Womenstake

Tuesday's Referendum in Missouri Certainly Wasn't about Health Reform

by Lisa Codispoti, Senior Counsel,
National Women's Law Center

If you read some of the press accounts of Tuesday's primary election in Missouri, you might think actually that voters approved a referendum on the ballot to reject health reform, for example, the New York Times headline "Missouri Voters Reject Health Law". But that would be wrong. Missouri primary voters did approve a ballot measure concerning one singular aspect from the health reform law. Let's clarify a few things. 

First, the ballot measure was not about the health reform law. The MO measure purports to target one specific piece of the new law—the so-called individual mandate, which is the requirement effective in 2014 that people—unless exempt—take personal responsibility and have health insurance so that we all have lower premium costs. The new health law is so much more than that. So the referendum had nothing to do with any of the law's important requirements, such as the requirement that insurance companies provide free preventative care, or stop charging women higher premiums just because they're women, or dropping people’s coverage when they get sick, or rejecting people due to pre-existing conditions.

Second, a word about turnout and who voted. The referendum occurred during a primary race in Missouri—which was heavily skewed toward Republican races; they outnumbered Democratic primaries races by almost a third. Accordingly, turnout was expected to heavily skew Republican. Given that those who showed up on Tuesday were not representative of the voting public in Missouri, let alone the rest of the country, the results in Missouri have little if any predictive weight about how the few other ballot measures like this might go. 

Finally, the ballot measure was incredibly confusing—with the exact text of the measure as follows:

Shall the Missouri Statutes be amended to:

• Deny the government authority to penalize citizens for refusing to purchase private health insurance or infringe upon the right to offer or accept direct payment for lawful healthcare services?
• Modify laws regarding the liquidation of certain domestic insurance companies?

If you had to vote on this, would you have known what a yes or no vote meant?

Let's be clear. Passage of Referendum C in Missouri has little practical effect—the health reform law is very much alive. The courts will ultimately decide about the personal responsibility requirement that the Missouri ballot measure addressed. In the mean time, key provisions of the law we all are counting on continue...

The Check is in the Mail Today for Those in the Medicare Prescription Drug "Donut Hole"

by Lisa Codispoti, Senior Counsel,
National Women's Law Center

The new health reform law has many different parts. If you or someone you know is on Medicare and has fallen into the Medicare prescription drug coverage gap known as the “donut hole,” one of those benefits starts today with a rebate check for $250 in the mail. Seniors don’t have to do anything to get their rebate check – it will be sent automatically once they have fallen into the donut hole.  

The “donut hole” describes the Medicare prescription drug coverage gap. Put most simply, under Medicare, the senior pays 25 percent of the cost of prescriptions for the first $2,830 of prescription drugs; but then the senior falls in the donut hole – where the senior has to pay the entire cost of prescription drugs out of pocket, until the senior has reached $6,440 for prescriptions that year, when Medicare coverage picks back up again.

What Women Should Be Listening For at the Bipartisan Health Reform Summit

by Lisa Codispoti, Senior Counsel, 
and Brigette Courtot, Policy Analyst, 
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? 

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. 

Health Reform Is Very Much Alive

by Lisa Codispoti, Senior Counsel,
National Women's Law Center

Opponents of health reform would like you to believe that it is dead. To be fair, it’s been hard of late to know whether to be optimistic, pessimistic or just plain in denial about the chances for passing comprehensive health reform this year. Given the last few weeks, which have felt a lot like a big roller coaster, it’s been hard for even for someone like me ― a perennial optimist ― to feel optimistic about the chances for passing comprehensive health reform.

Before the special election in Massachusetts, we were tantalizingly close to a deal that ironed out the key differences between the House and Senate bills. The change in the composition of the Senate following the special election in Massachusetts has paused momentum while the Congressional leadership and the President decide the best way forward. Publicly, they have turned their attention to the much-needed jobs legislation.

