Health Care Legislation Could Change Treatment For Women

There's been much talk of the recently passed health care bill and how it will affect millions of Americans. Host Michel Martin sits down with Marcia Greenberger, founder and co-president of the National Women's Law Center, about how the new law will change health care for women.

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MICHEL MARTIN, host:

Now we want to talk more about health care. The health care overhaul bill signed by President Obama on March 23rd has been lauded as a history making and needed correction to our flawed health care delivery system, or a budget-busting monster that will come back to haunt us in years to come.

There are many aspects of the bill that will be vetted in weeks to come, but we wanted to talk about one overlooked aspect. It makes a lot of changes for women. Here to take us through what these changes are and what they mean is Marcia Greenberger. She's the founder and co-president of the National Women's Law Center. Marcia, thank you so much for being with us.

Ms. MARCIA GREENBERGER (Founder and Co-President, National Women's Law Center): Thank so much for having me here.

MARTIN: Why does this bill have such an impact on women? I mean, I think a lot of people would find that surprising.

Ms. GREENBERGER: Well, they do find it surprising. But, actually, it's probably in some respects more important for women than any other group, not only because women, of course, take care not only of their own health, but also their family's health and because women are in the health care system often, that's their paid professional job, too, but because the health care system has been especially discriminatory and it has not treated women well.

MARTIN: I think that many people might bristle at the notion that the health care system is discriminatory. So if you could just give one example of why you think that is. And if you don't mind, we're going to set the, quote, "question of abortion" aside, because that has many dimensions of it. We will talk about your perspective on that at the end, which you do have.

But why do you say that the health care system is discriminatory, or at least has been discriminatory?

Ms. GREENBERGER: It is something that surprises people when they hear. But there actually is explicit sex-based discrimination in insurance. If you have to go on what's called the individual market to buy an insurance plan, insurance companies will charge women more than men of the same age for the same exact insurance plan, excluding maternity coverage. So, for example, if you are...

MARTIN: So, we're not talking about the fact that women who are of child-bearing age and who are going to have children need more medical services? That's not what this is about, 'cause I think that's the first thing that comes to mind.

Ms. GREENBERGER: Well, it isn't about the maternity. It is true that women generally do use more health care services than men, even excluding maternity, but not that many more services. The National Women's Law Center did a study that showed that some insurance companies will charge women 10 percent more, others 50 percent more. The rates are crazy in their disparities. So, it turns out that it's more expensive for a 40-year-old woman, who doesn't smoke, to buy insurance than it is for a 40-year-old male smoker today in most states.

MARTIN: So, how does this bill address that?

Ms. GREENBERGER: Well, this bill actually explicitly bans what's called gender rating in health care plans, so that health insurance cannot charge women having to buy insurance on their own more than men. It also will ban gender rating in what is called small groups of under 100 employees, because what also happens is for small employers, if the workplace is more women than men, insurance companies will charge that employer more to cover their female employees.

MARTIN: Well, there are some provisions of the bill that specifically speak to women. For example, starting this September, women no longer need to have prior approval from a primary care doctor to see an obstetrician or gynecologist.

Ms. GREENBERGER: Right.

MARTIN: What impact do you think this will have?

Ms. GREENBERGER: Well, that's also very big because often it serves as a gatekeeper to have to go to another doctor to get permission to see an OB/GYN. It becomes more expensive because you have to go to two visits instead of one visit. So, being able to go right to an OB/GYN is very important and for many women it is the OB/GYN that is their primary health care provider.

MARTIN: Some of the provisions of the bill start immediately, but some start down the road. For example, in 2014, the law will require that all insurance policies include maternity care and contraceptive drugs and devices. I think some people might be quite surprised to find that maternity care is not routinely covered.

Ms. GREENBERGER: Yes. If you get your insurance from an employer, the laws that prohibit sex discrimination in employment prohibit the employer from discriminating against its employees. So, women get maternity care and don't have to pay more if it's their employer providing the plan. But if you have to go out and buy it on your own right now, most plans don't offer maternity coverage at all, and if they do, they charge women exorbitant amounts to cover it.

So, one of the really important things is to require maternity coverage to be included and it's got other very good provisions, especially for victims of domestic violence.

MARTIN: I'm going to stop you and ask you talk about that. One of the things that you've talked to us about before you came in to have this conversation is you said that another major change starting in 2014 is that no one can be denied coverage for a preexisting condition. And you're saying that this has particular importance to women. Why?

Ms. GREENBERGER: Well, insurance companies have viewed all kinds of things as preexisting conditions, which either preclude you from getting insurance all together, or say that this particular condition won't be covered. They have included in a number of states that still have not outlawed this practice that if you have been a domestic violence survivor, that is still viewed as you're having had a preexisting condition, which means in some instances women are denied health insurance all together. That will be precluded now.

Also, if you've had a C-section, some insurance companies have refused to offer women insurance at all or have excluded maternity coverage entirely.

MARTIN: There is one big issue with which you take issue, as I understand it. And I understand that, you know, you have a specific point of view about this because you are pro-choice. You do believe in abortion rights. But within that context, there is an issue that emerged over the life of this bill as this bill was being debated that is meant to bar federal funds from being used to pay for abortions.

And the president and the leaders, the congressional leaders say that this is merely maintaining the status quo. What's wrong with that?

Ms. GREENBERGER: Well, we have two problems quickly. First of all, we actually don't think the status quo was a good thing to maintain. Basically, right now, there's no federal funding that's allowed to go to abortions unless a woman's life is at stake or the pregnancy is a result of incest or rape. So, if there's a serious health issue, a pregnancy gone wrong, there is no federal funding available, no matter how serious the health issue for a pregnancy. That to us is wrong public policy and should not have been continued as part of the status quo.

But the second problem is we think this actually doesn't maintain the status quo. It sets up a situation where if women get any subsidy at all to help them pay for the insurance, even if they're paying most of the premiums from their own money, they have to go through extraordinary hoops in order to get coverage that will cover abortion services. And given that abortion services for pregnancy that has gone wrong or where there's really a serious health issue at stake could be very expensive, we are concerned that because of those barriers and hoops, insurance companies that provide that coverage now will actually decide to drop it.

MARTIN: But it's our understanding, according to information that we got from Susan Wood at George Washington University, that only a tiny percentage of abortions today are covered by insurance, about 15 percent, for a variety of reasons. It's either the insurance isn't available or they just prefer it for privacy reasons to pay out of pocket.

Ms. GREENBERGER: Yeah.

MARTIN: So, given that its a minority of abortions in this country are paid for with insurance now, do you really think it'll have that significant an effect?

Ms. GREENBERGER: Well, I think the problem again is that it's very good to have the insurance if you need it. So, especially for those problem pregnancies where a woman's health condition is at stake, that can be the kind of circumstance where a woman never intended to need the abortion to start with and is shocked to find out that the abortion services and coverage aren't available.

So we need insurance not only for circumstances where a woman might decide for whatever the reason is, as you said, that for privacy reasons or whatever, she would cover the cost herself but for those kinds of circumstances that are unintended, unexpected, can be very expensive. And that is a situation that we are especially troubled by.

MARTIN: Marcia Greenberger is founder and co-president of the National Women's Law Center and she joined us today in our studios in Washington, D.C. Marcia, thank you so much for being with us.

Ms. GREENBERGER: Well, thank you, I enjoyed it.

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