Women’s health: why women’s care should galvanize health care reform

Even after President Barack Obama set the record straight on health care with his speech to a joint session of Congress on September 9^th, calling out misinformation on both sides, misconception continues to swirl around the debate. Perhaps one of the most dangerous lies being spread focuses on abortion and the use of public money to fund procedures. Groups on the right are spreading a myth that health care reform will not only use public money to pay for abortions, but will force plans to cover them and as a consequence of reform the number of abortions in the country will increase.

These myths are dangerous firstly because they threaten to derail the entire debate, and therefore swallow up a chance for real reform by politicizing and falsifying it. But they are also highly dangerous because they use women’s care to block reform and therefore to block women’s access to better health care—access that, under our current system, is unequal and in great need of repair.

Women stand to gain much from health care reform—they pay more for health care, use the system more often, and are more likely to be underinsured than men. Because women as a group are poorer (earning 78 cents for every dollar earned by men) and use more care (needing additional visits for reproductive health, being more likely to suffer from chronic conditions, and tending to use more preventative care), women spend a larger share of their income on health related costs. But because insurers in most states can consider gender when setting premium rates, women and businesses with predominantly female workforces are often charged more than their male counterparts for equal coverage. And more women lack health coverage than men—45 percent of women, compared to 39 percent of men, were uninsured or underinsured in 2007. [1] Measures under proposal will aid women by limiting out-of-pocket costs, providing more affordable health insurance premiums, and prohibiting insurers from imposing caps on benefits. It can also provide oversight to ensure that women are not disproportionately impacted by the costs of health care.

But despite these facts, their health and right to care have yet to become a galvanizing force for reform, but are rather an excuse to block it. Abortion and women’s access to such care is a delicate and emotional topic in this country, but it is being used to scare voters away from health care reform. The sensitivity of the issue requires subtle consideration—and therefore careful steps have already been taken to ensure that both sides feel comfortable with the bills being considered. In late August, Rep. Lois Capps (D-CA) offered an amendment, called the Capps Amendment, which lays out clear boundaries that walk the fine line between the two emotional sides to the abortion debate.

With the Capps Amendment, insurers who sell policies on the national insurance exchange, one of the bipartisan solutions to health care reform, would not be required to offer abortion coverage, nor would they be prohibited from doing so, true for both private and public plans on the exchange. Each region of the country would also be required to have at least one plan available that covers abortion and one that does not.

The amendment would also respect state laws on abortion. Currently, in Idaho, Kentucky, Missouri and North Dakota, private insurance coverage of abortions is restricted to cases in which a woman’s life is in danger unless she purchases an insurance rider for an additional fee, according to the Guttmacher Institute. Oklahoma has a similar restriction, but also allows abortion in cases of rape or incest. These restrictions would go untouched with the Capps Amendment. Medicaid coverage of abortion would also continue to be restricted by the Hyde amendment, which prohibits federal funds from being used to provide abortions services except in cases of rape, incest or danger to a woman’s life, even if pending legislation were to extend Medicaid coverage. Although in my view these restrictions deny women an important facet of care, the sensitivity of the issue should keep their consideration out of current reform.

The assertion that Obama’s plan would pay for abortions becomes even less relevant when considering that not only do plans currently cover abortion treatment by and large, but the public is largely in support of reform continuing this coverage. A Guttmacher Institute survey found that around 86 percent of employment-based health plans currently cover abortion, and the Kaiser Family Foundation’s 2003 Employer Health Benefits Survey found that 46 percent of workers have coverage for abortion services. And when looking at larger firms, the rate is more than 50 percent. [2] (The discrepancy in numbers is likely due to a difference between the questions asked.) But more importantly, a recent poll conducted by the Mellman Group for the National Women’s Law Center found that 71 percent of voters supported requiring health plans to cover women’s reproductive health services if both a health exchange and public option are established.

President Obama spelled out a now given fact in his speech to congress by stating, “Under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place.” That is the simple truth—period. But one thing reform will do is ensure that women have better access to health care by doing away with discrimination in fees and coverage and bringing down the costs.

It is time women are put at the forefront of the debate not as a way to derail it, but as a prime example of why the country needs reform.