Women and Health Care: Stay Focused on the Real Benefits of Reform

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Women have a lot at stake in the debate over health care reform. Some seven in ten women are either uninsured or underinsured, and more than half report forgoing care or preventive visits because they can’t afford it. Meanwhile, insurance companies can charge women more for coverage, and can exclude them from plans because of “pre-existing conditions” like pregnancy or being victims of domestic abuse. Finally, women facing cancer or other serious illnesses are far more likely to suffer financial collapse when faced with benefit caps and high out-of-pocket spending limits.

This state of affairs is unacceptable and achieving affordable, comprehensive and accessible care for all Americans should be the goal of any final health reform bill. Both the House and Senate bills would end gender rating (the practice of charging higher premiums for women) in the individual and small business markets. Both bills also would end the practice of denying coverage because of pre-existing conditions and would set minimum benefit standards that ensure access to primary care and preventive services. Finally, the two versions both cap out-of-pocket spending and get rid of lifetime or annual benefit limits.

Yet, despite these important initiatives, controversy over women’s health issues remains strong in the reform debate—even among Democrats and traditional women’s advocates.



Abortion is one issue that continues to rankle. Two years ago when health reform efforts first began in earnest, many women saw coverage of comprehensive reproductive services as a key goal. This included coverage for contraceptives, prenatal care, a range of delivery options and screening—as well as abortion services. President Obama made it clear early on that the federal government would continue its ban on providing funding for abortion, and the procedure wouldn’t be included in any minimum set of benefits. But  now pro-choice advocates are facing the Stupak-Pitts amendment (and a possible amendment to the Senate bill) that would ban abortion in all plans—public and private—that are sold on proposed insurance exchanges.

Removing the Stupak-Pitts amendment (or any similar Senate version) from the final health reform bill has legal and political significance. The abortion ban sets a precedent by pushing government restrictions even further into the private lives of women. Abortion is legal in this country and if insurers want to provide coverage for their subscribers the government has no right to prevent them. Women are correct in wondering if this ban could be extended to contraceptives or fertility treatments under a more conservative administration.

But there are other issues where the feminist agenda has gone remarkably awry. Take the Senate bill’s proposed 5% tax on elective cosmetic surgery, an initiative that could bring in $6 billion over 10 years. Why is Terry O’Neill, the president of the National Organization for Women, taking the side of the American Society of Plastic Surgeons and opposing this tax?

An article by Jesse McKinley in the New York Times says that “middle-age women, who make up a bulk of her group’s financers, would be particularly susceptible to the tax, especially now. Many who have lost jobs might be considering surgery, she said, because they are looking to impress potential employers.

“‘They have to find work,’ Ms. O’Neill said. ‘And they are going for Botox or going for eye work, because the fact is we live in a society that punishes women for getting older.’”

The Times article continues; “Ms. O’Neill said women commonly pay higher health insurance premiums and suffer wage discrepancies from men. ‘And now they are going to put a tax on middle-aged women in a society that devalues them for being middle aged?’”

Christopher Beam, writing in Slate makes the argument that taxing elective cosmetic surgery and procedures is really a tax on working- and middle-class women, not the super-rich; with 70% of clients making less than $60,000 and 85% of them using credit to pay for procedures.

Beam suggests that cosmetic surgery might help some of these women advance economically, and actually stimulate the economy—his point being that research shows that better looking people get better jobs and are paid more than their more homely cohorts. Is this is where Terry O’Neill was heading when she cried foul over the aptly named Bo-Tax?

This seems like a huge waste of NOW’s political clout—supporting women’s vanity and society’s embrace of cosmetic surgery as an acceptable tool for economic recovery.

It is true that women age 40-54 are the group having the most cosmetic procedures. But this group, along with women 55-65, are also the ones most likely to go into medical bankruptcy, to lose their benefits through divorce, job loss or pre-existing conditions. The $6 billion raised through the “Bo-Tax” could go a little ways in remedying these far more serious women’s health problems.

Thankfully, most women’s health advocates seem to be steering clear of making the Bo-Tax a crucial issue for health reform. But that doesn’t seem to be the case with mammography, which became a hot-button issue after the U.S. Preventive Services Task Force came out with new recommendations that advise against routine screening in women under 50. As we’ve described it  here and here at HealthBeat, some advocates insist on seeing these recommendations as a call for “rationing” and an end to insurance coverage of routine mammography in these younger women.

At the blog Disruptive Women in Health Care, Phyllis Greenberger writes, “Okay, it’s enough already! Why is it that women are always the target? First it’s abortions, then mammograms, pap smears following closely, behind and now cosmetic surgery (although that’s not only women!) It looks like the Congress is desperate to find any savings anywhere.”

Senator Barbara Mikulski  (D-MD), giving political voice to this fear, introduced an amendment to the Senate’s health plan yesterday that mandates coverage for women’s preventive health and screening procedures. “I appreciate Health and Human Services Secretary Sebelius clarifying the administration's position on mammograms. However, I remain deeply troubled that the U.S. Preventive Services Task Force recommendation attacks the whole concept of preventive services for women. They say we don't need mammograms until we are 50.”

