Focus on Women
Gender parity in healthcare:
If we don't do it, who will?

by Elizabeth Pownall

As women took to the streets for the right to vote, so women ought to be taking to the streets for healthcare and public policies that address their needs, say healthcare activists.

Women have been neglected for years, both in healthcare research and legislation. Serious attention is beginning to be placed on the "uniqueness" of the female body (unique in that it differs from the male body), but the gender bias legacy is enduring. Just two years ago, less than 15 percent of the National Institute of Health's budget was devoted to women's health research.

Twenty-five years ago, vaginal deliveries were not covered by health insurance. Ten years ago, routine mammograms and gynecological examinations were not covered. Currently, prescription contraceptives are still not covered.

Conceiving the Conceivable

Viagra was covered by insurance companies immediately after it was approved by the FDA in 1988. Although it has been available for 35 years, prescription contraceptives arestill not covered by many insurance companies. What is this all about?

It is about discrimination, U.S. District Judge Robert Lasnik ruled in a class action lawsuit brought against Bartell Drugs, a Seattle based drugstore chain. Bartell Drugs is violating the Civil Rights Act of 1964 by not providing prescription contraceptive coverage in its employee health insurance plan, Lasnik decided. Although it applies solely to Bartell Drugs, the decision is quickly rippling through the country.

As of March, 17 states have insurance mandates that cover prescription contraceptives, including Texas and New Mexico, with Massachusetts still pending.

Two contraceptive parity bills, sponsored by Rep. Diane Rosenbaum (D-Porland) and Sen. Susan Castillo, (D-Eugene) were introduced to the Oregon Legislature by the Oregon Women's Health and Wellness Alliance this last legislative cycle, where they recently languished and died.

"Why?" asks Rep. Alan Bates, (D-Ashland), "It's birth control. Welcome to 1937 in the Oregon Legislature. The Catholic Coalition and far right Right to Life people don't want it."

The debate among legislators over contraceptive parity was heated; it is one of the reasons that Rep. Jan Lee (D-Clackamas) switched her Republican party affiliation. It was also the reason a bipartisan group of legislators staged a walk out in the Health Committee chaired by Rep. Jeff Kruse (R-Cottage Grove) who gave the bill a prefunctory "tap tap" hearing (the hearing is open by the tapping of a gavel, and closed immediately as the gavel taps down).

Originally business, insurance, Right to Life lobbies and the Catholic Coalition shunned contraceptive parity legislation, however things are changing with the recent Washington State decision, says lobbyist Maura Roche. Associated Oregon Industries (AOI), the largest business lobby in the state, recently warned employers in a newsletter that they could be at risk by failing to provide contraception coverage, she pointed out.

While contraceptive parity is equated with abortion by its Right to Life and the Catholic Coalition, the Oregon Health Department estimates that nearly half of all unintended pregnancies end in abortion. A 15 percent increase in the number of oral contraceptive users in a health plan would provide enough savings in pregnancy costs alone to provide oral contraceptive coverage for all users in the plan, the American Journal of Public Health reported in 1995.

"I have done a lot of soul searching on what we could possibly have done differently -- we had bipartisan support," says Rep. Diane Rosenbaum, (D-Portland), OWHA co-chair.

A task force has been formed to find other means than legislation to gain the insurance mandate. Among one of the options is a class action lawsuit similar to the one in Washington state.

Insurance companies resist mandates because mandates tend to drive up the cost of health care in general. A mandate may expand a particular medical benefit, but increased costs could effect health care access in other ways.

However, there is an inequity regarding women's health in insurance plans that cover basic health care. Women shoulder the financial burden by paying up to 68 percent of their own money for healthcare. "Men's health and bodies have always been the norm in designing health plans," says Gloria Feldt, president of Planned Parenthood. "Women's have been the abnorm."

At a recent women's healthcare conference at OSU that included contraceptive parity on its agenda Rep. Bill Witt, (R-Cedar Mill) and Rep. Betsy Close (R-Albany) implied university funding could be jeopardized because contraceptive parity was not getting a balanced perspective. When asked for his views on contraceptive parity, Witt refused to be interviewed, saying that he did not represent Eugene, although he is voicing opposition to a proposal that will affect the state.

"Contraception is a basic part of health care for women," says Sen. Susan Castillo, (D-Eugene), "It isn't just a focus on women, contraceptive parity helps the whole family." Castillo is co-chair of OWHWA.

