Proponents of health reform say women don't know what's in it in for them - and question why Democrats have been slow to target women. Analysts to Dems: Aim pitch at women

With health reform still struggling among voters, analysts say Democrats are missing the chance to win over one key group — women — despite dramatic proposals to transform the way insurers treat them.

All of the bills in Congress add strong new protections for women’s health, but President Barack Obama and congressional Democrats rarely talk about them.


Maternity care would be guaranteed. Insurance companies could no longer charge higher premiums for women than men.

And insurers now allowed to label a Cesarean section or even domestic violence a pre-existing condition to deny coverage would be barred from the practice.

But proponents of health reform say women don’t know what’s in it in for them — and question why Democrats have been slow to target women with the same intensity that political campaigns pursue this key swing group.

“In general, health reformers have missed the opportunity to define health reform as a bread-and-butter issue for women,” said Drew Altman, president of the Kaiser Family Foundation, a nonprofit health policy organization. “It gets discussed in the Beltway, but it doesn’t break through.”

Women typically make most of a family’s decisions on health care and have historically been more concerned about health care and supportive of making changes to the system. Women also are less likely to work at jobs that provide insurance or make the wages necessary to purchase coverage on their own. But in a surprise to Democratic strategists, polls find women are not much more likely than men to support health care reform.

A Kaiser Family Foundation survey from September showed 42 percent of women thought they would be better off if reform passed, while 42 percent of men thought the same. Women over 65 are less likely to support the plan than younger women.

“They feel conflicted,” said Celinda Lake, a leading Democratic pollster on health care issues.

Following a tumultuous summer, public opinion on health care reform has climbed back up to the levels seen before angry town halls dominated the news. But if Democrats want to strengthen support for the proposal, they need to zero in on women, proponents say.

“Women are the ones who are going to pay attention to health care, women are the swing vote on health care, women are the ‘influentials,’ meaning if women like the plan, then the men in their lives like the plan,” Lake said. “So in that sense, it makes sense to target women.”

Richard Kirsch, campaign manager for Health Care for America Now, an umbrella group of liberal organizations, said “a lot more can be done to focus health care as a women’s issue.”

“Particularly for independent women, focusing on this more can really help lift reform with the public,” he said.

First Lady Michelle Obama spoke with the leaders of women’s groups in September. Health and Human Services Secretary Kathleen Sebelius, White House health reform director Nancy-Ann DeParle and a cadre of senior White House aides who are women have done most of the outreach, speaking with women's groups, nurses and small businesses. HHS released a report earlier this year on how the system doesn't work for women.

Obama has targeted his message more broadly, appearing with nurses and emphasizing stability in cost and care as a key outcome of the reform legislation — which pollsters say appeals strongly to women — but he has yet to do an event aimed solely at making the case to women.

Linda Douglass, a spokeswoman for the White House Office of Health Reform, said more events targeting women are in the works, as part of a “vigorous outreach program.”

Sen. Barbara Mikulski (D-Md.), the dean of the Senate women, initiated her own drive two weeks ago that has included women-only talk-in on the Senate floor, an appearance by 11 women senators on CNN’s “Larry King Live” and a hearing last week in which a Colorado woman described how an insurer wouldn’t provide coverage unless she was sterilized.

The National Women’s Law Center, which produced an influential 2008 report on gender disparities in health care, launches a campaign Tuesday called Being a Woman Is Not a Pre-Existing Condition.

Still, with so much of the debate consumed by the public option, the divisions in Congress and the lack of bipartisan support, the message has been overshadowed.

“There has been a lot of attention this year on the need for health reform,” Sen. Sherrod Brown (D-Ohio) said last week, “but there has been too little focused on how health reform will work to improve the health and well-being of more than half our nation’s population — America’s women.”

Brown described the elimination of gender discrimination in health care as an historic advance comparable to landmark legislation prohibiting unequal treatment between men and women in employment, education and sports. “The sex discrimination in pricing, I have personally tried to get rid of that for 40 years,” said Eleanor Smeal, president of the Feminist Majority.

The problem is the individual market, where insurance is often more expensive and less predictable because people do not have the bargaining clout that comes with an employer-provided plan. The bills passed by five congressional committees would prohibit insurers from charging women more than they do men. Insurers would also be required to provide coverage regardless of pre-existing conditions and provide maternity care as part of a minimum benefits package.

The National Women’s Law Center report found women in some states pay 50 percent more in premiums — and it wasn’t necessarily because they received maternity care. The “vast majority” of the plans surveyed did not offer maternity coverage or women were asked to purchase a supplemental plan, according to the report.

“I imagine if we went out and did a poll, I don’t think they know this ends discrimination pricing,” Smeal said. “And most don’t even know they are paying more.”

The practice of charging higher premiums based on gender is prohibited or limited in 12 states, according to the law center report.

Insurers can end these practices but only if the risk pool is expanded by requiring all Americans — young and old, health and unhealthy — to purchase coverage, said Karen Ignagni, president of America’s Health Insurance Plans, the industry’s lobbying group.

AHIP released a report last week raising concerns that the individual mandate in the Finance Committee, which could be the blueprint for the Senate bill, may be too weak.

Jim Kessler, vice president for policy for Third Way, a centrist think tank, said with public opinion on health leveling off, a rigorous campaign for women’s support is more important after a bill is signed.

Women form the base of the Democratic Party — and if they’re not sold next year on health reform, Democrats will suffer in November 2010, Kessler said.

“The moment health care is signed into law, that is half-time. The next half is selling it to the American people — and women,” Kessler said. “They have to know what’s in it for them. The American people will either put a stamp of approval on reform or repeal it. That is going to be the central question.”