If only women didn't have those drippy, icky parts that make God-loving conservative politicians so edgy, politicians wouldn't be forced to do things like this to us. But women do have those icky parts, and thus we should understand that our job is to hush up - and be grateful for whatever crumbs we get.
Those crumbs, however, do not include routine gynecological care, nor do they include birth control. (Why am I so convinced that somewhere in this bill, Viagra is covered?)
Thanks, Democrats, for standing up for women - again! So far this week, I've turned down two fund-raising calls for the state and national Democratic party. At first, I was just angry over the Stupak amendment, but now I know I'm going to have to save that money in case I need a gynecologist.
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.
Got that? The Pap test itself will be covered - but not the visit to the gynecologist to get it.
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.
Uh, hello? Remember? Icky parts!
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 lightning 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."
Yet the voting on the amendment went exactly along pro- and anti-choice lines. The amendment passed by just one vote, with all the committee's Republicans as well as Pennsylvania Senator Robert Casey, an anti-abortion Democrat, voting against it. The committee's discussion of the amendment was dominated by Republicans' worry about the possibility of government money winding up in the hands of Planned Parenthood. Since there is no similar language included in the just-released House bill, the only hope for requiring full coverage for these essential services now lies with the Senate.
Good old Bob Casey! He's the same Pennsylvania senator who's now working on the Senate version of the Stupak amendment. (Hey, if you'd like to share your opinion with him, you can call him at 202-224-6324 or toll-free at 866-802-2833.)
While some within the anti-abortion movement have long opposed birth control, there is still widespread support for it among the general public, with virtually all women of childbearing age who have had sex using contraception. So why would senators treat birth control and other basic women's health services as a proxy for abortion? "People equate family planning services with Planned Parenthood, and they equate Planned Parenthood with abortion," says Adam Sonfield, an expert on funding for reproductive health services at the Guttmacher Institute. The senators who turned Mikulski's language into a referendum on abortion "either misunderstood or purposely distorted the amendment."
Such is the intellectual acumen of our elected officials. Either they're really that stupid - or pathological liars. (Or both.)
Either way, the irony of letting anti-abortion sentiment undercut the coverage of birth control is that it will likely lead to more abortions. "If women can't get this kind of primary care, there are three clear outcomes: cancer, abortions and infertility," says Anne Davis, medical director of Physicians for Reproductive Choice and Health, and a practicing Ob/Gyn in New York City. Davis cites the facts that untreated sexually transmitted infections can lead to infertility, and that pelvic exams help diagnose cervical cancers. As for the importance of covering--and not requiring women to kick in additional money for--birth control, Davis says, "It's fundamental primary preventive care. So if we don't do this, we're causing a lot of abortions."
Still, some Democrats involved in the health reform sausage-making process counsel patience. Noting that both Pap smears and mammograms should be covered by a reform bill, Senator Al Franken said, "There's more we need to do for women's health, but this is a huge step forward for American women, many of whom don't get these recommended screenings right now. What we pass may not be perfect, but it will make progress in improving the lives and health of women."
Oh, Al. What would Frannie say? More to the point, what would your daughter Thomasin say?
Yet, before we resign ourselves to a very imperfect health reform bill, it's worth reminding lawmakers that women's health extends far beyond abortion. And while those who make our laws may fear the consequences of taking a stand for basic services for this half of the population, the cost of not doing it, both in terms of health and politics, is sure to be far greater.
As I said, I've already turned down two Democratic fundraising calls this week. I don't know about you, but I'm just not feeling it these days. Why, if I didn't know better, I'd swear the Democratic party just doesn't care about women.