Oregon has its share of the national problem. In a recent study, Oregon ranked 21st in the nation in women's health. In a national report, Making the Grade, Dr. Michelle Berlin, OHSU professor and OB/GYN, along with others (including the National Women's Law Center, OHSU and the University of Pennsylvania), found access to healthcare to be the biggest issue facing Oregon. Sixteen percent of Oregon women, they found, are without health insurance.

Breast cancer is the most commonly reported cancer in Oregon, access to rural health care clinics is decreasing, teen pregnancy rates and incidents of domestic violence remain high. The list expands as Oregon's economy slips further into financial crisis.

Oregon is a leader in its bold attempt to address this disparity. In 1992, the Oregon Women's Health and Wellness Alliance (OWHWA), formed by state Senators Kate Brown and Tricia Smith, was introduced to the Oregon Legislature. The bipartisan alliance, which includes state agency representatives, lobbyists, attorneys, legislators, and community organizers, was created to address issues currently facing Oregon women. In its monthly meetings, it offers everyone "a free exchange of ideas," says Rep. Kathy Lowe, (D-Jennings Lodge), OWHWA member.

As a result, OWHWA legislation addresses public health issues, while legislators gain more insight into statewide concerns. OWHWA intentionally steers away from abortion issues and makes an effort to introduce legislation that is little or of no cost to the state.

"In creating the alliance we wanted to create a package of issues for women that would take a huge leap forward in terms of women's rights in one session," says Senate Democratic leader Kate Brown (D-Portland).

One of the largest victories for the alliance was in the Oregon Women's Health and Wellness Act of 1993, which included requiring health insurance coverage for mammograms and gynecological examinations. "The victory was huge," says Sen. Susan Castillo (D-Eugene), co-chair OWHWA, but the struggle continues. In the same year, OWHWA introduced a bill requiring insurance coverage for prescription contraceptives (contraceptive parity) which got defeated, and has since been reintroduced and continues to be a contemptuous debate in the Oregon Legislature (see story on page 14).


Why Focus on Women?
Women have different diseases and different health patterns from men, yet a great deal of public policy does not address the differences. Women spend two out of three healthcare dollars. Forty-three million women in the U.S. are perimenopausal or postmenopausal, and 90 percent of all children who live with a single parent live with their mothers. Research and public policy are slow to catch up with these facts.

"My tax dollars have gone to pay for a lot of research that has been geared to middle-aged white men," says Rep. Kathy Lowe, (D-Jennings Lodge). "Studies sponsored by Congress and the research grants have used white males as their test population. I want to know what's going on with me and my health," she says. "If we don't look out for each other, who in the world is going to?"

Women's health does not reside in a vacuum. If women are not adequately cared for, no one is. The treatment of all members of a society is a measure of the health of a society. If anyone is disregarded, ignored or brushed away, everyone suffers.

"What we are really talking about is the well being of women and families -- these issues are not discreet issues. You are talking about the workplace, people's ability to stay employed, their ability to function in a family and as an employee. And the health care issues -- they are all interlinked," says Rep. Diane Rosenbaum (D-Portland), co-chair OWHWA.


Where's the Men's Alliance?
"We've had a men's alliance forever and it's been doing a pretty good job -- for men," says Kitty Piercy, Planned Parenthood public affairs director and former OWHWA co-chair. Although women are in the majority, she says, their health needs have not received adequate attention.

However, this is changing as more women have gained political power. Over the last 10 years as women are taking seats in Congress, the nation has seen gun control, health insurance coverage, issues of choice, and domestic violence, take the front page.

The same is true in Oregon. Women have been taking leadership roles over the past 10 years, says Castillo. "In the early '90s," she says, "there were enough women who started wielding power."

There would be no OWHWA if there were no women in the Legislature, says Piercy. "Its not that men won't vote the right way," Piercy notes, "it's that the issues won't come up. They will not reach a level of importance. That's one of the reasons we want women in office. They focus on different things."

 

He Said, She Said
In a legislative session a few years ago, a domestic violence bill was getting offhanded comments by male legislators that the women legislators were being "too fussy." When a Democrat and Republican representative (both women) revealed that they had been DV victims, the "will of the body changed," says Piercy. "In the year I served on the Legislature I never again saw the sort of trivializing and minimizing of domestic violence that had been there in my first session."

Again, while a bill requiring insurance coverage for mammograms and routine gynecological exams was not getting a hearing, supporters went from bringing people in to testify to personally appealing to the committee chair, former state Rep. Eldon Johnson. Having failed all their attempts, a group of women legislators drove from Salem to Ashland to speak with Johnson's wife. Soon after that, the bill got a hearing, passed out of the committee, onto the floor and passed into law.

