Forgive me if I sound a little bitter despite being deeply moved by the passage of the Affordable Health Care Act this past weekend in the House. It IS a huge achievement and one-third of what we need to get the bill to President Obama to sign. I'm proud and grateful so many wonderful elected representatives who truly want to help Americans were able to move mountains and pass the bill.
It's just that, well, that was quick. We had a wonderful feminist moment there, didn't we, when we realized that women are treated differently than men by health insurers. We finally exposed the widespread practice of gender-rating--or disparate pricing by gender--for health insurance coverage that unfairly requires women to pay more than men with similar health status. We learned how eight states still allow insurers to consider domestic violence as a "pre-existing condition" to deny women coverage. We saw documentation of how common it is for women to be uninsured and underinsured whether it's employer-based coverage or self-procured, and how this made health insurance reform of particular interest to women. A quick statistic from the Commonwealth Study linked immediately above:
Six in ten women with moderate incomes (between $20,000 and $40,000) report being unable to pay medical bills, being contacted by a collection agency for unpaid medical bills, changing their way of life to pay medical bills or paying off medical debt over time, as did almost half (46%) of middle-income women.
Women rallying support around health insurance reform, I maintain, helped lift poll numbers for the public option and lift some of the curse extremist Teabaggers had tried to cast on the bill.
The moment lasted all of two weeks, concluding with the release of the Shriver/Center for American Progress report, A Woman's Nation Changes Everything. Among much interesting data, we discovered that women have now crossed the 50% threshold as co-breadwinners--or in some cases, sole breadwinners (for themselves and their kids if they have them). For a moment, it looked like a gendered analysis of health insurance coverage and a recognition of the centrality of women as not only consumers, but producers and drivers of the American economy, might result in real, truly beneficial change.
Then, this past weekend during the vote, conservatives launched their poison pill, one that had been dormant since its introduction at the beginning of the conversation about health care reform in the spring. The Stupak-Pitts-Kaptur-Ellsworth-Dahlkemper-Smith-Lipinski Amendment, written by a Republican and now popularly known by the name of its anti-choice Democratic Party lead sponsor, Stupak, has the following provisions:
The compromise amendment, offered Saturday by Rep. Bart Stupak (D-Mich.), in effect bans abortion coverage by all plans that are purchased using taxpayer dollars. Abortions could still be obtained by policyholders who pay their entire premiums without government assistance or by individuals receiving federal subsidies in the event of rape, incest or danger to the mother's life.
What the Stupak-Pitts Amendment does is set up a class turnstile, ensuring that the poorest women will not have access to private health insurance that covers comprehensive reproductive health, including abortion, as they will most certainly receive an affordability credit from the government. (It's estimated that 85% of Americans will receive some sort of affordability credit to help achieve near-universal health insurance coverage.) Women of means have, and will continue to have, access to the health care they need to terminate pregnancies. But lest we think "low-income women" or "moderate income women" means someone else, increasingly it means you, me, and women we know who'll be on the wrong side of the turnstile. After all, according to the Commonweath study above, almost half of middle income women had difficulty paying off medical bills too.
Here are the 64 Democrats who joined all Republicans in the House to pass the Stupak-Pitts Amendment. Cross-index that list with this chart showing votes by party and congressional district for and against the Affordable Health Care for America Act. (I'm formulating plans as to WHO to replace in the 2010 elections based on this information, aren't you?)
Basically, yes, health insurance reform--if it passes--will cure the un- and under-insured ills that plague women. "Pre-existing conditions," including pregnancy, a C-section, and domestic violence, as a pretext for denial of coverage will end. Gender-rating will end. These are no small gains for women. From the waist up and between the ages of 0 - puberty and menopause - death we appear to be in okay shape. But women in our childbearing years, what could be four or five decades between girlhood and mature, middle-aged nonchild-bearing woman? Good luck getting health insurance coverage from the waist down for some of the most important, life-changing experiences a woman can face.
See, if pregnancy will be covered by all insurers, the termination of a pregnancy--A LEGAL PROCEDURE--will not. I want to repeat that part. ABORTION IS A LEGAL PROCEDURE.
The Stupak-Pitts Amendment uses the pooled nature of insurance exchanges to put the Hyde amendment on steroids. If any insurer includes abortion in health coverage for women, it may not participate in the insurance exchange, as a single taxpayer dollar will be disallowed to any insurer that offers coverage for termination of a pregnancy. (Details here.) Stu-Pitts makes exceptions for federal funding in cases of rape, incest, and a physical disorder/injury/illness endangering the life of the woman. It therefore federalizes a patchwork of laws that exist in 15 states prohibiting abortion either in coverage offered by government-run plans for state employees or through private insurance or both (pdf). On the face of it, the exceptions might seem completely reasonable. But think of how many situations can't be crammed into the box of "life-threatening" or how the parameters are defined for a woman confronting an unwanted or unplanned pregnancy, instead of her ability to determine the parameters of necessity and appropriateness for herself. The sovereignty a woman has over her own body is never the starting point as it is with a man. This is classic anti-choice framing.
