As Gov. Arnold Schwarzenegger and the Democratic leadership in the Legislature negotiate a health care proposal that they hope everyone can agree upon, it's important to consider a California constituency that hasn't received enough attention during this debate: women.
They represent more than half the population, live longer and are more likely to have chronic health problems as they age. Women use more health care services over the course of their lives than men. At the same time, they earn less, and are less likely to have jobs with health benefits. Consequently, women are more dependent on public and spousal coverage – two forms of health coverage that are most threatened by state deficits and employer cost-shifting.
We have a window of opportunity this year to address the unique health care needs of women in California, but the policy solutions must be substantive. The health reform plan being negotiated by the governor and legislative leaders takes steps in the right direction, promising to create a new state purchasing pool to offer affordable coverage to working women and to cover millions of low-income women through expanded public programs. To address the health care challenges women face, the reform plan must create accessible, affordable and comprehensive coverage.
Both the governor's plan and the Democratic leadership bills would require everyone to have health coverage, but they wouldn't give everyone access to affordable, comprehensive group coverage. Both plans offer workable options for folks on a payroll or eligible for newly expanded public programs. But self-employed Californians above median income would still, as now, have to buy their own coverage in the individual market.
Approximately 800,000 women in California are self-employed, and that number keeps growing. For these women in particular, it is essential that health reform limit what they are required to spend to get health care, including premiums, deductibles and co-pays.
The governor's proposal would limit the cost of premiums for people earning up to four times the federal poverty rate; they would pay no more than 5 percent of their income for premiums but could pay more for deductibles and other out-of-pocket costs. The Democratic leadership bill includes a limit of 6.5 percent of income, including premiums and deductibles. Spending limits are essential to protect people from having to buy insurance they can't afford.
Neither the governor's plan nor the Democratic leadership bill defines the minimum benefits that individual insurance policies must include. Plans too often exclude vital women's health needs such as maternity care, reproductive health services and adequate preventive care. Reform needs to spell out standards for individual policies, to protect consumers from insurance products that do not cover the health care they really need. Allowing the self-employed to buy into the state purchasing pool would ensure that they, too, have comprehensive coverage at an affordable price.
We appreciate the work of the governor and legislative leaders to craft a health reform bill that can clear the political hurdles ahead. Any workable bill will still have to find adequate financing, but whatever compromise bill surfaces has to promise women something better than we have now.
The Women's Working Group on Universal Health Care calls on legislators and the governor to deliver a health care reform plan that includes:
• Affordable, accessible, high quality, comprehensive health care for all residents, independent of income, employment, gender, sexuality, ability, immigration, incarceration or health status.
• Comprehensive benefits.
• Access to care that is equitable, confidential and culturally and linguistically appropriate, with particular attention to vulnerable and underserved communities.
• Health care coverage that is affordable for individuals and families in relation to income.
• Health care policy that is fairly financed and establishes mechanisms for controlling costs without impeding access.
This is what California's women need from health care reform. And, we need it now.
Carlina Hansen executive director of the Women's Community Clinic, which provides free health care for uninsured and underinsured women in San Francisco. Co-authors of this piece included Kathy Kneer, president and CEO of Planned Parenthood Affiliates of California, and Ellen Shaffer, co-director of the Center for Policy Analysis and a board member of the National Women's Health Network. All are members of the Women's Working Group on Universal Health Care. Web site: www.womenleadforhealth.org.
