by Lisa Codispoti, Senior Counsel, National Women's Law Center

We are closer to adopting health reform than ever before in history. Now that the Senate passed their health reform legislation, the next step on the road to reform is for Senate and House leaders to work out differences between their two bills, and then each chamber would vote on the final compromise legislation. And while there are many common provisions between the bills, there are some key differences that the National Women’s Law Center is carefully monitoring and weighing in on to ensure the strongest possible health reform legislation for women and their families.

For more details on the differences between the two bills, check out our side-by-side comparison of the two bills [PDF], which examines these differences in greater detail. Here are just a few of the issues we are addressing:

1. Affordability: Regardless of insurance status, women are more likely than men to face affordability barriers to health care. As we’ve repeatedly said, health reform must make health care truly affordable for all women -– especially those with low-and moderate-incomes. While both bills provide affordability assistance to women and families under 400% of poverty (about $43,000 for a single woman, or $88,000 for a family of 4) by expanding eligibility for Medicaid and providing subsidies for both insurance premiums and out-of-pocket costs, the House provides stronger subsidies for those at lower income levels, and their Medicaid expansion is stronger by providing a more robust package of covered services and ensuring that Medicaid enrollees have access to providers by improving reimbursement for primary care providers. Accordingly, we support adopting the House affordability provisions for individuals and families with income under 250% of poverty.

2. Insurance Reforms: Women have long faced harmful and unfair insurance industry practices, such as gender rating and pre-existing condition exclusions. Both the Senate and House adopted important insurance market reforms that would limit many of these harmful practices; however, the House bill is much stronger because it would eliminate the practice of gender rating and health status rating for individuals and groups of all sizes (while the Senate bill would only apply these rules for individuals and groups up to 100). Furthermore, the Senate bill includes a potentially harmful “wellness” provision that would allow insurance premium discounts of up to 30% for participating in workplace wellness programs -– but would also, conversely, allow premium penalties (i.e. premium increases) for failing to participate in such programs or meet participation benchmarks. We are very concerned about the impact this could have on women, who may be more likely to face a premium penalty given that women are more likely to have a chronic condition that could limit their ability to meet wellness benchmarks. Accordingly, we support the House insurance reform framework, which would provide more robust insurance regulations that would hold insurance companies accountable, and does not include the harmful workplace wellness premium discounts/penalties.

3. Access to Comprehensive Benefits that Women Need, Including Access to Abortion: Unfortunately, the Stupak amendment in the House bill, and the Nelson provision in the Senate bill, would have the effect of severely limiting women’s access to coverage of abortion in insurance obtained through the new health insurance exchanges. Final health reform legislation must be improved to provide access to insurance coverage that includes abortion for women in the exchanges.

4. Reform Should Be Paid for Fairly and Responsibly: While both the House and Senate have developed plans to expand health care coverage without adding to the deficit, the House bill’s high-income surcharge is a fairer and more responsible way of financing reform. It raises revenue from those with the greatest ability to pay: couples with incomes over $1 million, individuals with incomes over $500,000, less than 1 percent of taxpayers. The surtax would have little impact on owners of small businesses. Less than 2 percent of taxpayers with any business income would be affected by the surcharge, and many of those affected are not small business owners but receiving income from passive investments.

However, the excise tax in the Senate bill could have an unfair and discriminatory impact on women. Price differentials in insurance plans may not simply be based on how generous the coverage is, but on a host of other factors. For example, insurance companies have historically charged employers with predominantly female workforces higher premiums because of the gender composition of their workforce. Moreover, if employers respond to an excise tax by shifting more costs to employees, women are more likely than men to be affected by this cost-shifting because on average they earn less and have greater health care needs. Accordingly, we support the House provisions for financing health care reform.

We are closer than ever before to accomplishing health reform. As our friends at Health Care for America Now are saying, we must finish reform right. In these final days, we need you to call your Members of Congress and tell them the time is now to pass health reform that truly works for women and their families.

Cross-posted from Womenstake