Health Care Stakeholder Discussion: Women

(Cross Talk) Nancy-Ann DeParle:
Am I supposed to press
something here? A Speaker:
Yes. When you’re speaking,
just press the red button. And when you’re not
speaking — [inaudible]. [laughter] Nancy-Ann DeParle:
This looks different than when I was in here before. I’m Nancy-Ann DeParle, and I’m
the director of the White House Office of Health Reform. And I want to introduce my
colleagues and good friends, Tina Tchen and Melody Barnes. Melody’s the assistant to the
President for domestic policy. And Tina is Director of the
Office of Public Engagement. A Speaker:
Very good. Nancy-Ann DeParle:
Is that right? OPE, which is a new title and
means exactly what you think, not just liaison but
engagement in the public. And also, we have Neera Tanden
who’s at the Department of Health and Human Services. And where is Dana Singiser? You don’t get out
of this that easy. Dana Singiser, who’s a Deputy in
the Office of Legislation and who has been working
with us here. And then a lot of other
women around the room. We’ll go around and introduce
everybody in a second. We appreciate you all coming
here on short notice to sit down and talk to us about health
reform and issues of women and families, with respect
to health reform. We’re here because health reform
is one of President’s Obama’s top priorities. And we want to hear from women
across the country about how we can fix the way the
system works now. All Americans are suffering
under the current system, but women, we think, are
paying a heavy price, both as patients and as
caregivers and as the glue of the system. Women have watched their budgets
stretch thin as their premiums have nearly doubled in
the last eight years. They feel the sticker shock of
close to double-digit rises in premiums and drug prices. Twenty-one million
women are uninsured. And women who try to purchase
insurance often find that the private market is
stacked against them. Premiums in the private market
for younger women are often higher than they are for men. In some states, insurance
companies can legally discriminate against women,
leaving them with higher healthcare bills or
no coverage at all. I know that the insurance
companies recently offered to stop charging women higher
premiums because of their gender. And we obviously
welcome that step, but we know that
we need to do more. We need reforms that will make
that policy the law of the land and that will bring down costs
and improve healthcare quality for women and all the Americans. A few weeks ago, The Department
of Health and Human Services released a report called
“Roadblocks to Healthcare” that shows how our current system
is leaving too many women struggling with high healthcare
costs and without the care they need. So I hope you’ll take the
time to visit our website,,
to read the report. We know that health
reform can’t wait. And the status quo is
unsustainable and unacceptable. And that’s why we want to engage
with women all around the country in regional forums and
discussion groups like this one and through our website where
this discussion is being live-streamed today. And we’re really looking
forward to hearing from you. I want to introduce
my colleagues. And then let’s just go around
and introduce ourselves, get right into the discussion. Melody, you want to start? Melody Barnes:
First of all, I want to thank Nancy-Ann and thank Nancy-Ann for her
leadership on this issue. She has just really been a
wonderful leader and moved this process through the White House. And also Neera and Tina and Dana
and other colleagues as well, because this is certainly a
priority for the President. And I think one of the things
I am quite pleased about — I guess it was in March, which in
some ways seems like yesterday and in some ways it seems
like about ten years ago, we launched this work
with the healthcare forum. And I know several of you
were here for that process. And we want to thank you
for your participation. But certainly since then,
Nancy-Ann and I have had the opportunity to travel
around the country, to all parts of the country and
engage with people and talk to them, in particular women, about
their experiences with our healthcare system and their
desire to try and drive down spiraling costs, to make sure
that people were covered for themselves, for their family,
and for their children. So this work is very
important to us. And we feel — I know I do —
that I bring those stories and those people into the office,
into our work, everyday. So having the opportunity to
now engage with you and hear specifically about your concerns
as we go through this process is very important and, I think, a
component and a continuation of that conversation. From a DPC
perspective, you know, we are supporting Nancy-Ann and
supporting Secretary Sebelius as they lead this effort. And particularly, we have an
interest in the issues of women’s health and also issues
that affect low-income people. And Jeff Crowley in my office
who has expertise on the Medicaid system and the Medicare
system has been actively involved in participating in
these conversations and this work as well. So I just want to thank you for
being here and for working with us and then turn
it over to Tina. Tina Tchen:
Well, thank you. And I won’t take long because
what we really want to do is hear from all of you. My additional hat — just
because I think it has relevance to this meeting too —
as many of you know, no one in the Obama White
House does one thing. As the President says, we
can do multiple things. We can multitask here. So in addition to being the
director of The Office of Public Engagement, I’m also the
executive director of the White House Council on
Women and Girls. And looking at healthcare is
certainly something we are doing, you know,
with the council, assisting Nancy-Ann ‘s office on
this and working with multiple agencies. Secretary Sebelius and I did an
event a couple of weeks ago with women small business owners here
in the district that we also, you know, webcast to really hear
about what is confronting small business owners, many
of whom are women, in these sort of great small
businesses that are in the engine of our economy and yet
really cannot afford to provide themselves and their
employees healthcare, especially in the
current economy. And so this is obviously
a crucial issue for us. I think, as Melody pointed out,
this table is not the only time we’ve been getting input. And we urge all of you to stay
in touch with us, you know, through, you know, our office or
directly to Nancy-Ann and her staff on — if we don’t touch
upon all of the issues today, to continue to stay and
dialogue with us on it. We’re also looking at issues
on health disparities. And we’ve tried to include
women from across the country. And many of you represent
national organizations, and so we very much want to
not only hear from, you know, what’s going on here in
Washington but provide us input on what’s happening, you know,
to your members, your clinics, your clients and patients
from across the country. So thank you all again for
coming and for your work and your advocacy in this area. Nancy-Ann DeParle:
Mary, you want to say — (inaudible) Mary:
Just briefly, I would say, again, we’ve been working with a lot
of you and we really appreciate everyone’s work. And I would just amplify one
point which is we are really at the moment where a lot of
people’s work over years in this room are coming to fruition. And we very much appreciate
how hard everyone is working. But of course, as Nancy-Ann
who is working the hardest can attest, it’s only going to
get harder from here on in. And we really need to hear from
you about your concerns and your ideas now as we go through these
next couple of weeks and months because this is really the
moment where, you know, the rubber hits the road. So I look forward to
a great discussion. And thank you all
for participating. Nancy-Ann DeParle:
Let’s go around and introduce ourselves and then we’ll get
into our discussion. Wendy? Wendy Chavkin:
I’m Wendy Chavkin. I’m a physician at Columbia’s
Mailman School of Public Health. Susan Wysocki:
I’m Susan Wysocki. I’m the President and CEO of The
National Association of Nurse Practitioners in Women’s Health
here in Washington, D.C. And I’m also a women’s
health nurse practitioner. Raul Gonzalez:
Hi, I’m Raul Gonzalez. I’m the Legislative Director
with the National Council of La Raza here in Washington. Mike Fraser:
Good morning. I’m Mike Fraser. I’m the CEO of The Association
of Maternal And Child Health Programs here in D.C. Cynthia Pearson:
I’m Cindy Pearson. I’m wearing two hats. I’m the director of The National
Women’s Health Network here in Washington, D.C., a Women’s
Health Consumer Organization. And I’m also a cofounder of
a national initiative called Raising Women’s Voices for
the Healthcare We Need. Marcia Greenberger:
I’m Marcia Greenberger, Co-President of the National
Women’s Law Center based in Washington, D.C. Eleanor Hinton-Hoyt:
Good morning. I’m Eleanor Hinton-Hoyt,
President and CEO of The Black Women’s Health Imperative. Sloane Rosenthal:
I’m Sloane Rosenthal with The National Family Planning and Reproductive
Health Association here in D.C. Susan Wood:
Hi, I’m Susan Wood. I’m at George Washington
University School of Public Health and Health services and
Director of the Jacobs Institute of Women’s Health. Donna Wagner:
Good morning. I’m Donna Wagner, and I’m here
representing the Older Women’s League. And I’m a professor of
Gerontology at Towson University. Karen Kaplan:
