WOMEN AND HEALTHCARE: WHY REFORM NEEDS TO HAPPEN

PART ONE: Biology Matters

Let's face it women's health needs are different than men's. Regular doctor visits are not a luxury but a requirement for women. By the time we begin our menstrual cycles and have graduated from puberty, annual visits to the gynecologist are a necessity to ensure our reproductive system is in good shape. Because women develop an early relationship to healthcare providers, seeing doctors becomes an integral part of our lives. Menstruation, contraception, pregnancy, childbirth and menopause entail continuous interactions with the healthcare system.

Our reproductive systems are not the only reason women see doctors more. Women are also prone to more chronic conditions, such as diabetes, asthma, and hypertension. Because of our reproductive organs we also contract a higher number of serious sexually transmitted diseases such as genital herpes, gonorrhea, Chlamydia and HIV. Without access to early detection of these STDs women's health can be in serious jeopardy.

Even with all the healthcare needs women face there are still more than 17 million American women without any coverage. Though many states have adopted Medicaid funded healthcare for women, for those - especially ages 18 to 40 - who earn incomes too high for Medicaid but are unable to gain coverage through an employer or spouse, their only option is privatized plans. This is where BIOLOGY MATTERS.

Private insurers are not required to follow the guidelines set forth by the Civil Rights Act, HIPAA or the Pregnancy Discrimination Act. This means there are no regulations on how they can determine premiums for women, and oftentimes they discriminate based on age, sex, and previous health conditions. Here are but a few obstacles women must face when trying to purchase private coverage.

GENDER RATING: HOW JUST BEING FEMALE MEANS YOU MUST PAY MORE

According to the National Women's Law Center report in October, 2008, among the plans examined:

* At age 25, women were charged between 6% and 45% more than men for individual market health plans.
* At age 40, women's monthly premiums ranged between 4% and 48% higher than men's monthly premiums.
* At age 55, women were charged 22% less to 8% more than the rates men were charged.

Currently there are only 10 states which prohibit private insurers to base their rates on gender. Those states are Washington, Oregon, Montana, Minnesota, Michigan, New York, Maine, New Hampshire, Massachusetts and New Jersey.

Many private insurers proclaim that according to "actuarial statistics" women, on average, have higher health care costs than men. According to the NWLC, "research demonstrates that in practice, the use of gender rating is often arbitrary and the wide swings in rates charged could hardly be actuarially justified, thereby underscoring the dangers of allowing rates based on gender." Because private insurers have free range to charge women up to 48% more than men based on gender alone, it's no wonder that when it comes to maternity coverage the process to obtain private insurance becomes more frustrating.

MATERNITY CARE: HOW BEING PREGNANT, PREGNANT IN THE PAST OR POSSIBLY PREGNANT IN THE FUTURE CAN MEAN LIMITED OR NO COVERAGE AT ALL

Here is a short clip from Friday's Senate Finance Committee. You may be surprised by what Sen. Jon Kyl (R-Ariz.) has to say.

Because the private insurance market does not have to follow the guidelines set forth by the Pregnancy Discrimination Act, oftentimes their policies are exclusionary of maternity coverage, severely limit the coverage, or simply charge outlandish premiums for the extra coverage. Here are a few examples of what women will face when trying to obtain maternity coverage:

* If a woman is already pregnant, individual insurers in most states are allowed to reject coverage altogether.
* If a woman is already pregnant but is required by the state to be issued coverage, most insurers are still allowed to perceive her pregnancy as a "pre-condition" thereby limiting or excluding maternity services altogether.
* If a woman has been pregnant in the past and is still within the child-bearing years, that can also be considered a "pre-condition" and denied coverage for future pregnancies
* If a woman has had a C-section in the past, most states will allow insurers to reject coverage altogether, charge women a higher premium or impose an exclusionary period during which it can refuse to cover a future C-section.

According to the NWLC, "out of the 3,500 individual insurance market policies that NWLC analyzed, just 12% include comprehensive maternity coverage, and these are available in less than half of the capital cities examined." In fact the NWLC could not find any maternity coverage in the capital cities of Hawaii, New Mexico, North Dakota and South Dakota.

Pre-conditions are yet another obstacle women must face in the private market. Your age, health status, and possibly your prescription medication history can be enough for insurers to reject coverage altogether. According to the NWLC, if you live in D.C., Arkansas, Idaho, Mississippi, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota and Wyoming, and are the victim of domestic violence, insurers ARE ALLOWED TO DENY COVERAGE.

Because the private insurance market does not need to follow the federal guidelines for employer-based coverage, it continues to deny women based on her biology. This is not justifiable actuarial statistics, this is blatant discrimination. It is no wonder that over 17 million women still do not have coverage in the United States. The premiums are too high; coverage is limited and oftentimes rejected altogether. If we want a healthy America we ABSOLUTELY MUST take care of its women because these women are our grandmothers, mothers, wives, sisters and daughters.

ACTION:

Send a message to your senators to oppose any further restrictions on women's reproductive health care, to withdraw a provision that would impose dramatically higher premium costs for middle-age women and men and to support a public health insurance plan. Health care reform should not restrict women's rights!

Thank you for all that you do!