Federal Policy Agenda for Women's Health

The federal government plays a major role in the health of women throughout the nation. Through national programs and assistance to the states, the federal government can establish laws addressing private and public health care policies, fund health and ancillary services to individuals, and fund and conduct public education and outreach campaigns. Unfortunately, over the last several years, federal policy has moved in the wrong direction in ways that have a major adverse impact on women’s health.

The “Affordability Gap” in Women’s Health Coverage
According to the most recently available figures, over 17 million women do not have any health insurance at all, representing an alarming increase in the number of uninsured women in the nation. Moreover, many women who are insured are particularly vulnerable. On average, women are more likely than men to experience an “affordability gap” in securing access to health coverage, as demonstrated by the following:

Women are more likely to have lower incomes than men;
Women are less likely to have coverage through their employer;
Women use more health care services;
Women have higher out-of-pocket costs than men as a share of their income
Women are more likely to avoid needed health care because of cost; and
Women are more likely to have medical bill and debt problems than men.

Overall, women face unique barriers to becoming insured and securing access to care due to their lower incomes and greater health care needs. As a result, policies that provide the most comprehensive benefits at the most affordable cost are the best way to help more women obtain meaningful coverage. Conversely, reforms that result in higher out of pocket expenses and limited benefits will not significantly improve the health and financial security of women.

Public Health Insurance Programs are Essential to Women’s Health
Millions of women, even more than men, rely on public programs for their health insurance. Medicare and Medicaid are two of the public programs that provide crucial health care services for women, yet policy changes have been enacted that significantly weaken both programs and reduce critically important health care services available to women most in need.

Medicare
Adoption of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 has resulted in significant changes to Medicare’s core structure, and created grave consequences for the lowest income beneficiaries, primarily women. The new program’s systemic problems are numerous, including an overly complex structure that is confusing for beneficiaries to use and limits coverage for many even if they can navigate the system. Perhaps most egregious is the Part D prescription drug benefit plan which went into effect on January 1, 2006. It eliminated federal funding for secondary prescription drug coverage through Medicaid for the poorest Medicare beneficiaries, leaving them with few viable alternatives for securing their costly prescriptions. The law also created a gap known as the “donut hole” that caps the benefit for Part D beneficiaries who meet an initial coverage limit, forcing them to pay the full costs for any drugs they need beyond that limit unless they reach the “catastrophic coverage” ceiling.

Medicaid
The Administration supports restructuring Medicaid from an entitlement program, in which everyone who is eligible may be enrolled, to a block grant, which provides only a finite allotment of funds to each state. Under a block grant approach, because the funds would be limited, eligible persons could nonetheless be denied coverage and fewer services would be covered for those who are enrolled. The cuts in state programs resulting from block grants would disproportionately hurt women, since women are the majority of adult beneficiaries.

Tax Cuts Impact
Any federal efforts to improve women’s health, including Medicare and Medicaid, require resources. But a series of large tax cuts enacted in the last few years leave few federal dollars to target health needs. More tax cuts are being proposed, which could mean even fewer resources would be available to meet the needs of women’s health, just when the country will be faced with the retirement of the baby boom generation and a substantial increase in costs associated with this expansion of the aging population.

Reproductive Rights
Women’s reproductive rights suffered a severe setback in 2007. In April, the Supreme Court decided Gonzales v. Carhart by a margin of one vote. In the decision, the Court upheld a nationwide ban on a medically approved abortion procedure, even though the ban lacks an exception allowing the procedure when necessary for the health of a woman. This decision undermines a core principle of Roe v. Wade and, more broadly, permits the federal government to interfere with the medical decisions of a woman and her doctor. Throughout the opinion, the majority conveyed a lack of regard for the validity of the judgment of women and the doctors who care for them. Justice Ginsberg’s dissent called the opinion “alarming.”

In response, pro-choice leaders in Congress have championed the Freedom of Choice Act to codify the core principles of Roe v. Wade. Congressional leaders have also embraced a legislative agenda that is designed to prevent unintended pregnancies through improved access to contraceptives and comprehensive sex education. Recent reports of growing disparities in the rates of unintended pregnancies between low-income women and women with higher incomes raise serious concerns about the significant underfunding of publicly-funded family planning services.

This country can do better. The following recommended federal policies would promote women’s health and well-being:

Women’s Access to Health Care Services

Access to Insurance

To give all women access to health insurance, the federal government should:

Establish a universal health care system that achieves comprehensive and affordable coverage for all.
Broaden eligibility requirements for federal publicly funded health insurance programs, including Medicaid, so that low-income women without access to private insurance have coverage for the range of services they need.
Strengthen and expand federal publicly funded health insurance programs, including Medicare, to ensure that they remain available and affordable to older and disabled women, and that they cover the full range of services women need.
Invest in outreach, public education, and culturally sensitive materials, and remove bureaucratic hurdles, to ensure that women who are eligible for publicly funded health insurance programs are informed of their choices and can participate in these programs.
Improve access to employer-based health care coverage for workers and their families, and make this coverage affordable.
Improve transparency so that quality measures are publicly reported, reform the payment system to decrease unnecessary care and control costs, increase consumer decision-making and develop secure and confidential health information technology to ensure that all women have access to high quality, affordable health care.