Good morning. I’m Karen Kaplan. I’m the CEO of the Ovarian
Cancer National Alliance. Our office is here in D.C. Cecile Richards:
I’m Cecile Richards. I’m the President of the Planned
Parenthood Federation of America. Laurie Rubiner:
Laurie Rubiner, I’m Vice President for Advocacy
and Public Policy at Planned Parenthood Federation. Christine Brunswick:
Hi, I’m Christine Brunswick, Vice-President of The National
Breast Cancer Coalition. Randy Schmidt:
Hi, I’m Randy Schmidt. I’m with the YWCA USA. Martha Nolan:
I’m Martha Nolan, Vice-President of Public Policy
at the Society For Women’s Health Research. Lisa Tate:
I’m Lisa Tate,
Chief Executive with WomenHeart, The National Coalition for
Women with Heart Disease. Susan Scanlan:
I’m Susan Scanlan. I wear two hats as well. I’m the President of The
Women’s Research and Education Institution. And as such, I’m interested in
military women’s health and veteran women’s health. I’m also chair of the
National Council of Women’s Organizations, an alliance
of 230 women’s organizations representing 12
million American women. Eleanor Smeal:
Hi, I’m Eleanor Smeal, President of The Feminist
Majority Foundation. Alta Deshara:
I’m Alta Deshara, a professor of Law and Bioethics at the University of
Wisconsin, Madison, School of Law and
School of Medicine. Sabrina Corlette:
I’m Sabrina Corlette. I’m Director of Health Policy
Programs at the National Partnership for
Women and Families. Vanessa Gamble:
Good morning. I’m Vanessa Northington Gamble. I’m University Professor of
Medical Humanities and Health Policy at the George
Washington University. Mary Jean Schumann:
I’m Mary Jean Schumann. I’m the Chief Programs Officer
at The American Nurse’s Association. I’m also a nurse
practitioner by education. And I have five daughters,
so — (laugther) A Speaker:
You win. (laughter) A Speaker:
No, they win. (laughter) Jerry Joseph:
Well, I’m Jerry Joseph, and I’m the President of
the American College of Obstetricians and Gynecologists,
also a practicing obstetrician and gynecologist for a number of
years in New Orleans, Louisiana. I don’t have five daughters, so
I can only imagine what that’s like. I have one, and that’s enough. (laughter) Jerry Joseph:
It’s a great pleasure
to be here. And thank you for
the opportunity. Priscilla Wong:
Good morning. I’m Priscilla Wong with the
National Asian-Pacific American Women’s Forum here in D.C. Nancy-Ann DeParle:
All right. Well, let’s just get
a conversation going. I can tell this is
not going to be hard. I’ll just put on the table what
issues in our current system are of particular concern to women
in the healthcare system. Sabrina, you’re nodding.
You start us off. Sabrina Corlette:
Sure. I think this was really —
there’s just this constant drumbeat. And I think for us there’s
such an urgency right now. Seven-Six percent of women
support or strongly support passing healthcare reform. So women are with you. They are excited. And they appreciate
your leadership. For us, we have six main things
that we’re really focused on with healthcare reform. One is affordability,
particularly if we’re talking about having an individual
obligation to purchase coverage. We need to have coverage that
is affordable to families. Women need to be able to
purchase coverage for their children, their spouse’s, and
they need to know that it’s affordable over the long-term. And that means too that
it’s got to be sustainable. So one of the things that we’ve
been really focused on is bringing costs under control. And we think that that can be a
win/win for women and families and for the society as a whole. If we can get care to be
more patient-centered, particularly for people who
have chronic conditions, we think that that can really
lead to, overall, saving money. I was struck, I think many folks
have read the piece in The New Yorker by (inaudible) And I thought, you know, what
really hit home for me in that piece was, quite frankly, the
medical community in Osage County has lost sight of putting
the patient at the center. And I think if we start to do
that, we can bring costs down. Susan Wood:
Susan Wood, I would like to respond to that because we’ve actually hoped to be releasing
a report next week from George Washington University that
actually talks about the direct cost of chronic illness
and women and how the — essentially, you know, billion,
tens and hundreds of billions of dollars that we do spend on
chronic illness later in life are really best addressed early
on through prevention and primary care and that if we
look at primary care in a very comprehensive way, the services
are high quality and are appropriate during the
reproductive years. The payoff really can be later
in life with reduction in heart disease, cancer,
diabetes, and, you know, mental illness and depression
that are really costing the system a great deal. So I think that sort of fit into
your point about how some of the ways to bring down the cost is
through primary care and that the costs that women incur
in direct medical costs and economic costs are quite high
and really quite significant. And we have the opportunity,
through high quality care early in life during reproductive
years in the fair comprehensive manner, to make sure that we can
begin to prevent and mitigate the consequences of health
and disability later in life. A Speaker:
So picking up on what Susan said, first, thanks for doing this. I think focusing on women’s
healthcare is so important because obviously we have
different healthcare needs than men and mainly
because we reproduce. And I think this focus —
for Planned Parenthood, we’re primarily a preventative
healthcare provider. And I think what’s important to
remember as we go into reform, it’s not simply just
increasing coverage. It’s also where are folks
going to get their healthcare. For most women, their primary
healthcare provider is their OB. And that’s for low-income women,
women with insurance, you know. In fact, at Planned Parenthood,
we see about 3 million women a year. Upward of 60% of them are women
— we’re their only doctor. And I think the other thing,
as we think about prevention, because it does save money for
so many women — for example, they come to Planned Parenthood
because they may need contraceptive services. But once they’re in the door,
then we can get them breast cancer screening or
cervical cancer screenings. And a lot of services that they
wouldn’t necessarily go out, particularly if
they’re low-income, they wouldn’t go out
and seek on their own. And so I think there’s a way in
which we can make sure that the kinds of providers — that
there are essential community providers for women like Planned
Parenthood and other healthcare clinics that women tend to go to
that are part of the coverage, part of the exchange. A Speaker:
Vanessa? Vanessa Gamble:
Some of you are wearing two hats. I’m between two meetings today. And the other meeting where I
was at this morning and where I’m going back is trying to
increase the number of women and minorities who are going
into health professions. And that’s been a
passion of mine. And I think it’s time that
we wake up and smell the demographics in terms of who
are the young people today. And I think this brings up a
broader question of who’s going to provide the care so that
we could have health reform, we could have payment. But we need not just women and
their families — because women are the gatekeepers for their
children and their families, but who is going to
provide the care. Because as Massachusetts
has shown us, people might have coverage,
but they don’t have providers. So I think as we go through this
process of talking about quality and cost, we also have to think
about who will be the providers. Nancy-Ann DeParle:
I’m sorry. I can’t get everybody’s names. White jacket, yes. A Speaker:
Let me piggyback on Vanessa
and just say one of the overall issues that I think is going to
be neglected in the reform is caregiving, particularly
for the disabled, particularly for
people in the military, but generally American families. Who takes care of the sick? Who takes care of the
chronically ill, the disabled, the mentally ill? It’s women. It’s moms. The Older Women’s League I
know will join me on this. Something has to be done for the
unreimbursed cost that families, particularly moms or wives,
sustain in trying to keep people out of permanent care
situations, nursing homes, those kinds of things that
are much more expensive. But it has to be recognized. Nancy-Ann DeParle:
And what would you recommend specifically? A Speaker:
I think some kind of
coverage, some kind of, like a disability policy,
something that acknowledges tax credits. There has to be something
that can be done, particularly for the severely
injured veterans who are coming home now from the war and are as
healed as they’re going to be and then are sent home for mom
and dad or the wife to take care of. That’s not fair. A Speaker:
Yeah. I think the — you know, I would
agree with all these folks, that one of the things that’s
been spoken about least, in terms of the Health
System Reform Movement, is the issue of the workforce
and the workforce in terms of direct-care providers, the
ability to have sufficient direct-care providers who are
sufficiently educated and sufficiently reimbursed so that
they can provide services, which most families cannot
afford to purchase even if they can find one. And then to extend
that much more broadly. It’s not just about coverage,
although it starts there. But it is about workforce. It’s about advanced practice,
registered nurses who can provide that. It’s about all of those folks
