Position on Health Care

The American Association of University Women (AAUW) believes that everyone is entitled to health care that is high-quality, affordable, and easily accessible. This position stems from AAUW's 2011-2013 Public Policy Program, which advocates for "increased access to quality affordable health care."¹

As the Obama administration and Congress embarked on a year-long debate over comprehensive health care reform legislation, AAUW stressed the need for a new system that would produce access to quality and affordable health care for all Americans. Such a goal was especially important as the debate took place amidst the backdrop of a prolonged economic recession. Health care security is intrinsically tied to economic security, and this relationship is particularly true for women, who earn less than men on average and are therefore less able to afford insurance or care. AAUW believes that, although not perfect by any stretch, many of the reforms included in these laws will improve the collective health of the American people. It is our hope that the elimination of preexisting conditions and gender rating in the individual and small groups markets will result in better outcomes for more women. Unfortunately, many women will find that they have less coverage for full reproductive services due to far-reaching limitations in the new law. AAUW will continue to work to restore full access to all health care for women.

In March 2010, President Obama signed two bills into law—the Patient Protection and Affordable Care Act,² as well as the Health Care and Education Affordability Reconciliation Act³—which significantly overhauled the nation's health care system. Over the course of the year-long debate, AAUW communicated our priorities on the legislation to members of Congress, engaged our members and activists, and worked with coalition partners on areas of mutual concern. Our three main health care priorities—an end to gender rating, protection of women's reproductive health services, and ensuring coverage of preventive care—were directly addressed in the final legislation, each with varying degrees of success and setbacks:

• Ending  the practice of "gender rating": Gender rating is the process by  which insurance companies charge men and women different premiums for  individually-purchased health care plans. A 2009 poll indicated that more  than 60 percent of Americans believe the practice should be banned.⁴ According to a 2008 report by the National Women's Law Center, women of  various ages are often charged more than men even when purchasing  identical health care plans. Their study concluded that at age 25, women  were charged anywhere from six percent to 45 percent more than men for  individual market plans; at age 45, women's monthly premiums ranged from  four percent to 48 percent higher than men's monthly premiums.⁵ Under the new law, the practice of gender rating will be banned for plans  offered in both the individual and small group markets (defined as  organizations employing 100 or fewer persons).⁶ Unfortunately, insurance companies may continue to pursue this  discriminatory practice under plans offered in the large group market.

• Requiring  coverage of women's reproductive health services: AAUW's  2009-2011 Public Policy Program advocates, "choice in the determination of  one's reproductive life…increased access to health care and family  planning services including expansion of patients' rights."⁷ AAUW has long believed that politicians should not insert themselves into  the decision-making process when it comes to reproductive health care,  which is a basic element of women's health care overall. Unfortunately, an  attempt was in fact made to significantly undermine coverage of women's  reproductive health services. AAUW played a key role in a coalition effort  that kept the so-called Stupak amendment – a provision that would have  effectively banned insurance companies from providing insurance coverage  of abortion, even for women who paid with their own private money for such  care – out of the final legislation.⁸ However, the new law does require insurance companies providing abortion  coverage to collect two separate payments from each enrollee: one for the  portion of the premium covering abortion care, and one for the remainder  of the premium itself.⁹ This requirement is needless and burdensome, unnecessarily stigmatizing  reproductive health care, and it may reduce overall abortion coverage  among private health insurance plans.¹⁰ Further, individual states may decide to exclude abortion coverage in  their health insurance exchanges, and indeed many states have already done  so. Going forward, AAUW will continue to work with our coalition allies to  monitor and address this issue.