Access to Health Care Services Beyond Insurance Coverage

To help women overcome many of the barriers that prevent them from receiving health care services, the federal government should:

Strengthen programs that make pharmaceuticals more affordable.
Strengthen public health system infrastructures to improve their ability to address major public health crises.
Remove the barriers to quality health care faced by women of color and of different ethnic backgrounds by supporting culturally competent services, including those that address language barriers.
Remove the barriers to quality health care faced by lesbians by identifying and supporting policies and programs that address their needs, including research into lesbian health and strengthening and enforcing anti-discrimination laws.
Remove the barriers to quality health care faced by women with disabilities by identifying and supporting policies and programs that allow full physical and financial access to services.
Require that employers provide or otherwise ensure adequate, flexible, and paid family and medical leave benefits so that employees can take time off to take care of their own health needs or those of family members.
Require private insurers to cover contraceptives when they provide other prescription coverage.
Provide financial assistance to cover the costs of long-term care services, including home and community-based care, nursing home and respite care, and help ensure quality long-term care by further developing and enforcing appropriate standards.
Make available and accessible “safety net” health care services for underserved and uninsured women.
Require that private insurers cover mental health conditions on the same basis that they cover physical health conditions.
Require pharmacies to ensure that a woman’s legal request for prescription or over-the-counter contraceptives is fulfilled without discrimination or delay.

Addressing Wellness and Prevention

To help promote good health and prevent disease among women, the federal government should:

Expand federal programs and increase funding to provide and/or cover preventive screenings like mammograms, Pap smears, and screening for colorectal cancer, osteoporosis, sexually transmitted diseases and domestic violence.
Increase investment in programs that support physical activity, assist women in getting nutritious food, and educate women about nutrition.
Investigate gender-based barriers to girls’ and women’s participation in physical activities and enforce applicable civil rights laws when violations are found.
Expand federal efforts that support and encourage women not to smoke and allow the FDA to regulate tobacco. Such efforts should include covering smoking prevention and cessation in federal insurance programs, increasing the federal excise tax on cigarettes and enforcing federal laws prohibiting minors from buying cigarettes.
Increase support for substance abuse programs that address women’s needs, including covering treatment in federal insurance programs, providing child care in federally supported programs, and addressing substance abuse by women who are victims of violence or in prison.
Create a dedicated federal funding stream for comprehensive, medically-accurate sex education, and eliminate federal funding for abstinence-only programs that promote gender stereotypes and misinformation about contraceptives.

Key Conditions, Diseases and Causes of Death for Women

To help address specific health conditions, diseases and causes of death faced by women, the federal government should:

Increase funding for women's health research, including research on cardiovascular disease, stroke, lung cancer, breast cancer, diabetes, HIV/AIDS, arthritis, violence against women, sexually transmitted diseases, depression and eating disorders.
Collect, publish and analyze health data on women in general and on specific populations of women (by race, ethnicity, sexual orientation, disability, socioeconomic status, region and age) and provide the data in a form that allows comparisons across these dimensions.
Develop and support programs to evaluate and promote effective prevention and health promotion interventions.
Increase funding for programs to prevent and treat the diseases, causes of death and conditions that constitute key health risks for women.
Enhance support for the specific programs and policies addressing heart and other cardiovascular diseases. Particularly important are increased support for the Well-Integrated Screening Education for Women Across the Nation (WISEWOMAN) program, and for expanded funding for key screening, counseling and therapy services for beneficiaries with cardiovascular disease.
Expand federal programs, including Medicaid, to provide HIV/AIDS pharmaceutical therapies and up-to-date treatments to women with HIV, as well as those who have developed AIDS.
Increase investments in mental health care services, including community-based services for women.
Expand and invest in federal programs that provide family planning, make infertility treatments more affordable, and increase funding for comprehensive prenatal and post-partum care.
Protect and expand women's access to abortion services by removing abortion restrictions on health plan coverage of medically necessary procedures, including in federally-funded health plans, eliminating restrictions on abortion services provided at federal facilities and enforcing “clinic access” laws that ban interference with reproductive health services.
Enact legislation to codify the principles of Roe v. Wade to ensure access to abortion.
Remove limits imposed on U.S. funding of family planning services throughout the world.
Remove unnecessary age and other access restrictions included as part of the approval of over-the-counter emergency contraception by the Food and Drug Administration.
Invest in surveillance and research on effective strategies to combat domestic violence and sexual assault, and support programs that address the health, financial and other needs of victims of these violent crimes.

Living in a Healthy Community

To ensure that all communities promote women’s health and well-being, the federal government should:

Require that adequate funds are raised in a fair and equitable manner through the federal tax system to address the health needs of women.
Expand programs that provide financial assistance to low-income women and their families, and help the working poor and other low-income women attain economic security.
Enact new prohibitions against discrimination on the basis of sexual orientation, genetic information, and domestic violence, and actively enforce the anti-discrimination laws that are already in place.
Enact legislation that would end sex discrimination in health care, and provide stronger protection for women from discriminatory pay practices.
Expand gun violence prevention efforts, including regulating the design, manufacture, distribution and sale of firearms and ammunition, and requiring standardized licensing and registration systems.
Require better monitoring of diseases that may be caused by environmental factors, fund more research to address the relationship between the environment and disease (e.g., cancer and reproductive problems in men and women), and more strictly regulate those toxins and other substances that are related to health problems.
Actively enforce current federal requirements protecting health in the workplace, expand those protections to require ergonomically correct workplace environments and ensure that occupational health rules adequately protect women.