who have a scope of practice that can be utilized to
provide those services. And I think we’re missing the
boat if we don’t address that piece. Nancy-Ann DeParle:
Marcia? Marcia Greenberger:
Well, it’s great not to go first, because a lot of issues
got raised already. But I have a list
that I’ve been making. And I’ll try to be brief
in some of these issues, either to amplify on some of the
very good points that have been made before or just
add a few more. I don’t think we can underscore
enough how important affordability is to women
and to their families. And affordability is not just
the issue of premiums but also deductibility,
principles and copays, and all of the other elements
that go into what actual costs there are in
securing healthcare. And when we think about the
fact that women earn less, that they — in
fact, unfortunately, some of the data showed just
this month that in the rate of unemployment, women are
suffering more now over this past month with the
data just released. And then most specifically,
for women-headed households, that really underscores
the urgency of the issue, not only of getting healthcare
reform — which is really where I should have started by saying
how important your efforts are and how much we support them —
but also making sure that we can make this reform affordable. And because healthcare costs
have been so extraordinary, we’ve seen bankruptcies
due, in large measure, to healthcare costs that
women couldn’t afford. Even severe bankruptcy has
affected women the most. In the context of affordability,
both in terms of women earning less and having to deal with
their family’s healthcare cost and being the
caregivers as well, we’ve also seen
unfortunately that, especially in the
private market, when women are forced to have to
go secure healthcare themselves, they’re actually charged more
than men in wildly different rates. In some states — the National
(inaudible) Center did a study that documented that in one
state an insurance company might charge the woman with exactly
the same age as a man 20%, in another state 40% more, in
another state even 60% more. And that’s excluding maternity
coverage where women have to pay even more for an extra rider
to get the maternity coverage. And that rider will often have
the kinds of waiting periods that could be as long as two
years and make it virtually impossible to get the maternity
coverage to begin with that they need. So affordability can’t be
underscored too many times. So in healthcare
reform, to deal with it, we also need to make sure
that we deal with some of the insurance market reforms that
are going to be very important in making sure that the
system works properly. And we know there have been some
discussions about looking at this issue with respect to
employers who have a small number of employees to be sure
that they are protected from some insurance practices, gender
rating as I mentioned for example. But we’ve seen this being a
problem for larger employers too. So we think it’s very important
for these insurance market reforms to include all employers
for the protection of the workforce in general,
and especially women. The discrimination
sometimes that women face, such as in the rates
that they have to pay, can also affect their benefits
like the maternity benefits that I mentioned. So I think we really need to be
sure that there are protections against discrimination in
healthcare reform so that women of color, those who face
discrimination on different bases, receive protection. And finally, as these
maternity special riders show, we need to be sure that we have
comprehensive benefits and that we don’t segregate out women’s
reproductive health needs. They’re so important. And the idea that, as I say that
women in the maternity need to cover those costs themselves,
have cost not only those women and the families but also all of
us who are fighting so hard to make sure that we
reduce infant mortality, that we have healthy children,
that we have healthy families. By not covering those
reproductive needs, we really, I think, put ourselves
behind in the future as well. A Speaker:
I would just add I absolutely agree. And this is a wonderful
listening session, probably not just for
you but also for us. So we appreciate that
opportunity to be with each other. I think one of the things that
— there’s a big difference between healthcare reform and
health reform for our members. And health reform to us is a
bigger strategy to improve health, not just in a clinical
session but what happens outside of the clinical setting. So we’re very concerned about
assuring that within health reform, not just
healthcare reform, we’re also strengthening the
programs that happen outside of the clinical setting, in the
communities and different neighborhoods and states. And so one concrete that we
would love to share with you is The Maternal and Child Health
Block Grant to states that provide services to moms, kids,
and family in states has been severely eroded over
the past many years. And that’s one opportunity
to really make a concrete, specific improvement
in women’s health, through The Maternal and
Child Health Block Grant. A Speaker:
Susan? Susan:
Yes, a couple of things. First of all, a number of
issues have been brought up. I think Marcia’s issue of
looking at the — you know, when you don’t have
coverage of maternity care, you have outcomes that
somebody pays for. And that’s us at the very end. And the kind of reform that we
should be looking at should be looking at much longer horizons. The short horizon of saving
money here by cutting out maternity services there is not
what’s going to save us money if we’re looking at the long-term. We need to look at health
promotion and disease prevention. And we also — that
Maternal Child Block Grant, Planned Parenthood,
the Title X program, all those programs where women
are of reproductive age and often don’t have the means —
but there are women of means who also go to the programs — have
suffered over the last many years because of, you know, no
increase in funding at all while healthcare costs go up. I also want to point out
— and I do represent nurse practitioners — that it’s nurse
practitioners in those settings that are providing the
care in Planned Parenthood. It’s nurse practitioners
in those maternal block, child block programs, nurse
practitioners in Title X. That’s where I got my feet wet,
was as a nurse practitioner in a Title X program providing
those basic services; breast cancer screening,
cervical cancer screening, diabetes screening, blood
pressure screening, all those things that are basic
and giving women the tools to stay healthy. And I think those
are very important. The other thing I want to just
address is the issue that Vanessa brought up in
terms of having, you know, a community based
healthcare professional. One of the thoughts that we
should put into this is having people who are from the
community providing care to the community because you can take
all the cultural diversity courses in the world, but
nothing matches being from a community and being able
to provide care there. And I have much more
to say about that. The one thing I do
want to emphasize, when we look at
healthcare reform, I hope we’re not
just looking at cost. But this whole system really
needs to examine how we deliver that care. And it make sense
when I hear, you know, foreheads being smitted, where
are we going to find the physicians to provide primary
care when I know that nurse practitioners are — and other
advance practice nursing — are ready to provide that care. And that’s our passion, to
provide that kind of care. And looking at how do we get
more of those and what is the right mix of healthcare
professionals that we should have to address the drastic
needs that we have today and, you know, look at a whole shift. Not just about money, but about
the mix and how healthcare is delivered to keep us healthy. A Speaker:
[Inaudible].>>Nancy-Ann DeParle:
Great. Yes? Well, both of you. (laughter)>>Nancy-Ann DeParle:
Take turns. A Speaker:
We have a lot of the same issues, so we can speak in unison. This is so good,
thank you very much. I have heard — I think we’ve
covered a lot of the key issues. I would like to
address just three. One is the insurance issue. Two is the distribution
of specialist physicians. And three is the issue
of health literacy. And let me start there. I represent women in
terms of ovarian cancer. It is a disease for which there
is no early detection test. So we say until there’s a
test, awareness is best. We need to teach women how
to listen to their bodies. The symptoms are subtle, and we
do not have good communication programs that address the
literacy needs of underserved populations. That’s very key. The second issue is the
distribution of gynecologic oncologists. There are very few of them
compared to the needs for them. And particularly, there are
very few in rural areas. They just don’t exist for a
whole variety of reasons. Once a woman is diagnosed with
ovarian cancer or with other gynecologic cancers, they really
do need the services of a gynec–. So that’s the second point. And the third point is when we
talk about insurance reform, I think we need to address the
issue of portability in two areas. One is, for cancer particularly,
it’s a very expensive disease. It is also considered a
pre-existing condition which rules out a lot of women. And it’s not portable. You can’t take it from
one place to another. You can’t take your insurance. So if you have cancer and
