Written by Lisa Codispoti and Brigette Courtot,
National Women's Law Center
On Monday, President Obama released his health reform plan in advance of Thursday’s bipartisan health reform summit. The President’s plan bridges some of the differences between the Senate and House health reform bills, but largely builds from the Senate bill (see NWLC's comparison of key provisions of the House and Senate bills). Now we wait to hear from Republicans what concrete proposals they will offer to address our nation’s health care crisis (although many of their proposals have been included in the President’s proposal). But what does all this mean for women and access to comprehensive, affordable, quality health care?
Cross-posted from NWLC's blog
At the start of this debate some time ago, the National Women’s Law Center issued “8 Questions to Ask About Health Reform Plans” to guide advocates in analyzing whether health reform proposals meet the needs of women. Below, we’ve used these questions to analyze President Obama’s proposal, and will do the same for the Republican proposal once they release it. These questions can be a helpful guide for women’s advocates as they watch the Summit (you can watch it live Thursday at 10am) -– to decide for themselves if different health reform proposals will truly provide access to affordable, high quality, comprehensive health care.
At the start of this debate some time ago, the National Women’s Law Center issued “8 Questions to Ask About Health Reform Plans” to guide advocates in analyzing whether health reform proposals meet the needs of women. Below, we’ve used these questions to analyze President Obama’s proposal, and will do the same for the Republican proposal once they release it. These questions can be a helpful guide for women’s advocates as they watch the Summit (you can watch it live Thursday at 10am) -– to decide for themselves if different health reform proposals will truly provide access to affordable, high quality, comprehensive health care.
Whatever the outcome of the Summit, make no mistake: Congress must move forward to quickly adopt comprehensive health care reform. Women and their families can no longer wait.
Questions to Ask About Health Reform Plans to Ensure They Meet the Needs of Women
Question: Does the plan expand access to ensure that health coverage is available to all? Health insurance coverage provides women with greater access to health care and improves health outcomes. But millions of women remain uninsured and underinsured in the current health care system. Health reform plans must expand access to health coverage to all women, regardless of age, disability, geography, sexual orientation, income, health, work, or marital status. A truly inclusive health care system is one in which no one is left out.
Answer: President Obama’s proposal will establish new health insurance exchanges, new marketplaces where women and families and small businesses can shop for and compare insurance plans that must meet certain standards. Insurance coverage — with subsidies for those who can’t afford it — will be available regardless of factors such as health status, gender, disability or marital status. Those without access to affordable health care through their employers will also be eligible to obtain coverage through the exchanges. Unfortunately, the President’s proposal does not address health access problems specific to immigrant women. His plan does not change the Senate provision that would prohibit undocumented immigrants from purchasing health coverage at full cost — and with their own private dollars — in the new exchanges, nor does it change current law requiring legally present immigrants to wait five years to obtain Medicaid, maintaining a barrier to perhaps the only affordable health care coverage option for this population.
Question: Does the plan provide care that is affordable? Women have lower incomes than men, in general, and a greater share of their income is consumed by health care costs. Regardless of whether they have health coverage, women are more likely to delay or avoid getting the care they need because they cannot pay for it. Health coverage must be affordable relative to income. Moreover, affordability should be based on all the costs of a woman’s health care, including her insurance premiums and out-of-pocket costs like deductibles and copayments. There should be adequate subsidies for those who are ineligible for programs like Medicaid but can’t afford the total cost of their health coverage.
Answer: President Obama’s proposal will ensure access to more affordable health coverage by expanding eligibility for Medicaid for those up to 133% of poverty (or about $29,000 for a family of four) and providing sliding scale tax credits for insurance premiums and help with out of pocket costs for those up to 400% of poverty (or about $88,000 for a family of four). The President’s proposal also makes prescription drugs more affordable for older women by closing the “donut hole” in the Medicare prescription drug benefit, which currently requires seniors who reach a coverage limit to pay the full cost of expensive medicines.
Question: Does the plan ensure comprehensive health coverage? Health insurance must cover the services that women need to stay healthy and to treat physical and mental illnesses at all stages of life. Health reform plans should set a standard for health benefits that require coverage for all necessary care, including preventive care and a full range of reproductive health services.
Answer: President Obama’s proposal will ensure access to more comprehensive health care coverage for many women. Plans sold in the new exchanges must cover a comprehensive set of health care services that women need –- including maternity care, prescription drugs, mental health coverage, and no-cost preventive care. All current health plans will eventually be required to provide no-cost coverage of preventive care services. Unfortunately, the President’s proposal adopts the Senate bill’s harmful provision on insurance coverage of abortion services, which includes a “two check provision” that creates an arbitrary and burdensome system for abortion coverage by private insurers which will deter individuals from purchasing abortion coverage for themselves and their dependents, and deter health care plans from offering it. (For more, here's NWLC's fact sheet on the Senate’s abortion provision.)
