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Health Care Reform—Obama’s Challenge

Obama meets with Republicans today in a health-care summit. Women who helped put him in office expect him to step up and lead—on both access to quality care and access to abortion.

When House Speaker Nancy Pelosi allowed Bart Stupak’s anti-abortion amendment to the health care reform bill to come to a vote in 2009, it wasn’t the first time women’s health issues had been discussed in the context of health care reform. But, as with most debates in Washington, the intensity of the abortion debate sucked all the oxygen away from other unique issues facing women—particularly young women—in the health insurance market.

Not that abortion access is a minor issue to America’s women, young or old. Democratic Congressman Bart Stupak’s persistence in linking abortion access to health care access and his disingenuous insistence that somehow, some way, American tax dollars might be used to fund an abortion, have functioned as a rallying cry for conservatives already opposed to health care reform. And because Stupak’s pet amendment would amount to the broadest restriction on women’s access to abortion services since Roe v. Wade—and even cause women who need an abortion to save their own lives or because they are carrying a dead or dying fetus to face incredible hurdles and outright prohibitions—women’s groups have necessarily focused on preserving women’s long-held access to abortion services. Accordingly, the soundbite-driven media has treated abortion as the only issue for women in health care reform. Stupak has succeeded not just in promoting abortion as key to the health care reform debate; he’s succeeded in making it the biggest issue for women, and in taking away valuable resources from broader health care access issues.

President Obama’s proposed reforms to Congress’ proposed health care reforms mirrored the larger lack of attention to women’s issues in the bill. There wasn’t a word in the proposal about killing the Stupak abortion coverage amendment or the Nelson “compromise” amendment that was no better; no mention of an effective provision to eliminate gender discrimination in premium pricing, despite the significant loopholes in the House bill; no whisper of what will happen to Senator Barbara Mikulski’s provisions related to co-pay free health screenings for women.

Instead, there’s plenty of specificity about how the affordability provisions and tax breaks will affect families of four, and little clarity on how smaller families or single women will have access to the tax breaks or affordable coverage. Obama’s new proposal focuses a great deal on the individual mandate and insurance rate-review provisions, talks at length about revenue generation, Medicare doughnut holes and anti-fraud provisions, but doesn’t manage to find space for contemplation of mandating contraception coverage.

The problem is that Obama’s proposal promises to incorporate parts of the House and Senate bills with his suggested additions—but he doesn’t suggest which pieces of the House and Senate bills will remain. Will he keep Stupak’s abortion language, or accept Nelson’s language or side with the many pro-choice women who helped elect him and prevent anti-choice partisans from imposing the most significant restrictions on abortion in a generation? Will Mikulski’s amendment on the specific health choices women need access to, including mammograms, survive the President’s scrutiny—let alone that of the House and Senate? Perhaps the answers will come out of Obama’s bipartisan health care meeting—but, in all likelihood, what few provisions there are aimed specifically at women’s disparate health care access will continue to be subject to the political process.

The statistics on health insurance for women remain grim—and unique to women. Around 18 percent of American women are without health insurance. More than half of women have problems accessing health care due to cost, despite the fact that they have health insurance. Thirteen states and the District of Columbia allow insurance companies to eliminate contraceptives from their drug coverage—and when they can, they sometimes do, despite the fact that covering contraception is decidedly cheaper than covering pregnancy or children. Of course, care during pregnancy is hardly a sure thing: 16 percent of women (including 23 percent of Hispanic women, 24 percent of African-American women and 30 percent of Native American women) don’t receive any prenatal care or get what care they do receive late.

Women face different issues than do men when it comes to health insurance in terms of access, cost and what we need covered. Yet, Obama’s plan remains seemingly one-size-fits-all. Women know too well that often means “one-size-fits-none.” While some women will benefit from increased access to the insurance market, a plan that doesn’t take into account the unique health care and health access challenges that women face will necessarily fall short of reforming the health insurance market in ways that provide women with equal, and equally useful, access to it.

Even as women look to reform to help improve access to the health care they need, the concern regarding abortion remains, and the lack of specificity on the abortion question hasn’t shielded the President’s plan from attack from anti-choice forces. On Tuesday, Stupak announced he would oppose the legislation because it doesn’t go far enough in keeping women from accessing abortion services. For Stupak, apparently, the most important part of reforming America’s health care system is making sure it limits as much as possible women’s access to a class of reproductive health coverage that he doesn’t believe they should exercise.

While maintaining access to abortion coverage is critically important, a health care reform program that fails to resolve many of the ongoing inequities in the health care system—be they for women, the poor or people of color—isn’t much of a reform at all. While mobilizing (through the Women’s Media Center among other groups) to push Congress to reconsider the abortion provisions inserted into the bill by anti-choice legislators, women need to also push to make sure the provisions for their health care access aren’t sacrificed on the altar of tax cuts and Medicare doughnut holes.

Obama can choose to exercise some political leadership on both women’s health access and access to abortion services on behalf of the voters that helped put him into office, or he can bow to the forces that refused to vote for him anyway. A year ago, Ms. magazine—to much criticism—ran a cover trumpeting Obama’s election with a mocked up picture of him wearing a T-shirt that said “This Is What a Feminist Looks Like.” Now, more than at any other point of his presidency thus far, is time for him to either prove his feminist credentials, or relinquish his metaphorical T-shirt and, with it, the support of a large number of women voters.

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