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Ending Sex Discrimination in Health Care

On Monday, thousands of people and organizations, including the National Women’s Law Center, submitted comments urging the Department of Health and Human Services to release strong final regulations for Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination in health care. The ACA has many provisions that target specific forms of discrimination in health care—such as prohibiting insurance companies from charging women more than men or denying insurance coverage to people because of a pre-existing condition. Section 1557, on the other hand, broadly prohibits discrimination on the basis of race, color, national original, sex, age, and disability in health programs or activities that receive federal funding, were created by Title I of the ACA, such as the Health Insurance Marketplaces, or are run by an executive agency, such as Medicaid and Medicare.

Section 1557 is the first time that federal law has broadly prohibited discrimination in health programs or activities and combined with other provisions of the ACA will go a long way towards ending longstanding discrimination in health care. Prior to the ACA, insurance companies in the individual market routinely charged women more than men for health insurance; didn’t cover birth control or maternity care; denied women health care coverage for any number of reasons including because they had taken medication to prevent HIV after being raped or had acne. Insurance companies even targeted women diagnosed with breast cancer, looking for any way to rescind their insurance coverage to get out of paying for their care. The ACA prohibits all of these practices.

Undertreated and Misdiagnosed

Section 1557 goes beyond these specific provisions to reach longstanding, systemic discrimination and gender bias in health care that has kept women from getting the care and treatment they need. For example, because of continued gender bias in research and training, women are routinely unable to get a correct diagnosis and treatment. Ninety percent of women with chronic pain report that the health care system discriminates against female patients. In fact, women’s pain is routinely undertreated and often dismissed. One nurse told a woman experiencing severe pain because her fallopian tubes were twisted, cutting off the blood supply to her ovary, “You’re just feeling a little pain, honey.” The woman spent hours in agony in the emergency room while doctors and nurses alike dismissed her as exaggerating her pain. This was not an isolated incident. Men typically wait an average of 49 minutes before receiving treatment for abdominal pain. Women, on the other hand, have to wait an average of 65 minutes for the same thing.

And it’s not just pain treatment. Doctors offer less aggressive treatment and sometimes no treatment at all for women with heart disease. It also takes longer for doctors to recognize when women are actually having a heart attack. As a result, more women than men die from heart attacks [PDF] each year. Yet, most cardiologists don’t know this. The problem goes back to the earliest research on heart disease, which focused exclusively on men. Even today, research on heart disease is done mostly on white, middle-aged men. For example, the current heart disease prevention guidelines relied on studies in which women made up fewer than 30% of the research population. But women’s heart disease and heart attack symptoms are different than men’s. Women also respond differently to treatment.

To make matters worse, just as with other forms of pain, doctors may not take women’s symptoms seriously. As one doctor noted, “In training, we were taught to be on the lookout for hysterical females who come to the emergency room.” Men experiencing symptoms of heart disease are more likely than women to be sent to a cardiologist for further testing.

More to Be Done

Section 1557 will help address these disparities. Not only does Section 1557 apply to hospitals and clinics that receive federal funds—which includes the vast majority of medical providers—but it also applies to research and training programs that receive federal funding. In addition, health insurance companies that participate in the Health Insurance Marketplaces must comply with Section 1557.

That’s why the final rule for Section 1557 must be as strong as possible. Discrimination in health care has serious consequences for women’s health. Hospitals, clinics, researchers, medical and nursing schools, and health insurance companies must take active steps to end discriminatory practices and comply with Section 1557’s anti-discrimination requirements.

It's time for change, and we must act now. Time's up.