Colorado’s U.S. congressional delegation expressed support this week for the move to end gender discrimination in the current health care insurance market through regulatory legislation — the entire delegation, that is, except 5th District Republican Doug Lamborn, a free-market Colorado Springs ideologist who appears to be looking past the modern history of the health insurance industry to see consumer choice as the way to create more equitable rates.
That’s not good enough for lawmakers responding to calls from the increasing numbers of American women frustrated by years of uneven rates and inadequate biased coverage.
Many of those women live in Colorado, particularly the roughly 185,000 women buying insurance on the individual market here. In addition to paying up to 59 percent more than men do for coverage, they find that landing a plan with maternity coverage is nearly impossible. They’re also often denied coverage due to pre-existing gender-specific conditions, such as having once had a C-section.
Gender inequality in the insurance market has risen to the top of the health reform issues being debated this week, thanks to a campaign launched by the National Women’s Law Center and designed to reframe the health care debate as a gender issue. The campaign, titled “Being a Woman Isn’t a Pre-Existing Condition,” encourages women to call and write their representatives, demanding that health care reform include provisions that address women’s realities.
The Law Center cites three main issues for women in obtaining health care: In many markets, including the individual insurance market in Colorado, women pay higher premiums; they are almost always denied maternity coverage; and many are denied coverage for “preexisting medical conditions” or histories that include a C-section or domestic abuse.
In fact, with one small exception, all three of the Democratic health-care reform bills making their way through Congress right now (S1679, HR3200, and S1796) would eliminate gender bias in the health care market, according to Brigette Courtot, senior policy analyst with the National Women’s Law Center.
All three bills would mandate insurance companies to offer maternity coverage. All three would also ban discrimination based on medical histories.
Both the House bill and the Senate Health, Education, and Labor Committee bill would also end the practice of charging women higher premiums across all markets. The Senate finance committee bill, however, would continue to allow insurance companies to charge higher rates for women when insuring with more than 50 to 100 employees (depending on the state’s definition of small business).
Colorado’s Democratic U.S. representatives expressed specific support for mandates that would end gender discrimination.
Sen. Michael Bennet went one further, signing an Oct. 23 letter asking Senate leaders to ensure that the final health bill eliminates gender ratings and ends discrimination based on pre-existing conditions —across all markets. The letter urged that these reforms be implemented no later than 2013.
“If these reforms are not applied to the group market, women working for some employers with majority female workforces, such as child care providers or home health agencies, will never be protected from the harmful insurance industry practice of gender rating.”
Republican U.S. Rep. Michael Coffman of the 6th Congressional District is crossing party lines to support eliminating gender discrimination in health care. Although Coffman says he supports an “adjusted community rating which includes age and geographic location as well as certain lifestyle habits,” he does not think such a rating should differentiate between men and women.
“Health insurance premiums should not be based on gender or preexisting conditions,” said Coffman. “I also believe all plans should offer the opportunity to obtain coverage for pre-natal and delivery care.”
But Doug Lamborn has insisted there is no need to mandate insurance companies cease discriminating against women.
“The free market, not the federal government, should dictate how private insurance companies determine their policies,” he said.
“Government mandates always have unintended consequences. I support health care reform that puts patients in charge of their own health care, giving families more freedom to choose the plan that fits their needs. Reform must provide access to coverage for all Americans, in a financially feasible way, through offering tax cuts for low-income individuals or for those who purchase coverage in non-group/individual markets.”
The problem, says the Law Center’s Courtot, is that when a system is inherently unequal, tax incentives are an anemic response.
“When you have a discriminatory market where it’s more expensive for certain people to get coverage, a tax incentive is not equally generous,” she said. “You need to pair those things with market protections.”
Even if a federal health care bill passes this fall — and even if gender reforms make it into the final version — women may not see reform before 2013. In Colorado, however, a bill could bring about reform as early as 2011.
Last fall, two Democratic lawmakers, State Rep. Sue Schafer of Wheat Ridge and State Sen. Morgan Carroll of Aurora, introduced HB09-1224 to end the practice of gender discrimination in health care in the state of Colorado. Carroll said last session “the insurance lobby was successful in rolling [the bill] back into a study.”
At its Oct. 19 meeting, the 10-member interim health care task force assigned to the study voted in favor of a draft bill(pdf) that would end gender discrimination in setting health insurance premiums. The vote was 9-1, with Rep. Jim Kerr, a Republican from Littleton, as the lone dissenter.
In discussions about the bill, Kerr distinguished himself by suggesting that since “women like to shop,” they should put that skill to use in finding better health insurance.
The committee also narrowly passed a draft bill(pdf) that would mandate insurance companies to include maternity coverage. The vote was 6-4, with all Democrats on the committee voting for the bill and all the Republicans voting against it.
At the end of a recent presentation to the interim health care committee, Lisa Codispoti, senior counsel for the National Women’s Law Center, drew an uncomfortable parallel between race and gender.
“Indeed, many years ago, Colorado passed a law that prohibited insurers from basing premium rates on an individual’s race or ethnicity. As with classifications based on race, generalizations on the basis of sex are unfair to individuals.”
Codispoti pointed out that even though certain ethnic groups may cost insurance companies more money, most people would find it repugnant to charge individuals higher premiums based on ethnicity.
“They similarly should not charge women higher rates,” she said.