What’s at Stake for Women in Health Care Reform

Marcia Greenberger

To meet women's needs, health care reform must result in affordable coverage - it must include income based subsidies for health care premiums; elimination of caps on services and prescriptions; and a strengthened Medicaid program.

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.

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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

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

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.

This post first appeared on the Huffington Post.

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