"For years we have not focussed on the differences between groups in health care, whether it be Latinos, blacks or women," says Rep. Alan Bates, family physician, (D-Ashland). "We fail as a society and as a medical community to do that, but we're waking up to it."


Is There a Doctor in the House?
The Oregon Medical Association (OMA) a group of physician delegates from across the state, supports the interest of doctors and medicine by drafting and lobbying legislation that effects the practice of medicine. No one from the OMA is currently a member of OWHWA. Members from both groups agree that having an OMA representative in OWHWA makes sense.

OMA lobbyist Scott Gallant suggests that the OMA has not been consistently involved with OWHWA because it has not received an official invitation.

Getting Involved

The Oregon Women's Health and Wellness Alliance is a voluntary work group of individuals, state agency representatives, community organizers and elected officials who have met since 1992 to collaborate on legislation affecting women.

Each session as the public has become aware of these bills, support and momentum have grown. The alliance gains its strength from its members. Anyone interested in getting on the OWHWA mailing list can contact Rep. Diane Rosenbaum at: rosenbaum.rep@state.or.us

The 2001 Alliance Package included these bills in the last legislative session:

-- Funding for Domestic and Sexual Violence Services which increases state support for domestic violence and sexual assault victim services. This bill passed; $2.5 million was awarded.

-- Contraceptive parity which prohibits insurance plans from excluding prescription contraception in their prescription medication benefit packages.

-- Emergency contraceptive access which would guarantee women access to contraception within 72 hours.

-- Prenatal care which increases access for prenatal care.

-- New Child Responsibility Act which provides up to 12 weeks of paid leave for new parents.

-- Student Child Care Block Grant which supports efforts to supplement the federal block grant for the purpose of providing childcare assistance to low-income, post-secondary students in Oregon.

-- The Student Block Grant and funding for domestic and sexual violence services have been passed in the last legislative session, however they could still receive cuts in the next special session. The rest of the bills are still in committees, which basically means they are dead for this session.

Women in Oregon Government
Although Oregon currently has the largest number of women in history in the Legislature, and one of the highest in the nation, a woman legislator is not necessarily a member of OWHWA and does not automatically support OWHWA's legislation.

House Majority leader Rep. Karen Minnis, (R-Wood Village) introduced the Oregon Women's Initiative (OWI) in February 2001. OWI is a group of Republican women legislators who have joined to create bill packages that are "women friendly." When asked how OWI distinguishes itself from OWHWA, Minnis says she did not know what the alliance was. She pointed out that OWI is a group of legislators that does not include any other organizations.

Recently Minnis sponsored a bill seeking a tax break for married parents if one of them was earning $40,000 a year and wanted to quit work to stay home with the children.

Minnis also sponsored a bill giving unemployment benefits to victims of domestic violence who have to leave their job if their life is in danger. While this is a benefit for domestic violence victims, this bill is very similar to a bill OWHWA introduced, and failed to pass four years ago in the Republican controlled Legislature.

Alliance members believe that OWI was formed in response to the success and attention OWHWA has been getting over the past 10 years. The Republican women did not invite Democrats to their press conference, which disappointed OWHWA members who have stressed bipartisanship in their legislative efforts. "It's too bad," says Lowe. "It defeats the purpose of the alliance."


Outside Looking In
"If you haven't been personally impacted in some way, you don't think about these issues as much," says Bev Stein, gubernatorial candidate. "People don't realize how vulnerable people can be -- when you are on the outside looking in you can see how vulnerable you are in our country. This is true for gay/lesbian rights and for women's rights."

Stein is one of three candidates seeking the Democrat ticket for the upcoming governor's race in the fall. With both the House and Senate in Republican control, the upcoming race is important for Oregon and OWHWA.

"It helps to have a woman in the right place at the right time," writes NPR senior news analyst Cokie Roberts in her book, We are Our Mother's Daughters. "It helps even more if that woman is backed by millions of women voters who might retaliate politically -- throw the bums out or in."

OWHWA members, who include men, agree that it is essential to have women in leadership, along with men. "It is very important to have a group that tries to focus on the issues of the day," says Piercy. "Science changes, medical practice changes, needs change; to have a group focused on what's happening to the needs of women in Oregon is a very good thing," she says. "Because you focus on what's happening to women, doesn't mean you disregard men."

Sen. Brown agrees. The success of OWHWA depends on Oregon's leaders. "If you put folks in charge who make these issues a priority," she says, "you'll see immediate changes."

Do the current legislators reflect the state of Oregon? "I think you have legislators in Salem who represent the people in their district who vote. There is a big difference," Bates says. "It is a subtle but significant one."

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