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10 Health Reform Provisions That Affect Women

Cheryl Clark, for HealthLeaders Media, January 21, 2010

Forget, just for a moment, the divisive topic of abortion in the context of health reform.

Embedded in the 2,409 pages of the Senate's health reform template are many other provisions that would impact women's healthcare, including breast cancer screening, ob/gyn specialty access, special tobacco cessation programs for women, and a new Office of Women's Health.

"There's so much in there that's good for women," says Lisa Codispoti, senior counsel for the National Women's Law Center. "The question remains about whether the bill is as good as we would like it to be, and whether it will make healthcare better for people than they have now."

Here are 10 health reform provisions that specifically deal with women's health:

1. Gender rating is the practice of charging women more for health insurance simply because they are women. While the House version of the bill eliminates the practice entirely, the Senate version eliminates it only for individuals who buy premiums directly from insurers and small groups.

Currently, women may pay double the premiums charged to men, a practice that Terry O'Neill, president of the National Organization for Women, calls "outrageous."

"The excuse health insurers use, sadly, is that women cost more because of prenatal care and childbirth, but what's ironic is that they move heaven and earth to deny prenatal care and childbirth, and consider having a prior Cesarean section a pre-existing condition," says O'Neill.

Gender rating is allowed to continue in the Senate bill for employers with more than 100 employees. For example, health plans that sell health coverage to larger companies with predominantly female workforces would still be allowed to charge more than the plan charges a similar company—say one in the same town with same age mix of employees—but where the workforce is predominantly male.

Groups that favor gender rating argue that men should not have to pay for healthcare provided for women. But, says O'Neill, women already pay for drugs like Viagra and prostate cancer care that apply only for men.

Robert Zirkelbach, spokesman for America's Health Insurance Plans, says, "We proposed months ago to eliminate gender rating in health insurance premiums as part of comprehensive health insurance reform."

Under the Senate bill, premiums may vary only by family size, geographic area, age (older people may pay up to three times more than younger enrollees), and use of tobacco. Under the House bill, premiums may vary by family size, geographic area, and age.

"We are hoping for the complete elimination of gender rating in all markets," says Lisa Codispoti, senior counsel for the National Women's Law Center, "but certainly eliminating it for individuals and small employers is an important step forward."

2. A new Office of Women's Health would be under the tutelage of the Agency for Healthcare Research and Quality. It would assure that women's healthcare receive an appropriate share of attention in clinical trials and research, and comparative effectiveness. In part out of fear that experimental procedures involving women may damage an unsuspected pregnancy, a revisit of the thalidomide tragedy, women were often excluded, which meant some studies erroneously assumed some benefits or harms in men would have the same impacts on women.

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