By: Micole Allekotte, FellowPosted on October 19, 2009 Issues: Health Care & Reproductive Rights

by Micole Allekotte, Health Fellow, 
National Women's Law Center 

At the Senate Health, Education, Labor and Pensions (HELP) Committee hearing last week Senator Burr asked Marcia Greenberger, NWLC’s Co-President, to talk about a sentence in the Center’s Nowhere to Turn report regarding domestic violence and state insurance laws. Marcia didn’t get a chance to fully answer his question, so the Center would like to clarify for anyone who is actually interested in the answers to their questions.

First, what the report said. “It is still legal in nine states and D.C. for insurers to reject applicants who are survivors of domestic violence.” Thankfully, since that time one of the states on that list, Arkansas, followed the lead of the other 41 states that had already banned this practice and passed legislation ensuring that domestic violence victims cannot be denied coverage based on that status. That leaves eight states and the District of Columbia that do not ban the insurance company practice of denying coverage to women who are survivors of domestic violence. 

So now 42 states have taken action to ensure that survivors of domestic violence are not discriminated against by insurance companies.  Why are these laws necessary?  A bit of history, also from the Center’s Nowhere to Turn report.  “In the early 1990s, advocates discovered that insurers had denied applications for coverage submitted by women who had experienced domestic violence.”  This information was confirmed by a survey by a subcommittee of the Senate Judiciary Committee, in which half of the largest insurance companies in the country admitted that they “used domestic violence as a factor when deciding whether to issue insurance and how much to charge.” Apparently the insurance companies found nothing wrong with this practice. 

Since 1994, the vast majority of states have passed laws to fix this problem, and some of the remaining states’ insurance commissioners, including North Carolina’s, say that they are now in the process of addressing the issue through explicit regulations or legislation.  But Senator Burr seemed to argue that because the North Carolina insurance commissioner has not seen in the language of an insurance policy questionnaire the question “Are you a victim of domestic violence?” that must mean that they are not discriminating.  Of course, we all know insurance companies can have more than just a questionnaire in front of them when they make decisions about who to cover. They know, as Marcia tried to say, about our emergency room visits, our broken bones, bruised faces, and therapy. All those medical records they ask for make it possible for them to discriminate against people because they had the gall to use their health insurance in the past. And to make it worse, insurance companies do not have to tell us why they are denying us coverage. Knowing that this type of discrimination is not illegal in your state, would you bother to complain to the insurance commissioner? Illegalizing the practice gives survivors a basis in law so that they can complain to their state insurance commissioners if they think they have been discriminated against on the basis of domestic violence.  

Before this turned into the public relations nightmare that it should be for insurance companies, they flat out admitted to a Senate subcommittee that they engaged in the despicable practice of denying insurance coverage to survivors of domestic violence or charging them more for the coverage they offered. After most states made the practice illegal and a firestorm of public criticism erupted, now they want us to just trust them that they no longer use domestic violence to decide who is insurable in the states where it remains legal? Maybe Senator Burr should have asked the insurance companies to prove that they are no longer discriminating instead of asking survivors to prove that they have been discriminated against. 

The bottom line is, as long as insurance companies can deny us coverage because we actually need medical care (and that is what a pre-existing condition is), insurance companies will continue to put profits before people.  While denying a woman health insurance because she is a survivor is appalling, being denied health insurance because of any pre-existing condition harms real people by punishing us for having had the audacity to get treatment we needed. To ensure that health insurance is available to everyone, legislation must include requirements that insurance companies accept anyone who applies for coverage, regardless of prior health insurance claims, health conditions, or history. After health reform, insurers will no longer be able to deny us coverage because of any pre-existing condition, whether it’s having been subjected to domestic violence, having had a Caesarean, or having survived cancer. Let’s not forget what health reform is about; we must get real reform done, not just for domestic violence survivors, but for all the people shut out of the insurance market by their need for medical treatment.