Rest assured, privately, the leaders are meeting to determine the best ways forward on health reform. But while leaders meet to decide the best way forward, the unfortunate result is that the public silence on health reform has even led to some press accounts characterizing health reform as near death. But to paraphrase Mark Twain, reports of the death of health reform have been greatly exaggerated. While there has been a public “pause,” behind the scenes meetings are still taking place, conversations are still ongoing, discussions about the best way forward continue.

Now Is No Time to Abandon Hope – or Our Efforts - for Health Reform That Works for Women...

by Lisa Codispoti, Senior Counsel, 
National Women's Law Center 

There is a lot of Wednesday morning quarterbacking about the reasons for, and impact of, yesterday’s election in Massachusetts. 

As it relates to health reform, I think that more than a few people are getting it wrong. Regarding those who say that the election was a rebuke of health reform, or that health reform is dead, I would say, they are full of Boston Beans. 

Here’s why: Massachusetts already has health reform, with an individual mandate, an employer mandate, and, at 97 percent, the highest rate of people with insurance in the country. As of last fall, a full 79 percent of Massachusetts residents supported their reform plan. And health reform legislation, like in the Senate bill, expressly contemplates allowing states like Massachusetts to continue along. 

And to those who would say health reform is dead, I would say, hold on!! Will it be harder? Yes -- there is no denying that both substantively and politically, it will be a tougher road to hoe. But as we have repeatedly said, if health reform was easy, we would have done it decades ago. 

In my mind, the key reason why health reform is not dead -- and cannot be dead -- is that the 31-million-plus reasons why we need health reform did not disappear with yesterday’s election. Simply put, yesterday’s election did not end the problems of people who lack health care, nor did it end unaffordable health care, nor insurance discrimination, nor gender rating, nor insurance coverage that doesn’t meet the needs of women. 

Health Reform Will End Gender Rating, Kind of, Sort of, Maybe…

by Lisa Codispoti, Senior Counsel, 
National Women's Law Center 

As we’ve discussed here many times before, gender rating is the harmful and discriminatory insurance practice of charging individuals and employers different premiums based on gender.  

For individuals buying coverage directly from insurance companies on the individual market, we found that women were often charged higher premiums than men. In the group market – where businesses obtain health insurance to offer their employees, gender rating affects the overall premium that a business pays, as insurers often determine a group’s premium based in part on the gender makeup of the business.ⁱ Thus, businesses with a predominately female workforce, such as child care providers, visiting nurse associations, and even some smaller school districts, face significantly higher health insurance premiums. How much more? One such employer with a predominantly female workforce estimated that, due to gender rating, her annual premiums were $2,000 higher per employee.ⁱⁱ Due to these higher premiums, gender rating may ultimately lead employers to forgo offering coverage to workers altogether, or shift a greater share of health insurance costs to employees.

While the House health reform bill would completely eliminate gender rating for individuals and businesses, the Senate bill would only eliminate gender rating for individuals and small businesses with up to 100 employees. Unless a state decides – in 2017 – to allow larger employers buy coverage in the new insurance exchanges and thus be subject to these new premium rules, insurance companies will still be allowed to charge larger businesses higher premiums based on the gender makeup of their workforce. 

When final health reform passes, we want to be able to say that gender rating will end. Period. No exceptions, no asterisks. Not kind of, not sort of. Unless the final health reform bill reflects the House language, we won’t be able to say that. Tell your members of Congress that the final reform bill must eliminate gender rating for all individuals and employers as the House bill does. Period. 

And for more information, download NWLC's new fact sheet: Close Insurance Company Loopholes: End Gender Rating in All Health Insurance Markets.

(i) National Association of Health Underwriters, Consumer Guide to Group Health Insurance 1, http://www.nahu.org/consumer/groupinsurance.cfm (last visited July 16, 2008)

(ii) Jenny Gold, Fight Erupts Over Health Insurance Rates For Businesses With More Women, Kaiser Health News, Oct. 25, 2009. http://www.kaiserhealthnews.org/Stories/2009/October/23/gender-discrimination-health-insurance.aspx

Next Step on the Road to Reform: Negotiating Differences Between the House & Senate Bills

by Lisa Codispoti, Senior Counsel, 
National Women's Law Center 

We are closer to adopting health reform than ever before in history. Now that the Senate passed their health reform legislation, the next step on the road to reform is for Senate and House leaders to work out differences between their two bills, and then each chamber would vote on the final compromise legislation. And while there are many common provisions between the bills, there are some key differences that the National Women’s Law Center is carefully monitoring and weighing in on to ensure the strongest possible health reform legislation for women and their families. 

