[Congressional Record Volume 155, Number 68 (Tuesday, May 5, 2009)]
[Senate]
[Pages S5130-S5131]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. KERRY:
  S. 969. A bill to amend the Public Health Service Act to ensure 
fairness in the coverage of women in the individual health insurance 
market; to the Committee on Health, Education, Labor, and Pensions.
  Mr. KERRY. Mr. President, there continues to be discrimination 
against women in the individual insurance market. As you know, the 
individual insurance market is often the last resort for health 
coverage for individuals who do not have access to an employer-
sponsored plan or who earn too much to qualify for Medicaid.
  To assist these women, I am today introducing the Women's Health 
Insurance Fairness Act of 2009, a bill that would end the 
discrimination against women who seek to purchase an insurance policy 
on the individual market.
  According to the Kaiser Family Foundation, of the 94.7 million women 
between the ages of 18 and 64 in 2007, 64 percent had insurance through 
an employer, 18 percent were uninsured, 13 percent were enrolled in 
Medicaid or another type of public insurance, and 6 percent were in the 
individual market. In other words, about 5.7 million American women in 
2007 received health insurance on the individual market. With rising 
unemployment, it is likely that more women will rely on individual 
insurance market for coverage in the future.
  This market is too often a problem for women for a number of reasons. 
First, women are often charged more than men for insurance in the 
individual market. Gender rating is a common insurance practice under 
which most women are charged higher premiums than men for identical 
coverage. Federal civil rights law prevents employers with more than 15 
employees from charging different premiums based on gender and other 
factors. This protection is not extended to policies sold in the 
individual insurance market.
  According to a recent report entitled ``Nowhere to Turn: How the 
Individual Health Insurance Market Fails Women'' by the National 
Women's Law Center, a 25 year old woman can pay up to 45 percent more 
than a 25 year old man for the same coverage. A 40 year old woman can 
pay up to 48 percent more than a 40 year old man for the same coverage. 
A 55 year old woman can pay up to 37 percent more than a 55 year old 
man for the same coverage.
  Today, only 10 states prohibit and 2 States limit gender rating in 
the individual market. I am pleased that Massachusetts is one of the 10 
States that prohibit insurers from charging different premiums based on 
gender. But, we should-make sure that this prohibition is extended to 
every state in the nation.
  A second problem facing women on the individual market is that 
insurers may delay, deny, or limit coverage to women due to pregnancy 
or delivery method. Over 30 years ago with the passage of the Pregnancy 
Discrimination Act of 1978, Federal civil rights law established as sex 
discrimination denial of coverage for pregnancy, childbirth and related 
conditions in employer-based insurance policies. Unfortunately, this 
protection is not extended to policies sold in the individual insurance 
market.
  Individual market insurers can deny coverage to women based on a 
``pre-existing condition''. If the insurer discovers that a woman 
applying for coverage had a Cesarean section in the past, they can: 
charge a higher premium; impose a waiting period during which it 
refuses to cover another C-section or pregnancy; or deny coverage 
unless the woman has been sterilized or is no longer of childbearing 
age.
  Currently, there are only 5 States which prohibit insurance carriers 
from refusing to sell individual health insurance coverage to 
applicants who have health conditions or problems. Massachusetts is one 
of the five states which require insurers to accept applicants 
regardless of health status. Again, this prohibition should be extended 
to every state in the nation.
  A third problem facing women is that the vast majority of policies do 
not provide coverage for maternity care. The 1978 Pregnancy 
Discrimination Act specified that employers with more than 15 employees 
must cover pregnancy on the same basis as other medical conditions. 
Once again, similar protections do not exist in the individual 
insurance market.
  The National Women's Law Center recently analyzed over 3,500 
individual insurance market policies and found that just 12 percent 
included comprehensive maternity coverage and another 9 percent 
provided coverage for maternity care that is not comprehensive. They 
also found that a limited number of insurers sell separate maternity 
coverage for an additional fee known as a ``rider'', but this 
supplemental coverage is often expensive and limited in scope.