If, as the Guttmacher Institute has found, 60% of the women choosing an abortion are mothers of one or more children, it's clear family size and a wish to best mother the child or children she already has shapes the choices of many women who elect to terminate a pregnancy. It becomes a decision made in the context of family. How does a reasonable desire to control one's family size and possibly avoid additional economic distress qualify as a "physical disorder/injury/illness" under the Stupak-Pitts amendment? In short, it doesn't. Instead the amendment forces mandatory procreation on poor women who, given other circumstances, perhaps would have made another choice.
Impact, If Enacted
One activist estimates that the abortion loophole, which contradicts the spirit of universal coverage of all Americans, will simply be the pretext through which all insurers deny coverage to low income people, most of whom would probably be women and, disproportionately, women of color at that. Abortion coverage would be offered, but since women with affordability credits couldn't purchase it, insurers would have a perfectly legal way to deny coverage to the low-income and/or less healthy.
And we all know that when women buy insurance, it's to cover the whole family. Realistically, how many women will have the means or the foresight to buy a separate insurance rider with separate funds that covers pregnancy termination? Will they if it means their whole family might lose out on coverage? What if their miscarriage gets classified as an abortion?
Many feminists have pointed out that the U.S. Conference of Catholic Bishops and their anti-choice arm lobbied the Stu-Pitts members of Congress hard on this issue. What's diabolical--and I use that term purposefully, as in, devilish--about the USCCB's efforts is that the culture war issue is a back door way to subvert the goal of universal health insurance coverage the public option is meant to provide. Coincidentally, politics over women's bodies benefits the insurance industry's bottom lines.
In the future, either insurers won't offer coverage for abortion services, abandoning the current practice of 87% of insurers who do, OR they will offer this coverage and gladly abandon the low-income (female), and less healthy part of the population. Right now, it looks as if the Stu-Pitts amendment is a culture war way to undo the public option; an infrequently used but key component of women's reproductive health has suddenly become the donut hole in health insurance reform.
And isn't that what we've been fighting for, a strong public option? Because, as has been noted again and again, mandating health insurance coverage but not providing a public option that will force insurers to compete with the public option's lower overhead will simply mean a GIANT GIVEAWAY to insurance companies. They'll have gained millions of new customers and maybe jettisoned the least healthy along the way--hello mega-huge corporate profits, goodbye competitive cost-controls. Our premiums will continue to rise. And a large swath of the population will continue to struggle without the insurance coverage they need.
Somehow this isn't what I think President Obama had in mind when he said as recently as November 6, 2009, that health insurance reform needs to have a strong public option. Or, see this July 16 White House video address to the American people:
Nor is this what the many good people in Congress envision who truly did toil long and hard to get us a public option.
So, I think the question for the White House, the House, and most immediately, the Senate, is this: DO WOMEN'S VOTES MATTER? DOES THE ENTIRETY OF OUR HEALTH MATTER?
Women get it on the public option. Women need to have ALL of their reproductive health care needs met, not health insurance that applies mostly above the waist. That includes coverage of a LEGAL procedure that some women need on occasion, yes, consistent with the Hyde amendment--which, to my regret, is still the law of the land last I checked. (Though some hardy folks want to repeal it.)
Women have been watching how men in the House treated Congresswomen who made statements on the floor:
We saw how 30 Republican Senators thought it was perfectly fine to leave the criminal gang rapes of female contractors in warzones like Iraq up to "arbitration" and voted against the Franken amendment, which would have made government subcontractors liable for the actions of their employees or lose the contract.
We're not stupid, though the Stu-Pitts of Congress may think we are. We know when gas is poured on the flames of the culture wars to obscure back door dismantling of the public option we ALL desperately need, men and women.
And we know who really has been fighting to better the lives of women. So, will they fight this final mile? I'm a feminist who desperately wants health insurance reform, and so long as I see members of Congress fighting to get that, I'll stand by them.
STRIP THE STUPAK-PITTS AMENDMENT FROM THE FINAL BILL. It's probably unconstitutional, discriminatory in its effects, intrudes on the rights of insurers to run their businesses, and undoes the work of the public option. We stood by you. Now stand by us. We heard that A Woman's Nation Changes Everything. But does it? And can we, going forward?
The Senate version must pass. Then a version goes to conference committee, at which time President Obama will be seated at the table. There are still a few more steps where the Stu-Pitts amendment can be stripped from the final bill. Can we whip our president, congresspeople, and senators to strip the amendment, keep the public option in, and keep voting yes?
Let's get real health insurance reform passed that truly covers everybody.
PS Viagra, prostate exams, and presumably male fertility issues are, of course, covered in full by the Affordable Health Care for All Act.
Cynematic blogs at P i l l o w b o o k. She has an adorable son who's the apple of her eye, and the crucial choice to limit her family to exactly that number of children.