you go to another place, that’s just too bad. I think the other issue is that
many women — and I can’t put a number on it — but many women
are caught in situations that are not good for them, in an
abusive difficult marriage, in an employment situation
that’s very bad because they can’t afford to lose
their health insurance. So these are issues, I think,
that need to be addressed. A Speaker:
Okay. I would like to switch to the
later part of life and talk about follow-up on the
caregiving issue and the prevention issue, as well
as the workforce issue. I’ll do it quickly. And thank you for giving us
this opportunity to share our thoughts with you today. Today there’s about one in every
four households in America who are involved in caring
for an older person. They are the default long-term
care system of this country. Not only are they spending time
and making some sacrifices in terms of career and work
and lifetime earnings, but they’re also spending money. Medicare does not
cover everything. Medicare is not the
perfect healthcare system. It’s great, but in a recent
study that I worked on last year, about 15 to 20% of a
caregiver’s income was spent on things that the older person
needed, their parent needed. They did not want their parent
to have to go, for example, on Medicaid to get their
long-term care facility paid for. They did not want to put them
in an assisted living facility. And a good chunk of that was on
healthcare issues that are not covered by Medicare. So this is a big thing. The prevention is a really
big important thing. And as a gerontologist, we
love the idea of prevention, but we have to also face the
fact that there’s 78 million people who are going to be
celebrating their 65th birthday in a few years. And many of us are
in that category. (laughter) A Speaker:
Okay. There’s a few things
we can prevent now, but we should have been
starting on it earlier. And really, we are
an aging society. And we have to consider the
needs, healthcare needs, of an aging population when
we’re talking about any of this. And finally, people have
talked about the workforce. And I have to say, one of the
biggest scarcities in this country right now
are geriatricians. And the primary care provider
is the person who is giving the care to Medicare
beneficiaries today. And those people
are not trained, and there’s a huge problem in
this country with pharmaceutical mis-prescribing for — they
call medical misadventures, whatever it is. But a lot of it is really due to
not really having the training. So thank you. A Speaker:
Thank you. I represent black women
primarily, poor women, and other women of color. So I could agree
with all of these. And I focus my remarks on
not only affordability but accessibility, accessibility to
quality of care and the highest standards of care that we can
get to poor women who cannot afford it and who do not
have access to treatment and alternative therapies because
often they’re not referred to that kind of treatment. So I think it’s important to
not only focus on workforce, which is badly needed in order
to address some of the cultural differences that are evident in
the kind of medicine that we provide, but also how do we
increase the number of people of color in communities who can
provide the kind of care and attention that we need in the
prevention and wellness model. So I would encourage us to think
of how do we address all of the health disparities that women of
color bear, disproportionately, by addressing how do we achieve
equity in health and healthcare, by developing a community based
model that integrates the highest standards of care with
everything else that we support and appreciate you giving us
this opportunity to talk about. Nancy-Ann DeParle:
Laurie and then Alta. Laurie Rubiner:
This is a little bit on that subject. But I just want to emphasize
the really important role that Medicare plays for women,
especially in the areas of family planning. It provides more coverage for
family planning and births than any other program. And we’ve been able to get some
state options for Medicaid coverage and, for example,
breast and cervical cancer treatment. And I think about 17
states have picked that up. And just as we’re thinking
about coverage expansions, that’s a really critical
program for women. So I hope that we keep
that in mind as well. Alta Deshara:
Thank you. You know, listening to all of
the ideas — and I suspect some of the others that will come up
— it occurs to me that what we’re really talking about is
trying to see this as a life cycle phenomenon, as opposed
to a series of very individual problems. And so there are five things
that occurred to me listening to everybody that might go into
flushing that idea out. The first is that, although
we’ve got tremendous expertise on reproductive health here, and
we all know how central that is, reproductive health should
not be misunderstood as only avoiding conception
of childbirth. But it really needs to include
the possibility of having children. And it’s one way of defanging
that issue slightly when we recognize that for many women
infertility or having a child is as much of a concern as
avoiding it at the wrong time. But perhaps even
more profoundly, we tend to skip right past a lot
of the non-reproductive aspects of women’s health because we are
all so focused on the fact that we have uteri. For example, Marcia Greenberger,
from the very beginning, was focused on the phenomenon
of women who were excluded from drug trials so that we now have
this huge unstudied natural history experiment on the use
of drugs and women and an equal degree of ignorance about the
way in which a variety of diseases affect women in ways
that are different than they affect men, regardless of
whether it’s drug related in terms of treatment. And so we’ve got huge knowledge
gaps that we tend to overlook. The second thing about the
non-reproductive aspects, I think, goes to what you
both were talking about, which is the
demography of women. We live longer than men, at
least we used to until we started smoking. And so we have a variety of
special issues in older age that are really not even
necessarily medical. A lot of lifestyle issues,
home structure issues, hygiene issues that may make
more of a difference in health outcomes than in number of
specific visits to a nurse or a doctor, as important
as those are, that have to somehow be folded
into our notion of healthcare. The third on cost, which
everyone’s very much aware of — again, I think I’m picking
up on Marcia who mentioned deductibles. There’s going to be some tension
here because cost control is often managed, is
often achieved, by having high deductibles in
order to incentivize kind of self-discipline in
the use of care. But since women
disproportionately access preventative services, those
high deductibles really affect us much more and they undermine
the goal of preventing disease in the long run, which is
what Susan was talking about. So just trying to keep an eye on
not allowing the cost measures and incentivizing measures to be
in tension with women’s needs. Fourth of the five, on access. There have been a number of
mentions of being able to get coverage. I don’t know that we’ve
connected that yet to the way the employment situation has
been changing and the degree to which part-time work fairly
often omits benefits. And so this discussion about the
public option versus no public option that’s been going on is
really essential to our needs. Because if we continue to have
provider plans that are employer based, women will
continue to suffer. In addition, for access — and
I’m assuming that somebody is going to talk about this,
expand upon it because it was referenced — almost all of our
reproductive needs in the areas of contraception and abortion
and even in STD screening are often viewed as life-style needs
as opposed to medical needs because we could avoid them
by not having sex so often. So there’s going to be a
tremendous temptation to drop those out of mandatory
coverage packages. This happens every
year in every state, and it’s something that
absolutely has to be resisted. And last, it’s great because
everybody’s talking about this, the role of women in healthcare,
not as the patients but as the providers. Because it’s true, we are
disproportionately the ones who are providing healthcare, either
professionally or informally as wives and daughters and mothers. And so the conclusion
it brings me to, when I look at all of
this, is that women are disproportionately the
consumers of healthcare, the purchasers of healthcare,
and the providers of healthcare. And we live longer to
do all of these things. (laughter) Alta:
Seriously, here’s my question. Why are we talking
about women’s health? We should be the norm,
not the special topic. We are the people that the
healthcare system is about. And if there’s any
special group out there, it’s men’s healthcare because
they use it less and need it less and use it for fewer years. So we should be changing the
notion of what is the norm around which we are building the
system as opposed to thinking of ourselves as special. (laughter) Jerry Joseph:
I totally and absolutely agree with you. As someone who has spent his
entire professional career dealing with women, I have
often said, tongue and cheek, that I love women. And it’s not a physical thing. I just think women are neat. I just gave a special address
a month ago saying how much I respect women for all of the
things that they end up doing in life, all of the things that
have been brought up today. Specifically, I just want to be
