As a longtime proponent of health care reform, I truly wish that the National Organization for Women could join in celebrating the historic passage of the Patient Protection and Affordable Care Act. It pains me to have to stand against what many see as a major achievement. But feminist, progressive principles are in direct conflict with many of the compromises built into and tacked onto this legislation.
The health care reform bill passed by Congress today offers a number of good solutions to our nation’s critical health care problems, but it also fails in many important respects. After a full year of controversy and compromise, the result is a highly flawed, diminished piece of legislation that continues reliance on a failing, profit-driven private insurance system and rewards those who have been abusive of their customers. With more than 45,000 unnecessary deaths annually and hundreds of thousands of bankruptcies each year due to medical bills, this bill is only a timid first step toward meaningful reform.
Fact: The bill contains a sweeping anti-abortion provision. Contrary to the talking points circulated by congressional leaders, the bill passed today ultimately achieves the same outcome as the infamous Stupak-Pitts Amendment, namely the likely elimination of all private as well as public insurance coverage for abortion. It imposes a bizarre requirement on insurance plan enrollees who buy coverage through the health insurance exchanges to write two monthly checks (one for an abortion care rider and one for all other health care). Even employers will have to write two separate checks for each of their employees requesting the abortion rider.
This burdensome, elaborate system must be eliminated. It is there because the Catholic bishops and extremist abortion rights opponents know that it will result in greatly restricting access to abortion care, currently one of the most common medical procedures for women.
Fact: President Obama made an eleventh-hour agreement to issue an executive order lending the weight of his office to the anti-abortion measures included in the bill. This move was designed to appease a handful of anti-choice Democrats who have held up health care reform in an effort to restrict women’s access to abortion. This executive order helps to cement the misconception that the Hyde Amendment is settled law rather than what it really is — an illegitimate tack-on to an annual must-pass appropriations bill. It also sends the outrageous message that it is acceptable to negotiate health care reform on the backs of women.
Fact: The bill permits age-rating, the practice of imposing higher premiums on older people. This practice has a disproportionate impact on women, whose incomes and savings are lower due to a lifetime of systematic wage discrimination.
Fact: The bill also permits gender-rating, the practice of charging women higher premiums simply because they are women. Some are under the mistaken impression that gender-rating has been prohibited, but that is only true in the individual and small-group markets. Larger group plans (more than 100 employees) sold through the exchanges will be permitted to discriminate against women — having an especially harmful impact in workplaces where women predominate.
We know why those gender- and age-rating provisions are in the bill: because insurers insisted on them, as they will generate billions of dollars in profits for the companies. Such discriminatory rating must be completely eliminated.
Fact: The bill imposes harsh restrictions on the ability of immigrants to access health care, imposing a 5-year waiting period on permanent, legal residents before they are eligible for assistance such as Medicaid, and prohibiting undocumented workers even to use their own money to purchase health insurance through an exchange. These provisions are counterproductive in terms of controlling health care costs; they are there because of ugly anti-immigrant sentiment, and must be eliminated.
Fact: The bill covers only 32 million of the 47 million uninsured in this country, does not contain a meaningful public option and provides no pathway to a single payer system like Medicare for all. Democratic negotiators crumpled before powerful business interests and right-wing extremists, and until they get a spine there will be no true competition to help rein in costs.
The bottom line is that everyone — citizen and non-citizen, undocumented immigrant and visitor — has a fundamental human right to health care. This right has been denied in the U.S. for far too long, while the rest of the industrialized world moved ahead to assure universal and affordable care for their people.
We call upon President Obama and elected officials in both houses to commit to a process of steady improvement of our health care system that will result in true reform with universal coverage, realistically affordable rates and no discrimination. We still have a lot of work to do before we can genuinely celebrate.