Question: Does the plan adopt insurance market reforms to end unfair practices? Women and their families are often at the mercy of insurance companies, especially if they must purchase coverage directly from the insurers through the individual insurance market. In many states, insurers can deny coverage to people with pre-existing health conditions; charge people more for their coverage because of their gender, age or health status; raise premiums significantly without oversight; refuse to cover treatment for certain conditions; and even revoke insurance policies for people who have been paying premiums for years. Reform proposals must end these unfair practices and promote a strong watchdog role for government to ensure that the reforms are implemented. Importantly, while state level insurance market reforms can begin to address these problems, more than half of all people with job-based insurance are covered by health plans that are not subject to state insurance regulations. Only federal regulations will have an impact on the coverage that this sizeable population receives.
Answer: President Obama’s proposal will end many unfair insurance industry practices. The plan would prohibit insurance companies from setting premiums based on gender and health status for individuals and small businesses, and require insurers to provide insurance coverage to all people regardless of pre-existing conditions. All plans would eventually be required to allow adult dependents would be able to stay on their parent’s health plan up to age 26, and would be prohibited from setting annual or lifetime dollar caps on coverage. Unfortunately, as in the Senate bill, the ban on gender and health status rating is only for the individual and small group insurance markets, so that larger groups (i.e.: employers with more than 101 employees) would still be subject to these unfair practices. The President’s proposal also strengthens accountability for insurance companies by creating new state and federal authority to review unreasonable or unjustified insurance premium increases, and ensures insurance companies spend premium dollars on medical claims -- by effectively limiting how much they can spend on CEO salaries and profits.
Question: Does the plan preserve or expand the role of public health insurance programs? Medicare, Medicaid, and the State Children’s Health Insurance Program (SCHIP) currently provide publicly-funded health insurance for nearly 50 million women. These public coverage programs serve as a vital health safety-net for low-income women and their families, and they must be preserved or expanded as part of any comprehensive health reform proposal. Since the majority of uninsured Americans are low-income, public coverage expansions have the potential to significantly reduce the ranks of the uninsured. Moreover, health reform proposals should establish an affordable public plan option in which anyone — regardless of income level, family, or job status — can participate. Even higher-income families and those who already have private health insurance should have the choice of purchasing coverage under a public health insurance plan.
Answer: President Obama’s proposal will expand Medicaid so that more low-income women and families are eligible for the program. The proposal would establish a new uniform floor for Medicaid eligibility, whereby people with incomes up to 133% of the federal poverty level (or about $29,000 for a family of four) could qualify for the program based solely on their income. Currently, Medicaid eligibility is based on income and other factors such as whether an individual is pregnant, parenting, or disabled. The President’s plan does not, however, include a public health insurance plan option.
Question: What is the role of employer-sponsored health coverage? Proposals that rely on the current system of job-based health insurance must help employers and workers alike. For example, the plan should help small or low-revenue business owners who want to provide health coverage to their employees but cannot afford the cost, and it should capture contributions from employers who don’t provide health coverage. Given that more than 20 percent of uninsured women work part-time, health reform plans should also help part-time employees and their partners or dependents access comprehensive coverage.
Answer: President Obama’s proposal will help more small businesses provide coverage to their workers, and would require contributions from larger employers whose workers get subsidized insurance through the new exchanges. The plan will provide $40 billion in tax credits to small businesses to help them provide insurance coverage for their employees. It also includes an employer responsibility provision to require businesses with 50+ workers to pay a fee if their employees receive government subsidies to purchase coverage through the new health insurance exchanges (e.g. if the employer offers no coverage at all, or only offers coverage that is not affordable for the worker). Part-time employees will be able to get insurance coverage through the exchange – with tax credit subsidies if income-eligible.
Question: Does the plan address health disparities faced by women in minority groups, as well as those women who live in rural and underserved areas? Access to quality health care is not equal among women. Women of color are more likely to be uninsured than their white counterparts; over a third of all Latinas lack health insurance, for instance, which is more than double the proportion of uninsured white women. Rural communities experience higher rates of chronic disease and have poorer overall health than their urban counterparts. Health reform plans should promote equity in health care access, treatment, research, and resources for all people in order to eliminate disparities in health outcomes and improve health and life expectancy for all.
Answer: President Obama’s proposal will reduce health disparities by making access to health coverage more equitable and by requiring the collection, analysis, and dissemination of health disparity data. The President’s proposal requires all federally supported health care and public health programs to collect standardized data on race, ethnicity, gender, geographic location, socioeconomic status, language, and disability status. The proposal also bolsters the health care provider workforce in underserved areas, so that women in rural and inner-city communities will have better access to the health care they need.
Question: Does the plan take steps to control costs, while ensuring quality care? Health reform can only be sustainable if plans address rising health care costs without compromising the quality of health care. Plans can promote effective cost controls that will also improve care, including secure electronic medical records, an emphasis on preventive health care, greater reliance on evidence-based protocols and lower drug and device prices, and better management and treatment of chronic diseases.
Answer: President Obama’s proposal will slow the growth of health care costs while promoting higher quality care by supporting delivery system innovations to make health care more patient-centered and better-coordinated. President Obama’s health plan uses a variety of tools to help control costs by reining in insurance company abuses, using new, innovative ways to reimburse providers for health care, covering preventive care and chronic disease management. The plan also includes improvements in health care quality to address harmful and costly problems like preventable medical errors or duplicate tests and procedures.
Cross-posted from NWLC's blog