sure people have touched on it, we really need to be sure that
we have mandatory maternity care in any package for all
women who get pregnant. Period. It’s the start of life. People have made points before
about the importance of a good start. And you just can’t replace that. Nancy-Ann DeParle:
So you’re a practicing OB/GYN. Do you see that
in your practice, where women come in that have
insurance coverage but they don’t have coverage
for maternity care? Jerry Joseph:
Absolutely. Small employers
don’t have to do it. And you know the exclusions
much better than I do. But there are a lot of women
that are in working families who don’t have maternity care. And that’s just wrong. And just like you made the
point, which is very valid, we, all of us tax payers,
end up paying for this, one way or the other. And there are so many things
that are preventable, if we can get to them early
enough, in prenatal care, that will mitigate
a life-long misery. And to the government and
to all of us tax payers, it means money. And that’s what much
of this is about, not only the human side of it
but also to be able to deliver healthcare that’s affordable
and that’s good healthcare to everybody. And I appreciate the
opportunity to be here. And I do think the same thing
has to do with the insurance reform. Too many little loopholes
for women in reform. And we need reform for that. And portability,
that was mentioned. That’s very important. And I appreciate the
opportunity to be here. Thank you. A Speaker:
Priscilla? Priscilla Wong:
Thank you. I just wanted to highlight three
points in particular to the population that we serve
which is Asian American, Native Hawaiian and
Pacific Islanders. We are a highly
immigrant population. Over 60% of us were foreign born
and tend to be from mixed-status families where our parents or
our grandparents also came to this country. And so as such, as
others have mentioned, immigrant women
are also, you know, the gatekeepers and the
consumers and the providers for their families and face the
added responsibility and burden, unfortunately, of waiting
periods or excessive documentation requirements
or, if there’s an individual mandate, perhaps not being
eligible for subsidies. And so I wanted to
emphasize that, you know, immigrants want to
pay into the system. It will help with
the cost sharing. They will pay into the system,
and as such they should be treated fairly so that they can
get coverage for themselves and their families. Two other points to piggyback
off of what Eleanor and others have raised around
health equity, obviously as a
community of color, we are extremely committed
and concerned and hope that healthcare reform is able
to address some of these iniquities, particularly
in the delivery system, around language access,
cultural competency, workforce development issues. We do not think it’s
appropriate that currently, as is the case for a lot
of immigrant families, the children are doing the
interpretation for their parents. They should not be in the
room with the OB or GYN in translating their mother’s
sexual and reproductive healthcare needs. And then lastly, many folks
have mentioned the need for comprehensive maternal
healthcare coverage. Again, I just want to emphasize
how much that’s needed for immigrant women
and their families. We know that there was a study
done by the American Journal on Obstetrics and Gynecology that
showed that for every one dollar spent on immigrant
prenatal coverage, we save three to four
dollars in post-care issues. And so I just want to emphasize
that all immigrant women should have access to prenatal coverage
at that crucial period. Nancy-Ann DeParle:
Cynthia? Cynthia Pearson:
Thank you. Nancy-Ann DeParle:
Maybe we should start
losing this system. Cynthia Pearson:
Well, I mentioned I got smiles from all of you when I said we were part
of a project called Raising Women’s Voices for the
Healthcare we Need. So the way we encourage women
to raise their own voice is by, first, listening to them. And we’ve done a series of
listening groups and speak-outs to ask women to tell us
what are their experiences. And from that we draw policy
recommendations for change. And many of them have
already been said, so I’m not going to repeat. I’ll mention one that hasn’t yet
been said and then one that’s sort of a larger thing
we’ve heard from women. The one specific is women
really don’t like it when their provider says they don’t
do what the person needs, the refusal clauses. And that is something that we
would like reform to tackle as a change because reform,
how ever it goes forward, will be making some parts of
healthcare that have been, you know, itemized at
individual or state levels, have some oversight
at the federal level. And women would really
appreciate it if, when they were talking to a
nurse, nurse practitioner, physician, they knew that their
medical needs were first in that practitioner’s engagement with
them and not the practitioner’s personal religious beliefs. So that’s one specific thing
that hasn’t been said yet. Everything else that’s been
said, we hear as well. But I want to also speak about
this larger thing that we hear which is — and I think it’s
important to say in this room because all of us have
heard the research findings, the survey findings, that say
people are a little scared of change. They do want affordability. They do want to make sure their
care is always available, they can’t lose it, it’s
affordable, it’s good quality. But they’re a little afraid
of a dramatic change. So I want to talk to you about
what women have told us about how much they not only want
change in the system but they want to be part of
making that change. And it’s around disparities,
outcomes, respectful treatment. I’ve got here, just
from one speak-out, women’s stories about times in
their healthcare experience when that went wrong. They were treated
with disrespect, they were treated in
a bad quality way. So women very much want, in
addition to that affordable coverage that’s
always available, they want it to improve. And they want it to improve in
ways that are very nitty-gritty, not much as, you know, those
healthcare quality standards are gray, but that’s not the
nitty-gritty experience that women have. And the reason why I wanted to
use my time to talk about that is because when women see the
opportunity to change healthcare in a way they want,
big changes happen. I just need to remind us all, in
this country in the last forty years, women have been part of
the biggest changes to transform the healthcare system. They broke down the quotas
on women in medical schools. They established the right
of patients to have written information about
the drugs they take. They solidly got behind and were
part of the growth of nurse practitioners and advanced
practice nurses as legitimate providers in their own right. And they created the culture of
informed decision making that every American should be able to
expect at their birthright now. That’s what women can do when
they see the possibility to change the system. And the women who are talking to
us in our Raising Women’s Voices Program, they see this not only
as a chance to get affordable coverage that is
always available, but a chance to make it be what
they really want it to be for themselves and for
their families. So I share that with you because
I know you’ve got a tall order. You’ve got legislative language
that you need to see go forward and be part of and think would
work and be able to be paid for. And you’ve got
continued notarization, as you opened up by saying,
that you’ve been out talking to people. So, you know, it’s there
for you to tap into. And the more you can talk
about what women will get from healthcare reform in a way
that touches the day to day experience of women, the
more women will be with you, your strongest partners
in moving this forward. Nancy-Ann DeParle:
I’m going to ask everybody to keep your comments to a couple minutes
here so we have plenty of time. I want to get to what you want
us to do and what you’re going to do to make sure to help us. A Speaker:
I’ll be brief. Thank you so much for
bringing us together. This is such a wonderful group. Thank you so much. I think the echos that you’re
hearing about workforce concerns and the ways those play into
people having meaningful access to healthcare only highlights
the need to do both sort of immediate steps to make sure
that when reform happens people can see providers immediately
and also to take the long-term steps that are so sorely needed
to make sure we address the nursing shortage, the
primary care shortage, to make sure we have culturally
competent care over time. I think it’s really necessary
to do both of those things. And Cecile mentioned protecting
essential community providers. There’s an enormous network of
federally funded healthcare providers that provide
high-quality culturally competent care that take
time to do counseling, that have those resources that
are able to see patients if they’re included in
the reform package. So I think those are sort of
wonderful steps we can take, if those immediate
things happen, in addition to the serious
need we have for the long-term workforce changes that
we need in this country. A Speaker:
I would like to just bring up
evidence based medicine because we haven’t talked about that. And I think that goes toward
both quality care and affordability of healthcare. And there are many examples in
the breast cancer community where evidence based
medicine was ignored, from hormone
replacement therapy, autologous bone
marrow transplants, and now we see screening
