…by Meg White
The place Meg puts the stuff she wrote
Treating Domestic Violence as a Preexisting Condition in the Healthcare Debate

by Meg White

After hearing so many miserable stories on the practices of rescission and denying coverage to “high-risk” individuals, I thought I could no longer be all that shocked by how dastardly and despicable private insurance companies could be. But that was before I was told that domestic violence is a preexisting condition.

The Service Employees International Union (SEIU) is bringing attention to the fact that it is legal in eight states and the District of Columbia for insurance companies to deny coverage due to previous instances of domestic violence. This is not merely a legalistic exercise, either: SEIU also notes that half of the largest insurers have used domestic violence as a reason to limit and/or deny care to customers in the past.

When you remove the public relations element, it makes sense that insurance companies would do this to minimize risk. After all, 35 percent of all calls to emergency rooms are related to domestic violence, and 37 percent of women making emergency room visits do so because of abuse from their current or former partner. Surely it gets expensive.

The practice of denying coverage to such victims is clearly reprehensible, and one which insurance companies and their corporate representatives on the Hill will be quick to distance themselves from. Furthermore, if we can assume there will be some sort of healthcare reform passed that resembles what the president laid out in his address last week, one can assume that preexisting conditions, disgustingly unfair or not, will be eliminated from the calculus of who gets insured. The fact that even Republican leaders in Congress can’t defend the idea of preexisting conditions suggests that the practice of denying victims of abuse coverage is likely on its way out.

The information that the SEIU cites on domestic violence as preexisting condition comes from a study published last fall by the National Women’s Law Center, which illustrated that there are plenty more ways in which private insurance companies discriminate against women (because around 85 percent of victims of domestic violence are women according to the Bureau of Justice Statistics, I don’t consider it a stretch to say that denying such victims insurance coverage amounts to sexual discrimination).

But the study also found that individual insurance is more expensive for women due to the practice of “gender rating,” even though women are generally healthier — and engage in more cost-saving preventative care — than men. Also, they found affordable maternal health insurance is notoriously difficult to obtain, leading this cartoonist to quip that just “being a woman” a preexisting condition.

The realities of the job market for women also means fair reform of health insurance may effect women more than men. Women are more likely to work part-time and in undervalued “pink collar” industries, both of which commonly lack healthcare insurance coverage. Furthermore, though there’s no broad scientific data on this, at least two studies I found confirmed my suspicion that women tend to work at smaller companies, which routinely have less secure health insurance profiles on the whole due to their limited bargaining power.

Even before they enter the job market, women are discriminated against in access to affordable healthcare. The Deficit Reduction Act of 2005 gave drug companies an economic incentive to stop offering birth control pills to colleges and other low-cost providers at a discount, meaning that a month’s worth of pills that once cost from $3 to $10 skyrocketed to somewhere between $30 and $50.

All of this makes women (especially poor, uninsured or under-insured women) the perfect poster children for healthcare reform. And as a woman who was for years and up until quite recently uninsured, I don’t mind being used for the cause. What I do mind is having my priorities being used against the cause as well.

Back in July I reported on the effort to use opposition to abortion to galvanize the anti-reform coalition within the healthcare debate. When you look straight on at the argument being made, it appears conservative lawmakers and activists are actually trying to convince religious people to believe that healthcare reform is a giant ruse to provide abortions for all.

To be clear, I respect the rights of citizens to say they don’t want the government to pay for abortions, just as I am allowed to object to my taxes being used to pay for wars or executions via the death penalty. But those same people better be willing to protest health insurance companies for covering the same services. Otherwise, such protesters are merely engaging in class warfare by denying poor women access to reproductive care that has always been available to the people who can afford it.

However hypocritical or nonsensical the argument, Democrats had already bought the threat I’d identified in my piece and caved to it immediately, using a similarly absurd argument (I assume they were trying via truthiness to make it look like they weren’t flaking out on half their constituency):

A letter from 19 House Democrats urging House Speaker Nancy Pelosi to strike such family planning coverage from healthcare reform notes that the lack of funding is a significant deciding factor in whether or not women decide to have an abortion:

The Guttmacher Policy Review, a leading pro-choice research organization noted “that about one third of women who would have had an abortion if support were available carried their pregnancies to term when the abortion fund was unavailable.”

The letter gleefully notes that denying coverage will “save lives by reducing the number of abortions.” But at what cost? Will family planning resources be so strapped by funding exclusions that women won’t be able to get coverage for birth control and emergency contraception, thereby increasing the number of abortions?

And to be precise, the exclusionary funding may not reduce the amount of abortions, but the amount of legal and safe abortions. Just because Congress won’t have to see it, doesn’t mean it won’t be there.

Elsewhere in that article I asked the theoretical question of whether or not we should sell out the issue of choice for the promise of change in our healthcare system. I call it “theoretical” because there was no way any real coalition of Democrats were willing to stand up for women’s rights on such a volatile subject. Of course we’re going to sell choice for change. If anyone had any doubt about it, it was erased when President Obama said in his address to the joint session of Congress on his priorities for a healthcare bill that “under our plan no federal dollars will be used to fund abortion.”

While everyone left of Rush Limbaugh is willing to stand up for battered women, the only people I can find still willing to touch the abortion issue as relates to the healthcare reform effort is the occasional pro-choice or women’s organization. National Organization of Women President Terry O’Neill issued a statement last week in response to Obama’s speech that said in part:

We will not tolerate the use and abuse of women’s health care needs to achieve other political ends. Marginalizing women’s health care marginalizes women as a class.

For far too long, family planning, pregnancy care and abortion have been marginalized as something “other” than basic health care, which NOW believes implicitly contributes to right-wing demonizing of abortion providers. Legislators continue to ban federal health care dollars from abortion, which directly opposes the will of the majority of the public that believes that abortion services should be covered in any health insurance reform plan.

I appreciate O’Neill’s words on the subject, but that’s what NOW does. By contrast, I don’t know anyone who’s willing to take such a stand defending the 30-year precedent of women’s choice if it means losing the healthcare reform battle. And, to be fair, that’s a calculation politicians had to make.

But it’s important to recognize that just because they got what they wanted in the insurance arena, doesn’t mean anti-choice advocates will be willing to stop at the healthcare reform debate. Frances Kissling warned in Salon.com yesterday that the anti-abortion movement is planning on using Obama’s guarantee of no federally-funded abortions in the healthcare reform bill to push for further restrictions on choice, and likened the attempt to the “effort to use public policy and healthcare reform to make abortion less available than it already is and stigmatize every woman who even contemplates it.”

Kissling also writes that asserting “that denying poor women the same access to abortion as other women is moral and ‘what a broad coalition of the faith community had asked for’ is as dishonest as claiming, like Joe ‘You Lie’ Wilson, that the healthcare reform plans are going to provide coverage to undocumented workers” because the “broad coalition” includes many groups that support government-subsidized abortion and family planning services.

So when Congress hammers out its plans for healthcare reform, I’m guessing victims of domestic violence will probably get a break as preexisting conditions fade out of favor. But a truly fair approach to healthcare coverage — one that would not discriminate against poor women — is not politically feasible. At that point we should ask ourselves this question: Is it more defensible to discriminate against poor people and rape victims than victims of domestic violence?


Image courtesy of Nathalie Renaud’s photostream on Flickr.

Originally published at BuzzFlash.com.

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