She adds,  “I believe that where data is conflicting, it is better to be safe than sorry. While the decision about when and how often to get a mammogram should be made by women individually in consultation with their doctors, access to mammograms should be universal so the decision is not made by insurance companies.”

I agree with Senator Mikulski that using the task force’s recommendations as fodder for limiting coverage for mammograms would be jumping the gun. And if her amendment gives community health centers and other primary care centers more funding, that can only be good for women. But I definitely do not agree that the USPSTF recommendation “attacks the whole concept of preventive services for women.” That’s just plain wrong and deceptive; decreasing the emphasis on preventive services was never the goal of the USPSTF guidelines and this knee-jerk response by Mikulski and other health advocates to dismiss them out of hand is a disservice to women.

Do we want evidence-based medicine or do we not? Why are these same advocates not outraged by the implication that a pretty significant share of women are being exposed to excessive levels of radiation and are being over-treated with chemotherapy and surgery they might not need? Or outraged, as the National Women’s Health Network was that even though researchers have known since 1993 that mammography was not a good screening tool, there is still nothing better to take its place. They issued this statement recently;

“We’re glad that the USPSTF has done what they’re supposed to do. They’ve told the truth about what studies have found, and now women have a better chance of getting an honest assessment about the value of a heavily promoted technology.”

In the end, it is vitally important to women—and all Americans—that Congress pass a comprehensive health reform plan this year. As written, minus the Stupak-Pitt amendment, both the House and Senate bills serve as a decent framework for expanding care to the uninsured and underinsured
and for helping right some of the fundamental wrongs in the way women currently experience health care. The key now for women’s advocates is to remain focused on what’s really important—and not start using the health reform stage for more questionable motives.

61 thoughts on “Women and Health Care: Stay Focused on the Real Benefits of Reform”

  1. you pose the key question when you ask whether we want evidence-based medicine or not. it seems fairly clear that the answer for many, if not most, Americans, is not.

  2. “This seems like a huge waste of NOW’s political clout—supporting women’s vanity and society’s embrace of cosmetic surgery as an acceptable tool for economic recovery.”
    I part company with you here, Maggie. I’m a big fan of NOW’s position on women’s health.
    Is breast reconstruction after cancer exempted from the “botox” clause?
    I certainly hope women won’t accept “good enough” health reform designed by men in suits. Let’s stand firm for access to reproductive services including the right to choose. Let’s protect the lives of living women and their children.
    I’ve recently met couples with insurance who were charged $2000 out of pocket to have a baby–to say nothing of the added costs of caesarian delivery or complications for child or mother. Does this encourage the building of healthy families?
    It’s not vanity medicine that motivates NOW to oppose the Stupak clause and its disciples.

  4. Maggie, I have another question that I posted on your December 1st blog “What Health Care Reform Will Mean For Most Americans: the Underinsured,” which I hope that you will answer.
    I have a friend who works a seasonal job where her employer take a large deduction from her paycheck for the insurance. During the months that she is on layoff, she has to pay much more. About three years ago she actually had to drop the insurance because, because the insurance refused to pay for treatment of an ailment because they said it was “pre-existing,” and also because she couldn’t afford to pay for the insurance when she was on layoff. Medi-Cal here in California ended up paying for her treatment of that ailment. I know that under health reform insurance corporations will no longer be allowed to refuse to pay because of “pre-existing” conditions. My question is, due to the large amount that my friend has to pay for her employer’s insurance, will she be able to get a subsidy to help her pay for the insurance and if so, will she have to wait until 2013, or will that apply immediately? For a lot of poor people, waiting until 2013 is still a long time to get relief. I must mention that her employer has an ESOP which my friend has over $2,000 invested, so being able get Medi-Cal anymore is not an option for her. This is even though she has no access to those funds as long as she’s employed there. If you can answer this question, I will appreciate it.

  5. To H.S. If any couple has out-of-pocket for maternity it’s probably because of their deductible and or coinsurance level. And, all health insurance companies, both group and individual cover complications. No individual health policies cover maternity, unless they are an HMO, but all cover complications period. If everyone wants no out-of-pocket costs then the only recourse is national health care with no private options along with a “slight” tax increase.

  6. Thanks to Henry for clarification. I’ll admit I only have anecdotal stories about the costs of complications of childbirth–such as the preemie who had to stay in the hospital for special care. Parents eeventually had $32,000 bill.
    As for that “slight” increase in taxes if we should go to “national health care with no private options,” comparative studies of tax burdens in OECD countries, show that Canadians earning $50,000 or $80,000 (US $) pay “slightly” more in taxes than we do, but end up with more disposable income to spend on non-health care items.

  8. Harriet, reconstructive surgery after deformity, illness, trauma, or surgery will not be taxed. Only elective cosmetic surgery will be taxed.

