Monday Media Roundup
Nancy Polikoff: Who is "Family" When We Talk About Family Caregiving Leave?

Carole Joffe: What Health Care Reform Could Be for Women’s Health

Today's post is from Carole Joffe, author of Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us (forthcoming in early 2010). Joffe is professor of sociology at the University of California-Davis and a researcher at the Bixby Center for Global Reproductive Health at the University of California-San Francisco, and she contributes to the blog at

Joffe"I have seen the future and it works" goes the old saying. Well, this writer has seen how the future of health care in America should work. I recently attended a press briefing on women and health care reform held by four Democratic Congresswomen—Jan Schakowsky of Illinois, Gwen Moore of Wisconsin, Carolyn Maloney of New York and Lois Capps of California. All four have taken leading roles in the current health care debates on Capitol Hill and all support H.R. 3200, the main health care bill passed by the House.

The proposals supported by these legislators struck me as bizarrely reasonable. "Bizarrely reasonable" only because what exists currently in many health insurance plans is so breathtakingly unreasonable when it comes to women's health care needs. The current landscape of health insurance for women is one in which a past C-section, even a current pregnancy, can constitute a "pre-existing condition" that can disqualify one from obtaining coverage; a history of past domestic violence can similarly be grounds for exclusion; some policies do not cover maternity care or contraception. (Ironically, at the same time this briefing was held, over in the Senate, during the Finance Committee's deliberations on health reform, the now famous exchange between Senator Jon Kyl of Arizona and Debbie Stabenow of Michigan was taking place. When Kyl, attempting to strike down a provision that would stipulate any benefits a health plan must provide, pontificated that he "did not need maternity care," Stabenow retorted, "I think your mom probably did!")

As the Congresswomen made clear in their statements, and as documented in a report Representative Maloney recently co-authored with Senator Chuck Shumer for the Joint Economic Committee, the particular vulnerabilities women face, economic and otherwise, throughout American society are mirrored in the present health care system. So-called "gender rating," one of the most egregious forms of discrimination in the health care system, in which women are charged far more than men for similar coverage, is now prevalent. (Healthy women can pay anywhere from 6%-45% more than men under some plans). Over half of all medical bankruptcies are filed by female-headed households. Married women, even those who are employed, are more likely to be covered through their spouse's health plan, and thus these women are at risk of losing this coverage if their spouse loses his job. As women generally tend to marry men who are older than they are, a considerable number of women between the ages of 55 and 64 lose their coverage as their husbands transition from employer-based health care to Medicare. Younger women, hit hard by the current weak job market, and no longer covered by their parents' plans, are also particularly vulnerable to being without health insurance—over one quarter of all women aged 19-24 go without, according to the Maloney-Schumer report.

To be sure, all of the Congresswomen at this briefing made it clear that it is not just women whom the current health care system is failing. Disparities along racial and class lines are also very much part of the story. As Gwen Moore, who represents Milwaukee, put it: "If the African-American community in Wisconsin were a country, we'd be 66th in the world in infant mortality." The group most likely to be without health care are those low income people who make just enough to not qualify for Medicaid, the national health care program for the poor. Children are inadequately covered as well. The Joint Economic Committee estimates that at least 121,000 children have lost coverage because of the job losses of their single mothers.

So what is the health care future these Congresswomen want to give us? Obviously, it is one in which each American has access to affordable health care, where there are no exclusions for pre-existing conditions, where there are no longer gender ratings, where people will not lose health insurance if they lose their jobs. But their vision encompasses far more than that. Lois Capps, a former school nurse, eloquently told the assembled journalists that "my life has been devoted to women's health." She spoke of increasing the number of nurses to deliver primary care (a significant cost cutting measure) and of her "firm belief in evidence-based sex-education" (translation—no more public funding of abstinence only sex education, which has been repeatedly shown to be ineffective). She told of the enormous benefits –both in terms of health and cost controls—there would be if there was widespread early screening for cardiovascular disease among women, which we now know often presents differently for females than it does for males. (Indeed, only when women began to be elected to Congress in appreciable numbers, and to take on leadership roles in health care, were women even used as subjects in health care research). Jan Schakowsky spoke in personal terms of her own past difficulties in gaining adequate coverage, and of her deep conviction that "of all the forms of discrimination, the worst is health, it's the most unfair."

In short, the health care reform these women want is not only compassionate, with its attention to reducing current disparities, but smart in its emphasis on prevention. But these savvy politicians are well aware that there is a tough fight ahead. All four are passionate supporters of a public option in any health care legislation, and remain optimistic about its passage—but have no illusions about the depth of the opposition to it. Congresswoman Moore also acknowledged that supporters of H.R. 3200 have not yet done a sufficient job of explaining to the public this legislation would be paid for. Though she is a staunch defender of abortion rights, Lois Capps, recognizing the explosive potential of this issue, has authored an amendment that would keep health care legislation "abortion neutral"—that is, neither extending the (extremely limited) terms on which public funds are used for abortion nor limiting the ability of private plans to provide such coverage (as many now do). But opponents in Congress, including some Democrats, continue to insist that no plan that is part of any health care bill can pay for abortions, even if private funds are used to pay for them.

The following weeks will determine whose vision of health care will carry the day—if indeed, there will be legislation at all. I know who I want to win.

[For more on the current health care debate, and its particular implications for women, see the new Feminist Majority Foundation Website, "Health Insurance and Women"]