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On Sept. 29, 2013, two days before a political showdown over Obamacare led to a government shutdown, U.S. Rep. Gwen Moore defended the health care law.
On MSNBC’s "Disrupt with Karen Finney" show, the Milwaukee Democrat described how bad women have had it -- and how things will improve with the Affordable Care Act.
"If you’re a victim of domestic violence, even that’s seen as a pre-existing condition. Women had to pay 50 percent more for health care because of gender rating. All of that is over."
So, we need to determine whether being a domestic violence victim is regarded as a pre-existing health condition; and whether women have had to pay 50 percent more for their health care because of "gender rating."
We also need to see how the health care law handles domestic violence and gender rating.
In 2009, first lady Michelle Obama made a statement similar to the first part of Moore’s claim. She said it was legal in some states to regard domestic violence as a pre-existing condition and use it as a basis for denying health insurance coverage.
The law center told us that its most recent check, in 2010, showed the District of Columbia as well as six states -- Idaho, Mississippi, North Carolina, South Carolina, Vermont and Wyoming -- had no law prohibiting the insurers from designating domestic violence as a pre-existing condition. However, there were restrictions in some of those states.
(The Kaiser Family Foundation, a nonpartisan health policy research group, also referred us to the law center on this question.)
In rating Michelle Obama’s statement, our colleagues pointed out that just because it's legal in some states for insurance companies to cite domestic violence as a pre-existing condition, it doesn't mean insurance companies are actually taking advantage of the loophole. Indeed, an insurer might deny a woman coverage based on an injury or condition without it being disclosed that the injury or condition was a result of domestic violence.
There was evidence in the 1990s that using domestic violence to deny coverage was widespread, but the law center told us it is not aware of any data on how many insurance companies actually use domestic violence now as a pre-existing condition.
Beginning on Jan. 1, 2014, the Affordable Care Act will prohibit insurance companies from denying coverage to people who already have health problems, such as high blood pressure, depression or diabetes, as well as "conditions arising out of domestic violence."
So, while there isn’t evidence that health insurers commonly use domestic violence as a pre-existing condition to deny coverage, it is "seen" as such in that it is legal in a handful of states for health insurers to do so. Moore is also correct that practice is being outlawed under Obamacare.
The second part of Moore’s claim is that women have had to pay 50 percent more for their health care because of "gender rating."
There’s no dispute that health insurers use gender as one factor in setting rates; others include age, family size, geographic region and health status. But Moore’s broad claim that women pay 50 percent higher rates isn’t so clear.
Moore cited a March 2012 report, again from the National Women’s Law Center. The center said it used the eHealthInsurance website to calculate premiums in the individual market -- in other words, premiums for women who purchase health insurance themselves, rather than getting it through their employer or spouse. The individual market is a key target of the Affordable Care Act.
The center said premiums were at least 50 percent higher for women than for men in a number of instances, including health plans for 25-year-olds in Arkansas, Iowa, Kansas, Pennsylvania, South Dakota, Virginia and Wyoming; and for 40-year-olds in Alabama, Arizona, Kansas and Kentucky.
Although federal anti-discrimination protections enacted prior to the Affordable Care Act generally prohibit employers from charging female employees higher premiums than male employees, businesses with predominantly female workforces are routinely charged more for group coverage, according to the law center. The reform law prohibits gender rating, beginning Jan. 1, 2014.
So, there is evidence that some women buying health insurance in the individual market, a key target of Obamacare, are charged 50 percent more than men for the same coverage. Such gender rating is made illegal under the health reform law.
Moore said domestic violence "is seen as a pre-existing" health condition and "women had to pay 50 percent more for health care because of gender ratings," but under Obamacare, "all of that is over."
The thrust of what Moore said is partially accurate, in that there is some evidence to back the pre-existing condition and 50 percent parts of her claim. She’s correct that the Affordable Care Act eliminates the treatment of domestic violence as a pre-existing condition and eliminates gender rating.
For a statement that is partially accurate but leaves out important details, we give Moore a Half True.
If you would like to comment on this item, you can do so on the Journal Sentinel’s web page.
MSNBC, U.S. Rep. Gwen Moore interview (quote at 2:35), Sept. 29, 2013
Email interview, U.S. Rep. Gwen Moore press secretary Staci Cox, Oct. 2 and 3, 2013
Email interview, National Women’s Law Center media director Rachel Perrone, Oct. 3, 2013
National Women’s Law Center, "Still Nowhere to Turn: Insurance Companies Treat Women Like a Pre-Existing Condition," Oct. 9, 2009
National Women’s Law Center, "Turning to Fairness -- Insurance Discrimination Against Women Today and the Affordable Care Act," March 2012
National Women’s Law Center, "Domestic violence in insurance"
McClatchy Newspapers, "Domestic violence as pre-existing condition? 8 states allow it," Oct. 4, 2009
Futures Without Violence, "How the Affordable Care Act Affects Victims of Domestic, Sexual and Dating Violence," June 2012
PolitiFact National, "Michelle Obama claims that domestic violence counts as a pre-existing condition in some states," Sept. 21, 2009
PolitiFact National, "Ban on denying insurance because of a pre-existing condition is achieved," March 26, 2010
PolitiFact National, "Slaughter claims that women pay 48 percent more for health insurance than men," Nov. 9, 2009
Center for American Progress, "There is a lot to celebrate for women’s health on the third anniversary of Obamacare," March 29, 2013
Women’s Law Project, "The United States Supreme Court has weighed in: The Affordable Care Act is here to stay," June 28, 2012
New York Times, "Gender gap persists in cost of health insurance," March 19, 2012
Interview, America’s Health Insurance Plans spokeswoman Susan Pisano, Oct. 4, 2013
Email interview, Kaiser Family Foundation communications officer Chris Lee, Oct. 3, 2013
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