being proposed for much, much younger women, which we
believe is inappropriate. But we think that any healthcare
reform needs to include and be cognizant of the importance
of evidence based medicine. A Speaker:
Thanks. I would like to quickly
make two points, sort of broaden two things
that were brought up earlier. One is the incredible importance
of research that is going to be needed in this
healthcare reform, because you’re going to
have, as we all know, limited dollars to actually
change or transform our healthcare system. And, therefore, what services
and care the women receive need to be what they really
need to be receiving. And as society has fought for
years for women to be studied, there’s still a great deal
more that needs to be done. And, you know, we feel that the
research needs to be translated quickly into practice, that the
underlying research needs to be done correctly. And that’s in addition to the
comparative effectiveness research being contemplated or
being done now and being done as contemplated under
healthcare reform. I sort of view those as two
different things because we don’t know what’s going
to happen in the bill. And in that research, we need to
make sure that women have been appropriately examined, that the
sex differences have been looked into in order that, you know,
the various drug issues that are raised, the various diagnoses,
that you’re appropriately diagnosed, diagnosed early, that
you get the right treatment, the practice is correct. It all ties into various
challenges because often with issues regarding
disparities, you know, they don’t diagnose you
correctly on heart disease or — (inaudible). And the second piece I would —
because I can go on a lot about that. I’ll just leave it there. And then the other piece goes to
something that Susan brought up and others. We keep talking about screening. But if we cut reimbursement
dramatically to imaging and diagnostic tools that not only
exist or are going to be in the pipeline, the access to those
tools will be enormously cut, using the term twice. In essence, you will not be able
to get what you need if not only the doctors don’t
have the equipment, aren’t willing to do it because
they’re not getting reimbursed correctly, and because of the
various screening tools that are coming out more, this is
impacting women in particular. A Speaker:
Thanks. Thanks for the intro. Just to follow up
on what Martha said, particularly about access to
imaging for microvascular disease and heart disease, it’s
a specific example that if imaging is not available for
some of these more specific tests that it will have a
disproportionate impact on women. So just to reiterate that. In terms of prevention, just
echoing what everyone has said here about access to primary
care and prevention, a couple things that
haven’t been said. One is the importance,
particularly for young women, related specifically
to heart disease. The good news about heart
disease is that heart disease death rates have leveled off for
both men and women slightly. That’s good. But the only cohort where heart
disease is increasing is in women age 35-45. I mean, that’s frightening. And with the obesity epidemic,
we’re likely to see more of that. So I think sometimes when you
think about heart disease, you only think
about older women. And in terms of
prevention and screening, it’s so important
for younger women. The other issue that I haven’t
heard brought up, I don’t think, is easy access and low barriers
to referrals to specialists. If you’re a woman
with heart disease, you need access to
prevention and primary care. But unfortunately, too often
women are not diagnosed by their primary care physician. They’re not getting detection
early enough, being diagnosed, so they get the
treatments they need. They can go to all the great
primary care physicians in the world, but if they’re
not being diagnosed, they need to be able
to go to a specialist. So for a woman with heart
disease or the precursors of heart disease, they have to be
able to get to a specialist to actually be able to
get the diagnosis. That’s what the data shows.
So thanks. Kelly Smith:
Hi, Kelly Smith. I want to go back
to nursing care. I don’t think they
really said this, that we must increase
home care, home nursing, at-home nursing care. I think it’s viewed as
an increase in cost, when actually it’s a
savings in dollars. What we’re doing is, after
serious operations, whatever, people go home, there’s
no home nursing care, especially for the elderly. They fall down, break a hip. And there’s all kinds of data
showing that without home nursing care that’s appropriate,
there’s more visits to the hospital and more costs. So I think that if we reframe
the debate on some of these things that have
been cruelly cut off, we would actually see a savings
in cost and more humane treatment. Now, to do that though, we must
increase the number of nursing training slots. There is a shortage of nurses. And so I think that nursing care
must be included in the package. And it should be a
standard of care. And we must accelerate
the training of nurses, which obviously
would reduce costs. And why they think everything
that women do increases cost, it’s a bias in the system. And back to bias, if there can
be a standard on insurance discrimination
through all packages, especially those that
are causing, you know, no prenatal care, et cetera,
it would be a cost savings. And I think you could put
this in as cost savings. The other thing is, I think the
public school systems — and I don’t know if this is in here —
should be used as part of this nursing healthcare reform. Kids are in school. There is a way to
increase — for example, I think past a certain age maybe
folic acid should be a part of standard preparation, that we
know now that folic acid is a prevention of all
kinds of disease. So I mean there’s got to be a
better use of the public school system for preventative care and
should be a part of the whole package. Now, one other thing you said,
how can we work together? What is the game? Is it going to — I mean, all
of us are experts on different parts of healthcare. But how can we be more effective
in this reform effort? Nancy-Ann DeParle:
Actually my question was, what are you going to do to help
us get health reform this year? Kelly Smith:
Well, we’re all going to obviously encourage it. But we’ve got to have a little
more knowledge of the game. I mean, how many healthcare
plans are going to be suggested? Is there going to
be a public one? Are there going to be standards
all across all of them? I mean, just give us
a little clue here. (laughter) Kelly Smith:
And also, give us some suggestions how we can help. Every group here wants to. There’s no question about it. We’re all geared up. But I think we could be more
effectively geared up if we knew exactly the game
we were playing. I think most of us are a little
— I’m speaking for myself. I would love it if we could get
some standards across all the healthcare plans, you know, so
that there’s some basic package. Everybody’s saying, oh, we
don’t want to hurt what is. Well, the inadequacy of
current coverage is big. I mean, we act as if the system
that is there — we talked about all those millions that are not
covered, which is horrifying. But of those who are covered,
they’re underinsured. I mean, there’s so many
exceptions and deductibles. And they don’t even know what it
is until something hits them. So if we could have some
standards throughout to prevent these loopholes, we would
actually have less bankruptcies, more effective healthcare,
and, in my opinion, less cost in the long run. A Speaker:
I’m going to call on two
people who have not had a chance to talk before. And to your question, I think
most people know that the President set forth,
during the campaign, a plan to address both lowering
costs for businesses and families, and getting
better coverage. And then the House and
the Senate are working, starting with those principles
that he laid forth, working on details
and bills right now. So this is really the crucial
time to engage with Congress as we are doing, certainly we
around this table are doing, to make sure that
your voices are heard. And by having this webcast, I
dare say that they’re hearing from all of us. A Speaker:
Sure. Thank you. Actually, I think it’s very
helpful to have a focus on women from the Latino perspective,
because Hispanic women are the most uninsured. And they’re concentrated in jobs
that don’t provide healthcare coverage. And they’re also
disproportionately small business owners who would be
affected by any mandates on providers. So it’s important for us, this
is a very resonant conversation. What I would like to maybe look
at in this brief time is just a couple frameworks for
us that are important. One is access, the
other is quality. When we talk about access,
clearly any healthcare reform has to increase the number
of people who are covered. If we go through this process
and we don’t have fewer Hispanics and Hispanic women
uninsured, then it’s failed. So we have to make sure that
we get more people covered. Obviously, cost is an issue
with regard to access. And there’s lots of really good
ideas on how to reduce cost here today. We talked about another issue
with regard to access is the immigrant issue. I would like to piggyback
on what Priscilla said. It’s not a black and white issue
as far as immigrant status. You have tons of
mixed-status families. And the presumption should be
that any child, any woman, any family is eligible if they
