Women Demand Equal Benefits for Equal Premiums

Congressional hearing examines health care coverage barriers.

ByJohn R. Parkinson
October 15, 2009, 3:20 PM

Oct. 15, 2009— -- Although she was in perfect health, Peggy Robertson says she was

denied health care coverage by an insurance company in 2007 because, they said, she had had a previous cesarean section.

But to her surprise, the company denying her coverage -- the Indianapolis-based Golden Rule Insurance Company -- had broken no laws.

Robertson recalled the story today during a the Health, Education, Labor and Pension Committee hearing on Capitol Hill, highlighting the gap in health care costs and coverage between men and women in America.

She and her husband had searched for independent health insurance options after they saw the cost of their current policy increase each year. Robertson's husband is self-employed, so they were unable to get access to a group health insurance policy.

Robertson contacted Golden Rule in an effort to find out why the company rejected her application, and was told in a letter that if she had been sterilized after the C-section, was over 40 years old, or had given birth two years before applying for coverage, she might have qualified for coverage.

"In order to consider coverage without a rider, we require that certain requirements be met," the company told Robertson in a letter she read to the committee today. "One requirement is that some form of sterilization has occurred since the Caesarean section delivery."

Committee members were shocked by Robertson's story.

"That gave me goose bumps," Sen. Barbara Mikulski, D-Md., said about the notion of sterilization. "That phrase, that concept, I found that bone chilling. No one in the United States in order to get health insurance should ever, ever be coerced into getting sterilization."

Robertson, too, was shocked and had contacted the International Caesarean Awareness Network, only to learn that, with individual insurance coverage, insurance companies in many states are free to pick and choose the people they insure.

"When it comes to health insurance, women are discriminated against," Mikulski said. "We pay more – in higher premiums – and get less. Often we are denied care, whether it's because pregnancy is considered a pre-existing condition, or because we're not covered for preventive and wellness initiatives."

Can Insurance Companies Discriminate?

In Robertson's home state of Colorado, it is actually legal for insurance companies to discriminate against women because of a previous Caesarean, either by denying coverage, requiring sterilization or charging significantly higher premiums. Having a C-section delivery increases the chances that the procedure will be performed again on subsequent pregnancies.

"My husband and I ended up accepting an insurance plan with a high deductible that honestly could financially ruin us if there was a family medical emergency," Robertson said.

With the out-of-pocket costs of having a C-section higher than coverage from maternity insurance, Robertson says she and her husband are unable to afford to have any more children.

Once a woman has had a C-section, many doctors require that any subsequent births must also be performed the same way because of a high risk of fatal complications during birth -- especially uterine rupture.

"Not only are women being denied coverage because of a previous Caesarean, but they are also being denied the opportunity to have a non-surgical delivery with their next pregnancy because of widespread policies that ban vaginal birth after Caesarean," Robertson testified.

Ellen Laden, director of public relations for Golden Rule, was reached for comment today by ABC News and said that the insurance company's decision to deny Robertson coverage in 2007 was state-specific to Colorado and that the policy at the company has changed.

"Today, in all of the states in which we do business, Golden Rule does offer coverage to women who have had previous C-section," Laden said, adding that determining whether the individual has to pay higher premiums depends on the state. "In some states, they may pay a higher premium. In other states there may be exclusionary riders – there may be a period of time in which we would not cover additional C-sections – it may be a six-month rider, a 12-month rider."

The HELP committee is considering legislation – the Affordable Health Choices Act – which aims to give women equal insurance benefits for equal premiums.

"We must continue our fight for women, whether it's in the workplace, the doctor's office or the hospital," Mikulski said. "Health care is a women's issue. Health care reform is a must-do women's issue. And health insurance reform is a must change women's issue."

ABC News' Lisa Stark contributed to this report.

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