For more details on the differences between the two bills, check out our side-by-side comparison of the two bills [PDF], which examines these differences in greater detail. Here are just a few of the issues we are addressing: 

1. Affordability: Regardless of insurance status, women are more likely than men to face affordability barriers to health care. As we’ve repeatedly said, health reform must make health care truly affordable for all women -– especially those with low-and moderate-incomes. While both bills provide affordability assistance to women and families under 400% of poverty (about $43,000 for a single woman, or $88,000 for a family of 4) by expanding eligibility for Medicaid and providing subsidies for both insurance premiums and out-of-pocket costs, the House provides stronger subsidies for those at lower income levels, and their Medicaid expansion is stronger by providing a more robust package of covered services and ensuring that Medicaid enrollees have access to providers by improving reimbursement for primary care providers. Accordingly, we support adopting the House affordability provisions for individuals and families with income under 250% of poverty. 

2. Insurance Reforms: Women have long faced harmful and unfair insurance industry practices, such as gender rating and pre-existing condition exclusions. Both the Senate and House adopted important insurance market reforms that would limit many of these harmful practices; however, the House bill is much stronger because it would eliminate the practice of gender rating and health status rating for individuals and groups of all sizes (while the Senate bill would only apply these rules for individuals and groups up to 100). Furthermore, the Senate bill includes a potentially harmful “wellness” provision that would allow insurance premium discounts of up to 30% for participating in workplace wellness programs -– but would also, conversely, allow premium penalties (i.e. premium increases) for failing to participate in such programs or meet participation benchmarks. We are very concerned about the impact this could have on women, who may be more likely to face a premium penalty given that women are more likely to have a chronic condition that could limit their ability to meet wellness benchmarks. Accordingly, we support the House insurance reform framework, which would provide more robust insurance regulations that would hold insurance companies accountable, and does not include the harmful workplace wellness premium discounts/penalties.

Paying More for Health Insurance Just Because You Work with More Women Than Men…

by Lisa Codispoti, Senior Counsel, 
National Women's Law Center 

While we have talked a lot about women paying more for insurance than men when they get coverage directly from insurance companies, this can also be a problem when you get insurance through your employer.

As we’ve written about before, gender rating is the common insurance industry practice of charging women and men different premiums for health insurance. Legal in 40 states, this practice means that women who buy insurance directly from insurance companies (in what is called the individual market) often face higher premiums for the same insurance coverage as men until around age 55, then some insurance companies start to charge men higher premiums than women. 

But less well known is that this also happens in the group market -- when employers get health coverage for their employees. While individual male and female employees working for the same employer can’t be charged different premiums by their employers (that would be employment discrimination), insurance companies charge employers different premiums based on the gender make-up of the workforce. 

What does that mean? Employers with majority female workforces, like child care providers, home care providers, dentists and others often face significantly higher health care costs –- simply because they employ a higher proportion of women. And this translates into real bucks: as Kaiser Health News wrote about the Visiting Nurse Association in Pennsylvania, with a mostly female workforce, pays about $2,000 more per employee than the national average for individual coverage. The continuation of health status rating and age rating means this too is a problem too for employers with older workers or sicker workers. 

And while most versions of the health reform bills in Congress would end gender rating for individuals and all employers, the bill reported by the Senate Finance Committee would end gender rating only for employers with up to 100 employees.  So if you happen work for an employer with 101 or more employees who happen to be more women than men, and/or sicker, and/or older, then you’re out of luck: the Finance bill won’t help you.  And since there will effectively be no limits on how insurance companies can charge employers of that size, any guesses as to what you think the insurance companies will do? Furthermore, an employer could effectively be financially penalized facing higher health care costs simply by growing their workforce by a single employee- by expanding beyond the 100 employee limit for the protections against these discriminatory insurance industry premium practices. Probably not the best way to encourage job growth.