  Currently, 5 States, including Massachusetts, have enacted laws 
requiring insurers to include coverage for maternity services in all 
individual health insurance policies sold in their state. Every woman 
should have access to these services.
  That is why I am introducing the Women's Health Insurance Fairness 
Act of 2009, to end the discrimination against women who seek to 
purchase an insurance policy on the individual market. It has three 
basic parts.
  First, the bill prevents insurers in the individual market from 
charging women higher premiums than men. Gender rating is insurance 
discrimination based on sex and should not be tolerated. Over 40 years 
ago, the insurance industry voluntarily abandoned its practice of using 
race as a rating factor and now it is time to end rating discrimination 
against women. Gender rating hurts women's health by inflating premiums 
and creating substantial financial barriers for women seeking to obtain 
health care coverage.
  Second, the bill prevents insurers in the individual market from 
denying or limiting coverage based on a current or past pregnancy or a 
past or future method of delivery. No longer will insurance companies 
be able to deny coverage to women simply by treating a pregnancy like a 
pre-existing condition. Similarly, they will not be able to impose 
waiting periods relating to a pregnancy. They will no longer be able to 
impose higher premiums or deductibles on women with prior Cesareans.
  Finally, the bill will require all insurance policies offered on the 
individual market to provide comprehensive maternity coverage for the 
full scope of maternity services from preconception through postpartum. 
There is a huge cost to our society by denying maternity coverage. In 
2005, the costs associated with preterm birth, one of the most 
expensive pregnancy complications linked to lack of prenatal care, 
totaled over $26.2 billion. Yet, for every $1 spent on preconception 
care saved anywhere from $1.60 to $5.19 in maternal care costs.
  If women do not have the necessary maternity coverage, they will be 
exposed to substantial out of pocket

[[Page S5131]]

costs. Too many women are unable to pay these costs. The average U.S. 
hospital cost for an uncomplicated vaginal delivery ranges from $7,500 
to $15,000 and from $11,000 to $19,000 for a caesarean delivery. I 
believe comprehensive maternity coverage will save money and improve 
maternal and child health outcomes. Those currently without coverage 
often turn to our public safety net for assistance. Today, forty 
percent of all pregnancies are covered by Medicaid. We need to do 
everything possible to increase health outcomes for our children.
  The bill would provide the Secretary of Health and Human Services 
with the authority to monitor compliance with the requirements of this 
act. It gives the Secretary the ability to assess fines of at least 
$10,000 against any health insurance company that fails to submit the 
required data. Additionally, the bill directs the Government 
Accountability Office to issue a report by December 31, 2010 about 
problems any remaining for women on the individual insurance market in 
all 50 States.
  I would like to thank a number of organizations who have already 
endorsed the legislation including the American College of 
Obstetricians and Gynecologists, Children's Defense Fund, Consumers 
Union, Families USA, the National Partnership for Women & Families, and 
OWL--The Voice of Midlife and Older Women.
  During the Senate's consideration of comprehensive health care 
reform, I will work with Senate Finance Committee Chairman Baucus, 
Ranking Member Grassley to make sure that discriminatory insurance 
practices against women are ended. I will also work with my 
Massachusetts colleague, Senate Committee on Health, Education, Labor 
and Pensions Chairman Ted Kennedy to make sure this legislation is 
enacted into law. As in other areas of health reform, Massachusetts is 
already leading the way in preventing insurers from engaging in 
practices that harm women. I believe the rest of the country should 
benefit from our experience.
  I find it especially appropriate to introduce this legislation as we 
approach Mother's Day on Sunday, May 10th and National Women's Health 
Week on May 10th-16th. I can think of no better gift to our mothers, 
daughters, and sisters than the gift of affordable and accessible 
insurance that meets their health needs.
                                 ______