Affordable Health Coverage for All Americans
The Finance Committee of the U.S. Senate recently released “Expanding Health Care Coverage: Proposals to Provide Affordable Coverage to All Americans,” which describes various policy options for providing affordable health care coverage to all Americans. The document outlines ideas being discussed to shape a new legislative proposal on health reform that would be introduced in the Senate by early June.
What does this mean for women? As the key health care decision makers for families, women have important influence over the health care system, and power to influence the health care reform debate in Congress. Congress needs to hear from us about policy options – they need to develop policy that truly meets the needs of women and our families. The Senate Finance Committee has asked for comments on this document by Friday, May 22, so we need to act quickly.
Raising Women’s Voices for the Health Care We Need (RWV) has identified five key principles for health care reform that meets the needs of women and their families. This fact sheet uses those principles to measure the current proposals being discussed by the Senate Finance Committee against the health reform priorities that women have identified for themselves, their families and their communities. Our analysis is intended to help women and others interested in health reform understand where the Finance Committee options are strong and where they’re lacking.
For the RWV principles: http://www.raisingwomensvoices.net/RWV-OurVision.html. For the Finance Committee document, go to www.finance.senate.gov, Legislation.
RWV Principle 1. Health care coverage must be affordable and always available. The Finance Committee is considering options to make coverage available by requiring private insurers to cover everyone who applies, without excluding anyone on the basis of age, gender or pre-existing conditions. The Committee is also considering establishing a public health insurance plan open to anyone, and/or opening Medicare to enrollment by individuals who are at least 55 years old.
RWV is pleased to see a proposed requirement that private insurers must cover everyone, so that exclusions based on such factors as gender or pre-existing conditions (i.e., breast cancer or having previously had a cesarean section delivery) would be outlawed. Expanded eligibility for Medicare – or the creation of a public health insurance plan -- is especially important for older women because women in the 50-64 age group who have been insured through a spouse’s policy often lose coverage when older spouses become eligible for Medicare.
To make coverage affordable for all Americans, the Committee proposes to offer subsidies to people with low to moderate incomes to help them buy insurance coverage; and to expand eligibility to Medicaid. After health insurance plans are available to everyone, and subsidies are in place, the federal government will mandate that everyone enroll in a plan.
RWV believes that providing subsidies for individuals and families is a good concept, but has doubts about whether it will actually make health insurance affordable unless there are also limits on the cost of health insurance. Massachusetts tried this approach and found that the subsidies that the state can afford to provide aren’t enough to cover the cost of insurance for everyone. Subsidies and eligibility for subsides must also take into account not just the cost of the premium, but all costs associated with getting the health care you need, including co-pays, deductibles, etc. RWV believes a proposed mandate could work if, and only if, the coverage offered is actually affordable.
RWV Principle 2. Health care systems must provide the acute, preventive, chronic and supportive health care services that we need. The Committee is considering options that mandate a broad range of medical benefits, including preventive and primary care and mental health services. Maternity care is specifically required, but there is no mention of other reproductive health services. The Committee is considering options that would continue existing coverage for home and community-based services for people with disabilities and expand coverage for birth centers.
RWV believes that the Committee is off to a good start and we’re happy to see special attention to some issues of concern to women, our families and our communities. We note the lack of specific language concerning comprehensive women’s health care across the lifespan, including reproductive health care. We will be watching closely to make sure the language concerning benefits in any proposed legislation can and will be interpreted to include comprehensive reproductive health care. RWV strongly opposes any efforts to codify the exclusion of any services that women need.
RWV Principle 3. Health care systems must provide care that meets the needs of diverse women and actively works to achieve equity and eliminate disparities. The Committee is considering options that would require private insurers to meet national standards for delivery of culturally and linguistically appropriate services; require the federal government to do a better job of collecting data that can be used to identify and potentially reduce disparities, and provide grants for programs to reduce infant mortality.
RWV believes that much more needs to be done, but we applaud the Committee for its efforts to identify even a few ways to address these issues in its options for expanding coverage. Some issues we are particularly concerned about include 1) ensuring that there are adequate numbers of health providers available to serve patients who have obtained coverage through health reform, particularly in low-income urban neighborhoods and rural areas; 2) promoting the delivery of health care in a way that is culturally competent and respectful of patients of all racial and ethnic backgrounds and gender identities, and that this care is available in a language that the patient can understand and engage in; and, 3) ensuring that patients with disabilities have access to medical offices and equipment necessary to make health care truly accessible to them.
RWV Principle 4. The health care system must be user-friendly, easy to navigate and transparent. The Committee is considering options that include a national Insurance Exchange, with one enrollment form, on-line and telephone access in multiple languages. The Committee is also considering options to simplify Medicaid enrollment. The Committee addressed public input into changes in state Medicaid programs, but didn’t address transparency in any other aspects of the health care system.
RWV is very pleased with the Committee’s attention to simplifying Medicaid enrollment and looks forward to the day when everyone can easily enroll in any plan. Many of our goals for patient-centered health care that is easy to use aren’t addressed in this set of policy options. We hope to have a system that works to educate patients on how to effectively navigate the health care system. We also encourage support for families via patient-centered education and services. RWV believes that a transparent system must include a significant role for consumers in advisory boards and committees at all levels of the system.
RWV Principle 5. We must ensure the highest attainable standard of health. The Senate Finance Committee doesn’t have primary responsibility for this issue, but even so, the Coverage Options paper includes some good proposals for improving health, including: grants for improving current programs and testing innovative new programs to improve health care services; expanded coverage of preventive health services to adults through Medicaid and Medicare; expanding the use of quality care measures; paying for smoking cessation drugs; and, continuing the expanded services, such as transportation, that are available to some Medicaid recipients.
RWV appreciates the role of the public health system in supporting good health for all, and appreciates the Finance Committee’s consideration of grants supporting population-based screening programs, and programs linking health care with other community services.
What can you do?
Let the Senate Finance Committee know what you think about their proposals.
Call: (202) 224-4515
Email: Health_Reform@finance-dem.senate.gov
Tell Senators Baucus and Grassley that women need coverage that is affordable, always available, and includes comprehensive women’s health care across the lifespan, including reproductive and maternity care. We want a system that is easy to use, transparent and accountable to consumers.
For more information about Raising Women’s Voices and our campaign to ensure that women’s needs are powerfully articulated, genuinely considered and incorporated into health care reform plans: www.raisingwomensvoices.net