This all compounds the problem with some of the other policy proposals in the Finance Committee bill.  For example, the excise tax on so-called “high cost” health plans. This is the tax on insurance companies, that would in turn be passed on to employers and ultimately employees, if you have a health plan that exceeds a certain cost threshold. Problem is, if you happen to work for one of these larger employers, because these discriminatory insurance practices will continue unchecked, you’ll pay more for insurance. Which means, you could be faced with a tax on your health insurance. Talk about a double whammy –- paying more for your insurance just because of the composition of your workforce AND possibly being taxed because of it to boot. 

Fortunately, Senator Barbara Mikulski of Maryland and 24 of her Senate colleagues have called on Senate leadership to ensure that health reform eliminates discriminatory insurance premium practices for all employers -- not just those of a certain size.  

Health reform shouldn’t set an arbitrary limit on the end of gender rating -– it’s just as wrong if you work for an employer with 101 employees, as it is if you work for an employer with 99 employees. Let’s hope they get that one right.

The First Lady's Call to Action

by Lisa Codispoti, Senior Counsel,    
National Women's Law Center 

“If we want to achieve true equality for women … we have to reform the system. The status quo is unacceptable. It is holding women and families back, and we know it.” -- First Lady Michelle Obama

First Lady Michelle Obama’s national call to action underscored the importance of health care reform as a women’s equality issue. And as the Senate is considering the Senate Finance Committee's health care reform proposal right now, her call to action is particularly poignant.

Every day, women must live with the reality that they can be denied health coverage because they had a Caesarean section or because they were a survivor of domestic violence. They have to live with the reality that, though compared to men they only make 77 cents to the dollar, they can be charged different premiums, simply for being a woman.

Thank the First Lady for standing up for women and their families and highlighting the inequities that women face in our broken health care system today.

What Will You Do Today to Honor Senator Kennedy's Life Cause, and Help Achieve Health Reform This Year?

by Lisa Codispoti, Senior Advisor, 
National Women's Law Center 

“And this is the cause of my life – new hope that we will break the old gridlock and guarantee that every American – north, south, east and west, young and old – will have decent, quality health care as a fundamental right and not a privilege.”  Senator Ted Kennedy, at the 2008 Democratic Convention in Denver.

For many of us, the fight for comprehensive health reform is deeply personal; and I am no exception. Awakening this morning to the news of the passing of Senator Kennedy was a punch in my gut.  No doubt, in our fight for health reform, we have lost a great leader for our cause. I am truly sorry that before his passing we were not able to achieve his dream, which at last year’s Democratic Convention, he called “the cause of his life.”  I was there when he delivered that speech – and it was nothing short of electric. 

On the news this morning, you have undoubtedly heard clips from great speeches he delivered over the course of his admirable and unparalleled career. No doubt this included the stirring final passage from the speech he delivered at the 1980 Democratic convention. But perhaps you didn’t hear what he said about health reform. 

“Finally, we cannot have a fair prosperity in isolation from a fair society. So I will continue to stand for a national health insurance.

We must not surrender to the relentless medical inflation that can bankrupt almost anyone and that may soon break the budgets of government at every level. Let us insist on real control over what doctors and hospitals can charge, and let us resolve that the state of a family's health shall never depend on the size of a family's wealth.

The President, the Vice President, the members of Congress have a medical plan that meets their needs in full….I say again, as I have before, if health insurance is good enough for the President, the Vice President and the Congress of the United States, then it is good enough for you and every family in America…..For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives, and the dream shall never die. ”

Senator Kennedy’s words are timeless – and timely; a reminder to us all about how long we have been fighting for this cause. So I want to ask all of you – what will you do today, and tomorrow, and the next day, to help make his life’s cause of health care for all a reality? In honor of Senator Kennedy, let’s redouble our efforts in this fight – which has never been more urgent. Let’s make his dream – his “life’s cause” - a reality.