When Being Female Is A Pre-Exisiting Condition
The beginning of August marked a serious victory for women’s health in America. Co-pay free contraception, coverage for domestic abuse screening and counseling, STI and HIV screening and counseling, and other forms of preventive care all became law under the historic Affordable Care Act.
Two of the ACA’s most significant accomplishments in the arena of women’s health - mandated maternity care and an end to gender-rating by insurance companies – are slated to go into effect in 2014. Nine states have already taken steps to mandate maternity care, and more are following suit to limit gender-rating. Significant unwillingness on the part of other states to embrace these reforms, however, reveals something troubling about who we hold responsible for conditions that give rise to women posing a higher “risk” to the health care system.
That the ACA covers counseling and support for survivors of domestic abuse and sexual assault is particularly notable, since high rates of sexualized violence is one of several things, like pregnancy, that has historically made being female a ‘pre-existing condition’ in the eyes of insurance companies. In 2009, MSNBC reported that in eight states and the District of Columbia it was legally permissible for insurance companies to deny coverage on the basis of a history of sexualized violence. Defenders of this practice tried to reduce this to something to do with objective facts, arguing that women who have been abused in the past are statistically more likely to be abused in the future and should rationally be paying more, ignoring the ways in which denying abuse victims care actually helps make that statistical chance a much more of a real possibility.
By extending care and support to survivors of intimate violence, the ACA marks a major departure from blaming women for the interpersonal and systemic violence perpetrated against them. Still, as the rationale behind denying women coverage because they’re being abused continues to thrive on more local levels, being female may remain a ‘pre-existing condition’ in practice and in perception if not in policy.
And in many ways, it is. Women experience gender-based discrimination in the workplace and in public and private spaces. Women face a one-in-four chance of being sexually abused as children, and a one-in-five chance of being raped during their lifetime – and are too often held responsible for their experiences. Long before a woman develops a condition for which she needs support from the health care system, she’s already been subjected to a world in which what happens to you because you’re female is your fault.
The differences between the new maternity coverage mandate and the realities women face today are stark: the National Women’s Law Center released a report in March 2012 that found that on the individual market, and in states where maternity care was not mandated, maternity care was only covered in only 6% of the coverage plans available to 30-year-old women covered maternity care. When the calculations included the states that did mandate maternity care, that number rose to an equally disheartening 12%. Additionally, the report found that 92% of America’s most popular insurance plans charged women more than men of the same age, and that even when costs incurred through maternity care were left out of the equation, women in the 25-40 age demographic paid 30% more than their male counterparts in close to one-third of available plans.
Much of the rhetorical opposition to the preventive women’s care and mandated maternity care covered by the ACA fails to recognize the structural reasons for why women need increased access to health care. Despite our cultural investment in the image of the nurturing mother who gives us chicken soup when we’re sick, we don’t seem to see mothers as entitled to maternity care or affordable care after they’ve had children. Women are at a higher risk for incurring medical costs not because they are more easily damaged or inherently needier when it comes to health care, but because they live in a culture which holds women and minorities accountable for the medical difficulties they face as a result of systemic discrimination and inequality.
While the Affordable Care Act makes significant progress in the area of maternity care, it does leaves out pregnant women under the age of 26. The fact that dependants are not covered - only policy-holders and their spouses - reflects a lack of awareness about what pregnancies under the age of 30 often look like. More than half of pregnant women under the age of 30 are single mothers, reports The New York Times, and this gap in coverage is likely to disproportionally affect already-marginalized populations.
The New York Times goes on to report that 92% of college-educated women get married before becoming pregnant, compared to 43% of those whose highest level of education is a high school diploma. For many women, marriage remains a class marker, and an inaccessible one at that. "The average cost of an uncomplicated childbirth is over $10,000 now; foisting that bill on young single mothers-to-be who are likely already facing financial difficulties flies in the face of everything health care reform was supposed to accomplish," writes Amanda Marcotte for Slate.
In the coming months, as the ACA continues to be implemented step-by-step, it's important to keep in mind that significant stigma still exists - particularly with regards to young women, poor women, and women of color - and that the remnants of that rhetoric still need to be dismantled.
Pauline Holdsworth is a reporter for Campus Progress. Follow her on Twitter at @holdswo.