain coverage for maternity care, which often includes prenatal care, the
costs associated with childbirth, and even infant care. Many individual plans
simply do not offer maternity coverage; if they do, maternity care is often
covered as an optional extension to a plan called a rider. A rider often
requires a woman to pay a higher premium for an average of 12 months before she
gets covered for maternity care. The plans often only offer a benefit of a few
thousand dollars–often much less than total maternity care costs.

The NWLC report concludes that riders often end up being a
bad deal for women. Judy Waxman, Vice President and Director of Health and
Reproductive Rights at the NWLC, notes, "Nobody knows that the [individual
market] plans out there don’t cover maternity [care] and the benefits are
terrible."

Employers, meanwhile, are required to cover maternity care
because courts determined it falls under the Pregnancy Discrimination Act of
1978.

McCain has appended a Guaranteed Access Plan to his larger
plan on health care reform, which is a state-by-state strategy for mandating
that those with pre-existing conditions are not denied coverage. The plan
offers little in the way of what conditions qualify as pre-existing and which
states should be targeted first. Some have called this component of his reform
plan "empty
rhetoric
."

In contrast, Democratic presidential nominee Sen. Barack
Obama’s plan to reform the health care system sets up a very different set of
incentives. Obama’s plan maintains current employer-based health coverage but
would also open up the purchase of federal employees’ plans to the general
public. Additionally, Obama’s proposed plan would prevent insurance companies
from denying coverage for pre-existing conditions. Though the plan raises a lot
of questions about who would be covered–for instance, would the plan be
available only to U.S. citizens or those with legal documents?–and how to make
such wide access to coverage affordable, the plan ultimately seeks to make
plans accessible and affordable to anyone wanting to purchase health insurance.

Will Reproductive Health Care Be Covered?

Women need coverage for maternity care, access to insurance
without pre-existing condition exclusions, and fair premiums, but they also
need comprehensive reproductive health care coverage. Moving forward with
health care reform makes many health policy officials that are concerned with
women’s health nervous that services like abortion, perhaps even birth control,
might be eliminated from publicly subsidized plans.
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"One of the critical elements of the benefits package has
got to address the reproductive health care needs of women.  That to me is not negotiable," said Kathleen
Stoll, director of health policy at Families USA.

The expansion of the Federal Employees Health Benefits
package, which Obama’s plan calls for, is unlikely to include abortion coverage
because the package currently has a ban
on abortion services
(PDF). Congress briefly reversed this ban on coverage
for abortion for federal employees in 1993, only to have the ban reinstated by
Congress two years later.

"The problem with the choice issue is that it can derail
some things. And we want to get health care reform and we want to make it
happen," Stoll said. "But it’s hard for me to imagine how you can take one
finite reproductive service off the table out of the many that women need and
call that comprehensive reproductive service."

How low-income people are covered tends also to
disproportionately affect women, because women tend to be
poorer
than men in every racial and ethnic group. "Medicaid is sort of the
major option for low-income people," said Usha Ranji, a senior policy analyst
at the Kaiser Family Foundation.

Currently public programs such as Medicaid don’t cover the
individual service of abortion in most states, except in very rare
circumstances when the procedure might save the life of the mother. But except
for its ban on abortion, Medicaid tends to have much better coverage than the
individual market for reproductive services like annual exams, prescription
drug benefits for birth control, and testing for sexually transmitted
infections than the individual market does.

The proposed
changes
to Medicaid differ slightly between the two candidates. Obama
proposes expanding eligibility for Medicaid and the State Health Insurance
Program (SCHIP), which is a program designed for low-income children. He also
proposes states to have flexibility for implementing the plan, but would
require a federal list of clinical preventative services, like cancer
screenings, be covered under Medicaid. Again, McCain’s plan advocates the
individual market by allowing funds originally dedicated to Medicaid and SCHIP
to be used for individual insurance plans and opposes expansion of eligibility
for these public plans.

Although health care reform for women, who tend to be
getting poorer care on the individual market and are more likely to be living
in poverty than men, will be an uphill battle, there is some room for optimism.
There are a number of women’s organizations fighting to ensure comprehensive
reproductive health care coverage in any upcoming health care reform. Raising Women’s Voices has been gathering stories and
using grassroots tactics to mobilize women immigrants,
women of color, and the most impoverished. They hope that by collecting the
stories of these women’s experiences with the health care system, they can
begin to call for appropriate policy action. "Once [women] hear that they’re not
alone with these problems then they’re willing to speak out about it," said
Lois Uttley, the organization’s director. "[Health care is] getting costly and
the coverage is getting worse."

