American Forum Op-Ed

By Anne R. Davis, MD, MPH

Every day, I hear from another woman who is losing her job and her health insurance. Every day, I worry. As an obstetrician/gynecologist, I know firsthand what can happen when a woman can’t afford reproductive health care, whether she has lost her insurance or her insurance doesn’t cover women’s basic needs. Cervical cancer develops unnoticed. Pregnant women go without critical prenatal care. Sexually transmitted diseases progress unchecked. We see the results in the emergency room.

Congress must give women a better shot at staying well. Health care reform must change the rules: Health insurance must be affordable to all women, and the insurance we buy must cover our reproductive health care.

In my own life, I’ve always had good health insurance. I go to my ob/gyn each year for a well-woman exam, my birth control is covered, and my hospital bills were paid when I had my two children. These are medical fundamentals -- women’s health care 101-- yet I consider myself lucky to have them. Too many women are not as fortunate. According to the Guttmacher Institute, more than one in four women or their partners have lost their jobs or health insurance in the past year. The institute also reports that one in four women delayed an ob/gyn visit in the last year to save money.

Since the recession began, dozens of women have made emergency appointments with me because they have been laid off and are on the brink of losing their health insurance. They wouldn’t bother if they didn’t depend on the prescriptions and treatments I provide. I always talk to them about how to get emergency care if the need arises, assuring them that I will help them navigate the system. Then we cross our fingers.

Melinda came to see me just before she lost her job and her insurance. She had large fibroids—benign tumors—in her uterus that made her bleed heavily. I prescribed birth control pills, which controlled the bleeding. Then, as sometimes happens with fibroids, the pills stopped working. She bled so heavily she was dizzy and unable to walk. After seven hours of bleeding, Melinda called our office, and we advised her to get to the emergency room immediately. She was in shock; the ER staff gave her a blood transfusion that saved her life.

The next step in her care would be an operation to remove the fibroids. But once Melinda was stable, the doctors discharged her without surgery. Hospitals are required to try to keep every patient alive, but they do not have to provide non-emergency care to people who can’t pay. The staff advised Melinda to apply for Medicaid and schedule the operation once she was covered. But because she receives unemployment benefits, Medicaid deemed Melinda too wealthy for assistance.

Melinda’s bleeding will return. I am her physician, but I can’t give her the treatment she needs. This makes me furious. I am trying to work around the system to get her care, and I know many other doctors who have done the same for patients in crisis. We don’t always succeed.

Sometimes my colleagues and I find ourselves unable to help some women who want to be mothers, like Christine. Christine came in for an IUD. She is 40 and had been pregnant recently. She and her husband have two children, and they wanted to have another baby. Her doctor estimated that even an uncomplicated birth would cost thousands more than they could afford. Christine’s insurance doesn’t pay for labor and delivery, and her family’s income was too high for Medicaid. She had an abortion and then came to me for long-term birth control—neither was covered by her insurance.

Christine’s health insurance policy, like many others, seems to be based on the premise that the reproductive system doesn’t exist, that reproductive health has nothing to do with our overall health. Explain that to her and Melinda.

I am fortunate to have had insurers that cover the essentials for reproductive health. But health care shouldn’t be a matter of luck. All of my patients deserve comprehensive reproductive health services as much as I do.

For too long, women in this country have been sicker than we should be, with far-ranging effects on the jobs we hold, the families we care for, and the society we live in. Congress now has an opportunity to improve the health of women dramatically. Our senators and representatives must put insurance within every woman’s reach.

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Davis, MD, MPH, is the medical director of Physicians for Reproductive Choice and Health and an obstetrician/gynecologist in New York City.
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Copyright (C) 2009 by the American Forum. 11/09