  9. It does seem like women are always getting the short end of the stick here. About the so-called BoTax, however, would there be exemptions included for fixing deformities or reconstructive surgeries? Although they are categorized as cosmetic surgeries, they are really quite different from the vain surgeries described here, like breast implants or botox.
    Maybe I haven’t been following this closely enough, but how is it possible for government to prescribe that abortion wouldn’t be covered in private insurance plans? Would that apply to all insurance plans, or just the government public option?

  10. So lets see …
    We spend substantially more on healthcare for women than we do for men.
    Women live about 6 years longer than men on average.
    And this is evidence of discrimination against women???????

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  15. Yeah, we should really be more concerned about trying to be healthy. Diet and exercise are the cornerstones of a healthy life. Prevention is always better than all the medicine in the world money can buy.

  16. Medicine is not always the cure. Staying healthy has a lot to do with your lifestyle. Diet and exercise always help… look into natural products as opposed to products produced by pharmaceutical companies who have a more interest in their investors than really finding a cure. That’s my opinion…

  19. Another big fan here of lifestyle and diet helping women to stay healthy. There is much to be said for looking at using holistic methods of treatment-I write about fibroids but keeping the body healthy inside and out (and keeping stress levels low) can help with many conditions which are “helped” by our Western lifestyle.
    However, it’s an interesting article to read.
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  23. F1
    I really like the fresh & innovative perspective you did on the issue. Frankly speaking I was not expecting it when I started off studying. Your concepts were easy to understand. Glad to know that there’s an individual out there that definitely understand

  25. Article is so interesting There is much to be said for looking at using holistic methods of treatment-I write about fibroids but keeping the body healthy inside and out (and keeping stress levels low) can help with many conditions which are “helped” by our Western lifestyle.

  26. There is much to be said for looking at using holistic methods of treatment-I write about fibroids but keeping the body healthy inside and out can help with many conditions which are “helped” by our Western lifestyle.

  27. Its really true,Medicine is not always the cure. Staying healthy has a lot to do with your lifestyle. Diet and exercise always help… look into natural products as opposed to products produced by pharmaceutical companies

  28. I feel that all Americans should be the goal of any final health reform bill. And House & Senate bills would end gender rating in the individual and small business markets. But I think there are other issues where the feminist agenda has gone remarkably awry.

  30. I think women won’t accept “good enough” health reform designed by men in suits. Let’s stand firm for access to reproductive services including the right to choose. Let’s protect the lives of living women and their children.

  31. first We pray to cannot face these problems.. with womens in our family.
    second if happen we have to care these womens.
    because its danger for womens..!!

  32. If Barack Obama’s comprehensive reform bill were passed, consumers would be able to buy discounted health insurance from an index of government-subsidised providers.and the debate over health care reform turned into a debate over abortion rights. Suddenly, a vote for reforming health care was also a vote for curtailing lower and middle-income access to abortions in the United States.

  34. Today many health plans don’t provide a comprehensive set of affordable benefits, forcing women to choose between paying out-of-pocket for necessary service or delaying or skipping care. Better information and benefit plans that are easier to understand, along with subsidies to offset their costs, will make a significant difference for American families

  37. “The first thing I’d do as president is sign the Freedom of Choice Act,”Obama said in his July speech to abortion advocates wooried about the increase of pro-life legislation at the state level…….

  38. I really like the fresh & innovative perspective you did on the issue. Frankly speaking I was not expecting it when I started off studying. Your concepts were easy to understand.

  39. ’tis rightly stated that “health is wealth”…..even if you are very affluent but are struck by any severe disease, then also the life resembles like hell…so its better to be conscious about your health and maintain a big distance from the so-called killers-“medicines”…
    because half half your health is deteriorated by them….so embrace the habit of exercising everyday and keep well…..
    :))

  47. Its an interesting article,I enjoyed reading it,Better information and benefit plans that are easier to understand, along with subsidies to offset their costs, will make a significant difference for American families…thanks

  48. I think women won’t accept “good enough” health reform designed by men in suits. Let’s stand firm for access to reproductive services including the right to choose.

  49. Thanks for sharing these useful information! about tubal reversal is a surgical procedure that restores fertility to women after a tubal ligation Hope that you will continue doing nice article like this. I will be one of your loyal reader if you maintain this kind of post!

  50. I like your post, the fact that the Medicines is not always the cure,Diet and exercise also help…. This article gives the light in which we can observe the reality.thanks

  52. I totally agree that this state of affairs is unacceptable achieving affordable, for all Americans…and I think it will make a significant difference for American families.

  56. Well Diet and exercise are the cornerstones of a healthy life. Prevention is always better than all the medicine in the world money can buy..Thanks for sharing with us..

  59. It’s really true that Medicines is not always the cure ,Diet and exercise also help.. I totally agree that this state of affairs is unacceptable achieving affordable, for all Americans.

  60. This seems like a huge waste of now’s political clout—supporting women’s vanity and society’s embrace of cosmetic surgery as an acceptable tool for economic recovery.

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