• Ensuring  access to and coverage of preventive services and care: According  to the Centers for Disease Control and Prevention, the two leading causes  of death for women in America by far are heart disease and cancer¹¹ — afflictions that can often be prevented if women have access to  preventive care services such as screenings, immunizations, and  educational material. Fortunately, the new law contains a specific women's  health provision, sponsored by Sen. Barbara Mikulski (D-MD), under which  insurance companies will be required to cover additional preventive health  care and screenings for women – such as mammograms and pap smears – at no  additional premium or co-payment cost.¹² Additionally, in August 2011, the U.S. Department of Health and Human  Services decided to adopt the recommendations of the Institute of Medicine  and require that "the full range" of  approved contraceptive methods be included among preventive-care services  available to women without a co-payment or cost sharing.¹³ Unfortunately, the department included a "religious refusal" exemption  provision to the proposed rule, allowing religious employers to refuse to  cover their employees' contraception. The department also adopted the IOM's  recommendation that education and counseling related to family planning,  screening for gestational diabetes, HPV testing as part of cervical cancer  screening for women over 30, counseling on sexually transmitted  infections, HIV counseling and screening, counseling and equipment for  breast-feeding, yearly wellness visits, and screening and counseling for  domestic violence be covered without a co-payment or cost sharing. This will  not only improve women's physical health, but also reduce the financial  strain on our health care system and improve the overall economy as a  result.

For more information, call 202/785-7793 or e-mail VoterEd@aauw.org.

¹ American Association of University Women. (June 2011). 2011-13 AAUW Public Policy Program. Retrieved February 7, 2011, from www.aauw.org/act/issue_advocacy/principles_priorities.cfm.

² U.S. Government Printing Office. (December 24, 2009). H.R.3590 – Patient Protection and Affordable Care Act. Retrieved May 13, 2010, from www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf.

³ U.S. Government Printing Office. (2010). H.R.4872 – Health Care and Education Affordability Reconciliation Act. Retrieved February 7, 2011, from www.gpo.gov/fdsys/pkg/BILLS-111hr4872enr/pdf/BILLS-111hr4872enr.pdf.

⁴ National Women's Law Center. (July 6, 2009). New Opinion Research Shows Broad Public Support for Reproductive Health Coverage in Health Reform. Retrieved February 7, 2011, from www.nwlc.org/press-release/new-opinion-research-show-broad-public-support-reproductive-health-coverage-health-ref.

⁵ National Women's Law Center. (September 2008). Nowhere to Turn: How the Individual Health Insurance Market Fails Women. Retrieved February 7, 2011, from action.nwlc.org/site/DocServer/NowhereToTurn.pdf?docID=601.

⁶ Raising Women's Voices. (January 7, 2010). Women's Priorities for the Best Combined Health Reform Bill. Retrieved March 5, 2010, from www.raisingwomensvoices.net/storage/blog-graphics/flyer-SideBySideColor-1-11.pdf.

⁷ American Association of University Women. (June 2011). 2011-13 AAUW Public Policy Program. Retrieved June 30, 2011, from www.aauw.org/advocacy/issue_advocacy/principles_priorities.cfm

⁸ Planned Parenthood Federation of America. (2009). Planned Parenthood and Health Care Reform.. Retrieved February 7, 2011, from www.plannedparenthoodaction.org/positions/planned-parenthood-hcr-825.htm.

⁹ Ibid.

¹⁰ Sara Rosenbaum, George Washington University Medical Center. (December 21, 2009). Abortion Provisions in the Senate Managers Amendment. Retrieved February 7, 2011, from www.talkingpointsmemo.com/documents/2009/12/gwu-analysis-of-nelson-provision.php?page=1.

¹¹ Centers for Disease Control and Prevention. (February 19, 2010). Leading Causes of Death in Females – United States, 2006. Retrieved February 7, 2011, from www.cdc.gov/women/lcod/.

¹² National Women's Law Center. (2010). Comparison of Key Provisions in the House and Senate Health Reform Bills. Retrieved February 7, 2011, from action.nwlc.org/site/DocServer/Side-by-Side.pdf?docID=801.

¹³ U.S. Department of Health and Human Services. (August 1, 2011).Affordable Care Act Ensures Women Receive Preventive Services at No Additional Cost. Retrieved August 15, 2011, from www.hhs.gov/news/press/2011pres/08/20110801b.html.