meet criteria based on income and other criteria set
by healthcare reform. Clearly, having more people in
the risk pool when we talk about private options is
going to reduce costs. It’s not going to
increase costs. And we need to make
sure that it’s clear, that having more people
participate is less costly. And the fact that if you look
at small business owners, having them to have to go
through extra verification processes, it’s not just going
to hurt them and their ability to engage in the system. But it’s not going to end up
with more people covered. And briefly, on quality, lots of
folks talked about cultural and linguistic competency. That’s an easy one, we think, to
deal with because that — it’s not as high cost and,
at the end of the day, you’re going to get more
people willing to go to get preventative care and getting
better care when they’re at the doctor. And so looking at an access
agenda, a quality agenda, we think, is the way to go to
make the system work better for Latinas. A Speaker:
I would like to suggest some
of the angles that accrue to this framework of looking at
women’s health across the lifespan, in addition to the
ones that have been mentioned which is not only all the ones
that have been mentioned about sort of a rationale,
preventative, you know, cost-containing benefits and
health magnifying benefits. But reproductive health is not
only important because of the next generation, because it’s
been a source of discrimination and all the rest of it,
but because actually it is inextricably linked to being
in women’s health across the lifespan so that when women go
in for their prenatal care or their family planning care, it’s
a magnificent opportunity to use the screening and detection that
you discover then to plan for their much later life. We could be intervening in the
hypertension that’s discovered during pregnancy so that when
she’s 65 she’s not a chronic hypertensive. And to cut to the chase
in the interest of time, what we would like to see is
an evidence based well women’s standard of care that addresses
women’s health across the lifespan. And I will leap to
your next question, which is what can we do for you. Lots of folks here can bring
you different constituencies. We’ve already brought you the
deans of schools of public health. Almost all of them across the
country are supporting this, been working with ACOG
who’s also supported this. Happy to rally the physician and
public health and other medical provider troops, because aside
from everything else, you know, it’s really no fun to be a
provider whose providing fragmented and irrational care. It’s not emotionally gratifying,
and it’s not intellectually gratifying at all. Nancy-Ann DeParle:
Sabrina? Sabrina Corlette:
Thank you. I’m going to touch on something
that I don’t think has been mentioned. But I’m going to add to the list
that Alta gave us around women’s roles. And one of them is healthcare
decision maker for their kids, for their spouses, and
for their aging relatives, and a couple things I urge you
to think about in terms of, as you are working with the Hill
to craft legislation around the idea of an exchange. Quite frankly, I think for
the majority of families, it’s going to be women that
are going to be gathering information about the
plans, comparing them, and making the choice. So as you think about the
design of the exchange, there needs to be transparency. Families need to know what their
financial liability is going to be over the course
of the year up front. There needs to be standards. I think we learned from Medicare
Part D that having 60 or 70 planned choices is not that
— it’s paralyzing to people. For low-income women, women
with cultural barriers, there needs to be
one-on-one assistance. A lot of women don’t have access
to an internet connection. Being able to go to
a one-touch shop, knowing what their
eligibility is, they may be eligible
for Medicaid. Their kids might be
eligible for CHIP. These are things that should
be up front, you know, made easy for people. And the only other point I want
to make — and it’s something that I don’t know — I hope you
guys are thinking about this. And Neera, I’m looking at you
because I think you’re going to be in charge. I hope this bill is
signed on October 1. And we’re going to be one of the
loudest voices cheering when that happens. On October 2, there needs to
be a massive public education campaign because
people need to know. The idea of an individual
obligation or family obligation to purchase coverage is
a huge paradigm shift. And people need to know
what their options are. They need to be educated. And they need to have the
resources available to them to make informed choices. That’s all. Nancy-Ann DeParle:
You’re going to be on implementation. I’m still trying to get people
to help us get this done. Vanessa, yes? Vanessa Gamble:
Two quick points. One is that we’ve heard
about home nursing care. But there are also a group of
mostly women in this country whose work is devalued. And that’s home health aids. And these are low-income
and immigrant women. And so that in terms of —
meaning their work is devalued, financial reimbursement, and
how we consider their work. This is cost savings too. So I think we have to
put that on the table. And then briefly, people have
talked about the issue of equity. And I think that we will be
fooling ourselves if we think for certain communities in
this country, people of color, gay and lesbian people, that if
we just have the card and the coverage that — that’s not it. There’s a whole body of research
that talks about what happens once you walk in the door. And The Institute of Medicine
report on equal treatment in 2002 has shown that for — with
the focus mostly on African Americans — that you can have
the insurance but you don’t get the quality of care. And it’s just not about
cultural competence. And so that we really have
to deal with that issue, that what happens once
one gets in the door. Nancy-Ann DeParle:
Mary Jean? Mary Jean Schumann:
Yes. I would like to
address two things. First, I would like to thank
Cynthia and Ellie for talking about the issue of making sure
that women have all of their options and the education
about all of the options, that’s not being judgmentally
provided in one way or the other. Nurses have a code of ethics. Physicians have a very
similar code of ethics. We believe that they need to
have full knowledge so they can make the best choice for
them and for their families. But secondly, let me go on to
some things that I don’t think we’ve talked about. And that is really looking at
alternative delivery models. And one of the things that
ANA is pulling together is a conference for nurses to look at
policy around alternate delivery models. We’ve talked a little bit,
touched a little bit on delivering in-school
based healthcare. Nurse-run clinics, I think, is
another important piece of that. We need to look at care
again in the communities. Geriatric folks, you know, it’s
hard for them to get on buses an travel to go access this care. We need to have the care in the
community that they can access readily and not have to have all
of those additional barriers. Another piece of that — and we
would support the healthcare home, medical home concept. We would urge you to think about
that being an all-provider concept. Another piece of this that’s
not been touched on at all is, I think as a mother
of five young women, intimate-partner violence is
an issue that nobody’s really talked about here. But it is key to so much of well
women care in terms of mental health issues, obesity issues,
alcohol and substance abuse issues. All of these pieces follow on
when we start to address the whole issue of intimate
partner violence. So I would urge you
to think about that. Nancy-Ann DeParle:
Okay. Susan and then Cecile. Susan:
And I too wanted to
add to what Mary Jean said about bringing up the whole concept of
the refusal and the importance of making sure that people do
know who they’re going to for their care and do
not get care refused, and to be treated with dignity. It is part of our
code of ethics, and it should be supported. That code of ethics
should be supported. And I know the
administration is doing that. I also wanted to add to what
Martha was saying about the reimbursement for
certain technologies. If we, for example
with DEXA screening, do not have reimbursement, that
will mean that a community physician’s office or a clinic
can no longer offer DEXA screening in the community, that
the individual can only go to a large healthcare center. They’re not going to travel. You know, I think about my own
mom who drove until three months before she died at 92. But she was not about to drive
out of that five square mile area that she drove. And she would not have gotten
DEXA screening if she had to go past that. And I also do want to, again,
re-emphasize — Ellie talks about school nurses. School nurses is probably
not what we all remember, where we have a school nurse who
was taking care of us when we got a cold. These school nurses
are, first of all, fewer of them taking
care of kids with IVs, multiple medications,
inhalers, sick kids. And there are fewer of them. We need to boost that system. And also to get people in the
homes so we can prevent that elderly person from falling
because they cannot see the fact that there’s a bump in the rug
or other things that could potentially cause them
to fall, break their hip, and then be in a nursing home. I used to work in
one of those too. And I can tell you what gets
women into nursing homes. And it’s a lot of those
