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Health Insurers Commit to 'Equal Health Care' for Women

By Jane Norman, CQ HealthBeat Associate Editor

October 15, 2009 –The nation's health insurers are fully committed to ending policies that charge women higher premiums or deny them coverage because of their age, gender or "pre-existing conditions" such as pregnancy, the head of the industry's trade association told a Senate committee Thursday.

But Karen Ignagni, president and chief executive of America's Health Insurance Plans (AHIP), also said repeatedly that health care overhaul legislation approved by Congress must ensure an individual mandate is included in which every American is required to obtain health coverage.

A study by PricewaterhouseCoopers released by AHIP this week caused a firestorm of criticism among Democrats because it projected an increase in premiums under the bill approved Oct. 13 by the Senate Finance Committee, which weakened the individual mandate by lessening penalties for those who decline to purchase insurance. But Ignagni defended the study, saying the message is that "costs are going to go up for individuals and working families if we don't have everyone participate."

In an interview after the hearing, Ignagni said insurers sent a letter to the Finance Committee when the individual mandate was changed and requested the study on Sept. 29 after detecting "alarming" trends in their own data on the impact of the bill. "Now members of Congress need to decide whether they want to focus on the cost issue, and we think they will focus on the cost issue because they don't want constituents to be disappointed," she said.

Ignagni appeared before the Health, Education, Labor and Pensions (HELP) Committee as a part of a panel that examined "equal health care for equal premiums" for women's health insurance. Committee member Barbara A. Mikulski, D-Md., said a 25-year-old woman is charged up to 45 percent more for a health insurance policy in the individual market than a man of the same age, and once she reaches 40 it can be 140 percent more.

Women also are denied coverage because they are pregnant, had a baby via cesarean section, or are victims of domestic violence, Mikulski said. And policies may exclude basic health needs, preventive care or maternity coverage.

Mikulski was especially disturbed by the testimony of Peggy Robertson of Centennial, Colo., who told of her problems obtaining insurance. Robertson, the mother of two boys, said that because her husband is self-employed, they applied for an individual policy with Golden Rule Insurance Co. shortly after the youngest child was born. She was denied coverage because she had undergone a cesarean section.

"I called Golden Rule, and they said that if I would get sterilized, they would then be able to offer insurance to me," Robertson said. She said she was "shocked" by this comment, but she learned from state insurance regulators that it was entirely legal for the company to deny coverage based on a previous cesarean and there was nothing she could do. She also read from a letter the company sent her.

Mikulski called that revelation "bone chilling" and said, "It put me on the edge of my chair." She added, "No one, no one, in the United States of America, in order to get health insurance, should ever be coerced into getting a sterilization."

John Parker, a spokesman for United Health, which owns Golden Rule, said that today Golden Rule in all the states in which it operates offers coverage to women who have had previous cesarean deliveries. "Also, if the reforms we have proposed, such as the elimination of pre-existing condition limitations coupled with a personal coverage requirement to bring everyone into the system are enacted, we could be certain that the circumstances in this case would not be replicated," he said.

Al Franken, D-Minn., said it's bad for everyone if women don't have access to adequate health care, and in the overhaul all women for the first time will have access to comprehensive benefits including maternity care, without paying more. "It's also a top priority for me that health reform includes a crucial women's health service, access to affordable family planning services," Franken said. "Access to contraception is a fundamental right of adult Americans."

The hearing featured witnesses from both the left and right. Mikulski said she worked with Republican Richard M. Burr of North Carolina to hear all sides. "We welcome diverse views—that's how we arrive at what we hope will be the sensible center," Mikulski told the witnesses. "Every single panelist will be treated with the utmost respect, dignity and civility."

Thus, HELP Committee Democrats listened poker-faced as they were harshly criticized for the overhaul bill they approved last summer.

"Unfortunately, the bills in front of Congress right now, the House Democrats' bills and the two bills in the Senate, are anti-women, anti-men and anti-American," said Diana Furchgott-Roth, a senior fellow at the conservative Hudson Institute. "They would provide worse care for all Americans. They would hurt our economy by raising taxes, increasing our national debt, raising the deficit. This would lower job creation and stop women from progressing."

But Marcia Greenberger, founder and co-president of the liberal-leaning National Women's Law Center, said the overhaul is needed to ensure justice and fairness for women. Greenberger said women face many challenges in the individual market, including a difficult and costly hunt for policies that will cover maternity care. A 2008 report on treatment of women by insurance policies by the center found just 12 percent offered comprehensive maternity coverage within policies. Some others may offer riders that can cost up to $1,000 a month in addition to regular premiums.

The hearing ended with a polite exchange between Mikulski and Ignagni that was in sharp contrast to the very tough rhetoric aimed at the insurance industry from some Democrats, including those now calling for an end to longtime exemptions from federal antitrust laws for health insurers.

Ignagni, asked about AHIP's relations with Democrats, said that PricewaterhouseCoopers was asked to meet with the Finance Committee along with members of her team. "We're going to continue to provide a great deal of data about the impacts we're seeing," she said. "We're going to continue to work on the policy. We're going to continue to offer suggestions. And we're going to continue to do what we've done since the beginning of the year, which is talk to members of Congress about how to make strategies or their proposals workable.

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