Women’s health care is an critical component
of any future health care reform. Women need to make their reproductive needs a
priority in the upcoming health care debate. But the type of plans
that we shift toward will be just as important as making sure reproductive
services are covered.

News Politics

Anti-Choice Democrats: ‘Open The Big Tent’ for Us

Christine Grimaldi & Ally Boguhn

“Make room for pro-life Democrats and invite pro-life, progressive independents back to the party to focus on the right to parent and ways to help women in crisis or unplanned pregnancies have more choices than abortion,” the group said in a report unveiled to allies at the event, including Democratic National Convention (DNC) delegates and the press.

Democrats for Life of America gathered Wednesday in Philadelphia during the party’s convention to honor Louisiana Gov. John Bel Edwards (D) for his anti-choice viewpoints, and to strategize ways to incorporate their policies into the party.

The group attributed Democratic losses at the state and federal level to the party’s increasing embrace of pro-choice politics. The best way for Democrats to reclaim seats in state houses, governors’ offices, and the U.S. Congress, they charged, is to “open the big tent” to candidates who oppose legal abortion care.

“Make room for pro-life Democrats and invite pro-life, progressive independents back to the party to focus on the right to parent and ways to help women in crisis or unplanned pregnancies have more choices than abortion,” the group said in a report unveiled to allies at the event, including Democratic National Convention (DNC) delegates and the press.

Democrats for Life of America members repeatedly attempted to distance themselves from Republicans, reiterating their support for policies such as Medicaid expansion and paid maternity leave, which they believe could convince people to carry their pregnancies to term.

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Their strategy, however, could have been lifted directly from conservatives’ anti-choice playbook.

The group relies, in part, on data from Marist, a group associated with anti-choice polling, to suggest that many in the party side with them on abortion rights. Executive Director Kristen Day could not explain to Rewire why the group supports a 20-week abortion ban, while Janet Robert, president of the group’s board of directors, trotted out scientifically false claims about fetal pain

Day told Rewire that she is working with pro-choice Democrats, including Sen. Kirsten Gillibrand and Rep. Rosa DeLauro, both from New York, on paid maternity leave. Day said she met with DeLauro the day before the group’s event.

Day identifies with Democrats despite a platform that for the first time embraces the repeal of restrictions for federal funding of abortion care. 

“Those are my people,” she said.

Day claimed to have been “kicked out of the pro-life movement” for supporting the Affordable Care Act. She said Democrats for Life of America is “not opposed to contraception,” though the group filed an amicus brief in U.S. Supreme Court cases on contraception. 

Democrats for Life of America says it has important allies in the U.S. House of Representatives and the U.S. Senate. Sens. Joe Donnelly (IN), Joe Manchin (WV), and Rep. Dan Lipinski (IL), along with former Rep. Bart Stupak (MI), serve on the group’s board of advisors, according to literature distributed at the convention.

Another alleged ally, Sen. Bob Casey (D-PA), came up during Edwards’ speech. Edwards said he had discussed the award, named for Casey’s father, former Pennsylvania Gov. Robert P. Casey, the defendant in the landmark Supreme Court decision, Planned Parenthood v. Casey, which opened up a flood of state-level abortions restrictions as long as those anti-choice policies did not represent an “undue burden.”

“Last night I happened to have the opportunity to speak to Sen. Bob Casey, and I told him … I was in Philadelphia, receiving this award today named after his father,” Edwards said.

The Louisiana governor added that though it may not seem it, there are many more anti-choice Democrats like the two of them who aren’t comfortable coming forward about their views.

“I’m telling you there are many more people out there like us than you might imagine,” Edwards said. “But sometimes it’s easier for those folks who feel like we do on these issues to remain silent because they’re not going to  be questioned, and they’re not going to be receiving any criticism.”

During his speech, Edwards touted the way he has put his views as an anti-choice Democrat into practice in his home state. “I am a proud Democrat, and I am also very proudly pro-life,” Edwards told the small gathering.

