miércoles, 24 de marzo de 2010

Reforma de salud en los Estados Unidos: ¿dónde nos deja a las mujeres?

Como ya habíamos comentado, el proceso por el cual la Administración Obama logró aprobar su reforma de salud no estuvo libre de cuestionamientos desde la perspectiva de género. Una vez más, los derechos reproductivos de las mujeres fueron eje de un mar de discusiones que, al final, terminaron en, entra otras cosas, una orden ejecutiva para establecer que dinero federal no podrá ser utilizado para sufragar abortos, salvo algunas excepciones.

No podemos evitar sentirnos decepcionadas de que, en circunstancias como esta, se siga reiterando un patrón que se niega a morir, a saber, el de las mujeres que ceden sus derechos en aras de un supuesto bien mayor. (Después de todo, el rol de la "mujer sacrificada" no es cualquier cosa). Hay mucha decepción (algunos grupos feministas y/o pro mujeres se sienten "traicionados") pero la decepción no puede ser obstáculo para reconocer que esta reforma adelanta necesidades de las mujeres que hace tiempo hacían falta. Entre otras cosas, obliga a los planes médicos a dar cubierta por mamografías, PAP smear, sonogramas.... y también, SORPRESA SORPRESA, obliga a los patronos a proveer un espacio en el lugar de trabajo para que las madres se extraigan leche para sus hijos/as. ¿Quiere esto decir que ha nacido una nueva causa de acción a nivel federal? No lo sé. Tampoco tengo claro cómo estas nuevas disposiciones aplican a Puerto Rico. Hay que averiguar más ya que los medios locales se han limitado a informarnos generalidades.

Desde aquí, intentaré informarles sobre el asunto. Comienzo dejándoles esto:

U.S. News & World Report
On Women
Health Reform: Where Women Stand to Gain

By Deborah Kotz
Posted: March 23, 2010
I was surprised to see women's reproductive rights groups use words like "betrayal," "onerous," and "unacceptable" in reaction to Sunday night's passage of the health care reform bill. (Then again, I was shocked to hear a Republican congressman shout "Baby killer" across the House floor at Democratic Rep. Bart Stupak, an avid opponent of abortion.) Coverage of abortion services took center stage in the days leading up to the bill's passage, with President Obama promising to sign an executive order that no federal funds will be used to cover abortions. In the end, no one is particularly happy with the compromise.

The National Right to Life Committee, an antiabortion group, referred to the legislation as "a pro-abortion bill" and said Obama's executive order "changes nothing" and doesn't fix any of the "pro-abortion provisions in the bill." House Republican Leader John Boehner agreed, telling his colleagues in this blog post that a yes vote on the legislation was a "vote for taxpayer-funded abortions." On the opposing side, the Center for Reproductive Rights issued a statement saying, "It is unacceptable that a pro-choice president has put his imprimatur on a highly restrictive and unjust anti-choice measure." Catholics for Choice called it a "step backward for women's rights."

Then again, women stand to benefit greatly from health reform in terms of increased maternity coverage, family planning services, and lower insurance premiums. So I'm wondering whether women's health activists consider the health reform legislation to be net positive or a net negative.

"This is a net gain," Planned Parenthood Vice President Laurie Rubiner tells me. "While we're a defender of abortion rights, we knew we'd have to do a balancing act, and we felt that the 3 million low-income women we serve would be better off with this legislation." However, she added that her organization, which provides abortions and other family-planning health services at reproductive health clinics, would have opposed health reform if it had included Stupak's amendment that banned abortion coverage by any insurance plan operating in the government's exchange. The Senate bill, which ultimately prevailed, allows plans to offer abortion coverage provided that the coverage is paid for with a separate check. (The Wall Street Journal, however, reported today that the system could be so cumbersome for insurers that many may choose not to offer abortion coverage. )

So, what do women stand to gain in healthcare reform?

1. Cheaper premiums. The health reform bill bans insurance companies from charging women more than men for insurance coverage. Research has shown that a whopping 95 percent of insurance companies use "gender rating" to charge women more than men for the same coverage for individual policies. For 60 percent of plans, a 40-year-old female who doesn't smoke will pay more for her policy than a 40-year-old male who does smoke. This practice will be reversed in 2014 when the insurance exchanges open.

2. Guaranteed coverage for mammograms and Pap smears. The women's preventive health amendment in the Senate bill ensures that women will be entitled to coverage for a wide range of screening services, including breast exams, mammograms, and Pap smears. Other preventive services that will be covered for both women and men include diabetes screening, vaccinations, colonoscopies, and smoking cessation programs. This will go into effect in six months. [More details on what's covered in the amendment]

3. Maternity care. Many private insurance companies don't offer it, but, starting in 2014, they'll be required to. They'll also have to cover newborn care, pediatric services (including dental and vision care), and mental health services like postpartum depression screening.

4. Better working conditions for nursing mothers. During the first year after giving birth, nursing mothers who work will be entitled to unpaid "reasonable break times" throughout the day to pump their milk. (The number and length of the breaks haven't been defined but could be addressed in a rule issued by the Department of Labor.) Employers would need to provide women a private place, other than a bathroom, to use a breast pump. The provision does, however, exempt companies with fewer than 50 workers if the requirement would impose an "undue hardship."

5. Easier access to insurance. Insurance companies will no longer be allowed to deny coverage based on pre-existing conditions. This is a particular boon to women who have been denied for such ridiculous things as having a previous C-section or being a victim of domestic violence.

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