falls and accidents. A Speaker:
Randy? Randy Schmidt:
As many people know, the YWCA USA is a provider
of services to women, girls, and families across the country. And a number of women that
we serve are low-income. And we’re very concerned about
what’s happening to low-income women across the country because
they may not be eligible for Medicaid, Medicare, SCHIP. They may not be able to get
employer based coverage. An individual insurance
market just completely is not accessible to these women
for a number of reasons. So we’re obviously concerned
about coverage for these women as well as any sort of
out-of-pocket cost that they may ensue because they do not have
the discretionary income to cover substantial cost. But I primarily wanted to touch
on a topic that was addressed most recently, and that’s
regarding implementation. And as someone who used to work
directly with low-income women, it’s completely feasible that
when the people who are going to be critical to helping
low-income women navigate any sort of system where they have
to determine coverage for themselves and their families
are going to be direct-service providers. They’re going to be the key
women that low-income women trust, they respect, they
have relationships with. They’re going to be the same
women that these individuals go to for help in filling
out housing applications. And so I think part of
discussing implementation needs to be how can we really insure
that those people on the front lines already working with
low-income women can help these women navigate this system. We saw this with regard to
Social Security privatization a little bit that, if we
created private accounts, how would women who have no
experience navigating — excuse me, investing in the stock
market be able to navigate the stock market. The same can be said for
navigating an insurance industry or deciding on plans when they
have no experience doing so. So I think it’s critical to
consider how do we work with people on the front lines who
are going to be helping these women make these decisions. Nancy-Ann DeParle:
Cecile, and then I’m going
to let Marcia have the last word
and we’ll wrap it up. Cecile Richards:
Okay. I’ll be fast. I just wanted to respond to your
very good question which is, what can we do to actually
get this to happen. Nancy-Ann DeParle:
Thank you. Cecile Richards:
I think there’s enormous enthusiasm in this country for
healthcare reform. And I think women, as
being very practical, are very excited about
the opportunities. I would just want
to say, comment, from the Planned
Parenthood point of view, one in four women come to
Planned Parenthood in their lifetime. So we have a huge constituency
that is very interested in what the outcome is. And we are sort of prepared to
move heaven and earth to have this happen. And I’m grateful to have an
administration that understands this is not just
a top down deal, this is a bottom up
deal effort also. We have to have the public
behind this whole concept. So the only two
things I would say is, I think women — to Alta’s very
good point — I think women’s healthcare has to be seen
as sort of part of it, not an outlier. And that’s just a
struggle we all deal with. And making sure that folks who
are providers to women are seen as part of the system and that
women’s healthcare isn’t worse off after reform
than it was before. And that seems like
maybe a laughable point, but I think it’s actually
something really fundamental as we think about the construct
of what’s provided for, what care is given,
and how it’s given, that that will be
an essential part. But we’re ready to dig in and
do the work on the ground. Thanks a lot. Marcia Greenberger:
Two smaller points and a bigger one. With all of the concerns that
have been articulated around this table — and
they’re all so important. They get translated obviously at
the end of the day into the kind of technical language of whether
these major life issues will be dealt with well or not. And so I have a couple of those
very technical things to say. For example, we’ve heard
about domestic violence. We know from some of our reports
and studies and elsewhere that women who are victims of
domestic violence often wind up finding that that’s being
treated as a pre-existing condition. So when people hear about the
public policy debates of how to deal with pre-existing
conditions, which sounds so technical, by
eliminating those kinds of issues, women who have
cesareans for example, c-sections and delivery, that’s
treated by insurance companies often as a pre-existing
condition for coverage all across the board. So those are fights that we
need to engage women in in the nitty-gritty of how these plans
are ultimately — and the legislation is
going to come out. And we want to be your ally in
making sure that we get the kind of healthcare reform that
has those protections in it. And we know that that means
we need to fight with you. It means that, for a public
plan which is going to be very important for women. And when we get to
the benefit package, we know how important it is not
to politicize the decisions about what is covered and what
is not because women will often find themselves somehow
marginalized if the decisions aren’t made on the basis
of medical need, evidence, professionalism. So we also want to be a
real ally and advocate, not only for some
of these details, but also in the design and
making sure that we do have the kind of independent commission,
medically based, evidence based, not politicized, to decide
what is cover and what isn’t. So I want to say, for the
purposes of the National Women’s Law Center — and I know that
that’s been echoed by others in this room, that we too want
to be allies and partners in getting into the actual fight to
be sure we get the healthcare reform that we know the
administration and you all are fighting for and that it is
healthcare reform that has those kinds of details in place. So we — and I’ll give a
little plug for We’ll have action alerts. We have organized telephone
calls with state based groups all over the country. We have the details that we hope
people will get informed about to speak out, and
to, in essence, really get into the legislative
process and fight for these victories so that we get the
reform and it’s the reform that women need for themselves
and for their families. Nancy-Ann DeParle:
Great. Thank you, Marcia. You’re one of the many people in
this room who has been working for this for years. And we thank you. And on behalf of Melody
and Tina and myself, we appreciate everything
you’re doing to help us get to healthcare reform that’s the
lowest cost for families and businesses and gets
everybody covered. That’s what we all want. And the next six to eight weeks
are going to be critical in that. So we really look forward to
continuing to hear from you and working with you. Tina, I’m going to let
you have the last hoorah. Tina Tchen:
Well again, thank you all for coming. I want to introduce two
people on the side there who, if you don’t know them already,
you know them by e-mail no doubt. Karen Richardson. Karen Richardson works in the
Office of Public Engagement doing our healthcare outreach. So she will be the point person,
and she has been in terms of pulling this meeting together. But then lots of the issues here
were also issues affecting women and girls which is why in my
role on the Council of Women and Girls, even outside of
healthcare, like the issues, domestic violence,
intimate partner violence, I think some of the — trying to
get more women and girls into health care. And the sciences are issues that
we’re looking at in the council. So I want to introduce Jeannie
Yaeger as well who is my special assistant on women’s outreach
and on the Council of Women and Girls. And then finally, for
everyone around the table, those who may be watching
this on the webcast, let me give you an e-mail
address to stay in touch with us. You may use this to send
additional reports. Some of you have referred to
research that you’ve done. I think it would be very
helpful for us to have it. And we will get it to
the healthcare team. Or if you have other issues
or you want to be involved, either ongoing updates and
what’s happening with healthcare or ongoing contact with us, what
the Council on Women and Girls is doing, we have an e-mail
address that we use for the Office of Public Engagement that
I promise you is always checked, in fact all the time. It’s the word
[email protected] So it’s the word, public, @,
WHO for White House office, EOP for Executive Office
of the President, .gov You may use that address for any
of these issues because that’s why we — you know, you can
just remember the one address. We will then get the
material to Neera, to Nancy-Ann if it’s
healthcare related. We’ll look at it, if it’s
Council on Women and Girls, you can send us
immigration materials. We cover actually that
entire waterfront. And so we want to thank you
for your continued support and efforts, as Nancy-Ann said, as
we move through this critical period. A Speaker:
I would be remiss from my
department if I don’t mention which is a
place where you can get really up-to-date information on the
debate, what’s happening, how health reform needs to pass this year. Why the costs have been actually too high. We have a myriad number of reports to report. Nancy-Ann mentioned at the beginning about the impact on women is on and we really hope and urge people to use that as a regular resource. Nancy-Ann DeParle:
Thanks everybody for coming.

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