Wednesday, September 16, 2009

No Health Insurance for DV Victims

It sounds too ludicrous to be true, but according to a press release issued by the Service Employees International Union, it is legal in DC and eight other states for insurance companies to refuse service to women if they have ever experienced domestic violence. In 1994, an informal survey conducted by the Subcommittee on Crime and Criminal Justice of the United States Senate Judiciary Committee revealed that 8 of the 16 largest insurers in the country used domestic violence as a factor when deciding whether to extend coverage and how much to charge if coverage was extended. DV is labeled by these companies to be a preexisting condition.

Regardless of your opinion on healthcare reform, we hope you share our view that this is unconscionable. Insurance companies are further victimizing a group of women who need healthcare the most due to injuries that are not their fault. Women in violent relationships frequently sustain injuries and experience illnesses that require medical attention. According to the US Department of Health, domestic violence is one of the most powerful predictors of increased health care utilization.

Many sources have commented on this issue, and the most common defense of the insurance company is to blame the victim. Commenters argue that people who scuba dive or bungee jump regularly have higher rates or are denied coverage because they put themselves in high risk situations. Therefore, they argue, women who put themselves in the high risk situation of being battered should also share the burden for their increased medical costs. The women should bear that burden, not their batterers.

Amanda at Pandagon reminds us that this policy has additional consequences.

Obviously, the major one is that the fear of losing insurance coverage might drive victims to avoid reaching out for help, and it may even mean that they don’t get treatment for their injuries after an abusive incident. And of course, the less a woman reaches out for help, the less likely she is to get out of the situation. In addition, one form of control that abusers use over their victims is financial dependence, and impoverishing a woman by denying her health care coverage will only make her more dependent on the abuser. I wouldn’t even be remotely surprised to find out if abusers often use health insurance as leverage over their victims, especially since a much higher percentage of women than men are covered through a spouse’s employer-provided insurance.

The report I link is heavy on screening recommendations, which is already a point of tension between people who look at these issues from a public health perspective and individual providers. After all, it’s both true that screening for domestic violence at the doctor’s office would help lower the overall incidence of it and that having those individual conversations is a miserable event for everyone involved. But obviously, providers can be convinced to set aside their reservations and do the screening if there’s an overall benefit to their patients. The problem, though, is if you include screening questions about domestic violence, you’re helping put your patient in danger of losing her insurance coverage or being accused of defrauding the insurance company if it comes out that she has been victimized, but declined to admit that in the screening process. More than anyone, doctors are sensitive to the importance of not provoking insurance companies to deny coverage, and I doubt they’ll eagerly sign up for further screening programs that could create financial problems for their patients.
Even though Georgia is not one of the states who allows domestic violence to be categorized as a preexisting condition, our own Senator Johnny Isakson voted against a proposed 2006 amendment to the Health Insurance Marketplace Modernization and Affordability Act that would have required insurers to stop ignoring state laws that make it illegal for them to deny coverage to domestic violence survivors, ostensibly reopening Georgia to the practice.

To encourage Congress to pass a healthcare reform bill that includes protections for domestic violence survivors, sign the petition here.

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