Citing his support for Medicaid expansion in Louisiana—which went into effect July 1—Edwards claimed he had run on an otherwise “progressive” platform except for when it came to abortion rights, adding that his policies demonstrate that “there is a difference between being anti-abortion and being pro-life.”

Edwards later made clear that he was disappointed with news that Emily’s List President Stephanie Schriock, whose organization works to elect pro-choice women to office, was being considered to fill the position of party chair in light of Rep. Debbie Wasserman Schultz’s resignation.

“It wouldn’t” help elect anti-choice politicians to office, said Edwards when asked about it by a reporter. “I don’t want to be overly critical, I don’t know the person, I just know that the signal that would send to the country—and to Democrats such as myself—would just be another step in the opposite direction of being a big tent party [on abortion].” 

Edwards made no secret of his anti-choice viewpoints during his run for governor in 2015. While on the campaign trail, he released a 30-second ad highlighting his wife’s decision not to terminate her pregnancy after a doctor told the couple their daughter would have spina bifida.

He received a 100 percent rating from anti-choice organization Louisiana Right to Life while running for governor, based off a scorecard asking him questions such as, “Do you support the reversal of Roe v. Wade?”

Though the Democratic Party platform and nominee have voiced the party’s support for abortion rights, Edwards has forged ahead with signing numerous pieces of anti-choice legislation into law, including a ban on the commonly used dilation and evacuation (D and E) procedure, and an extension of the state’s abortion care waiting period from 24 hours to 72 hours.

News Politics

NARAL President Tells Her Abortion Story at the Democratic National Convention

Ally Boguhn

Though reproductive rights and health have been discussed by both Democratic Party presidential nominee Hillary Clinton and Sen. Bernie Sanders (I-VT) while on the campaign trail, Democrats have come under fire for failing to ask about abortion care during the party’s debates.

Read more of our coverage of the Democratic National Convention here.

Ilyse Hogue, president of NARAL Pro-Choice America, told the story of her abortion on the stage of the Democratic National Convention (DNC) Wednesday evening in Philadelphia.

“Texas women are tough. We approach challenges with clear eyes and full hearts. To succeed in life, all we need are the tools, the trust, and the chance to chart our own path,” Hogue told the crowd on the third night of the party’s convention. “I was fortunate enough to have these things when I found out I was pregnant years ago. I wanted a family, but it was the wrong time.”

“I made the decision that was best for me — to have an abortion — and to get compassionate care at a clinic in my own community,” she continued. “Now, years later, my husband and I are parents to two incredible children.”

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Hogue noted that her experience is similar to those of women nationwide.

“About one in three American women have abortions by the age of 45, and the majority are mothers just trying to take care of the families they already have,” she said. “You see, it’s not as simple as bad girls get abortions and good girls have families. We are the same women at different times in our lives — each making decisions that are the best for us.”

As reported by Yahoo News, “Asked if she was the first to have spoken at a Democratic National Convention about having had an abortion for reasons other than a medical crisis, Hogue replied, ‘As far as I know.'”

Planned Parenthood Federation of America President Cecile Richards on Tuesday night was the first speaker at the DNC in Philadelphia to say the word “abortion” on stage, according to Vox’s Emily Crockett. 

Richards’ use of the word abortion was deliberate, and saying the word helps address the stigma that surrounds it, Planned Parenthood Action Fund’s Vice President of Communication Mary Alice Carter said in an interview with ThinkProgress. 

“When we talk about reproductive health, we talk about the full range of reproductive health, and that includes access to abortion. So we’re very deliberate in saying we stand up for a woman’s right to access an abortion,” Carter said.

“There is so much stigma around abortion and so many people that sit in shame and don’t talk about their abortion, and so it’s very important to have the head of Planned Parenthood say ‘abortion,’ it’s very important for any woman who’s had an abortion to say ‘abortion,’ and it’s important for us to start sharing those stories and start bringing it out of the shadows and recognizing that it’s a normal experience,” she added.

Though reproductive rights and health have been discussed by both Democratic Party presidential nominee Hillary Clinton and Sen. Bernie Sanders (I-VT) while on the campaign trail, Democrats have come under fire for failing to ask about abortion care during the party’s debates. In April, Clinton called out moderators for failing to ask “about a woman’s right to make her own decisions about reproductive health care” over the course of eight debates—though she did not use the term abortion in her condemnation.