Suddenly, healthcare reform seems to be on the mend. The public option returned from the brink of death. The town hall fever broke as inexplicably as it began. And Congress is in the process of remedying discriminatory insurance-company practices based on pre-existing conditions and gender. But just as the prognosis for our healthcare system is beginning to look sunnier, yet another complication has emerged: so far, reform legislation has failed to require insurers to cover some basic preventive services for women, or prevent providers from charging extra for them.
None of the bills emerging from the House and Senate require insurers to cover all the elements of a standard gynecological “well visit,” leaving essential care such as pelvic exams, domestic violence screening, counseling about sexually transmitted diseases, and, perhaps most startlingly, the provision of birth control off the list of basic benefits all insurers must cover. Nor are these services protected from “cost sharing,” which means that, depending on what’s in the bill that emerges from the Senate, and, later, the contents of a final bill, women could wind up having to pay for some of these services out of their own pockets. So far, mammograms and Pap tests are covered in every version of the legislation.
Granted, Congress can’t–and shouldn’t–get into the business of spelling out every possible cause for a trip to the doctor. No one wants the process to collapse under a mountain of requests from special interest groups à la the Clinton mess in 1993. But women, half of all adult patients, are not a special interest group. And since both the House and Senate bills include lists of specific services that must be covered by health insurance companies and be provided without asking patients for additional money, it’s hard to understand why all the services provided in a basic well-woman visit to the gynecologist isn’t on them along with maternity care, newborn care, pediatric dental and vision services, and substance use disorder services.
The fault for the initial omission can be laid at the feet of Democrats, who shied away from the issue, not wanting to invite controversy, according to women’s health advocates who tried unsuccessfully to get women’s preventive health care included in the basic benefits package. Some of the concern had to do with cost. Adding any required service to the basic benefits package would mean the Congressional Budget Office would give the bill a higher score, or price tag, leaving it more vulnerable to attack by budget hawks. But another part of the problem clearly stems from the fact that women’s bodies have become political lightening rods, even when abortion is not the issue.
Consider what happened when the subject of women’s preventive healthcare services came up in the Senate Health, Education, Labor and Pensions Committee (HELP) in July, after the minimum benefits package had already been determined. Because some essential care for women wasn’t included in the list, HELP committee member Senator Barbara Mikulski proposed an amendment that would require the Health Resources and Services Administration (HRSA) to stipulate that basic women’s health services would be covered. The language said nothing about abortion, referring only to “preventive care and screenings.”