WASHINGTON Eight states and the District of Columbia dont have laws that specifically bar insurance companies from using domestic violence as a pre-existing condition to deny health coverage, according to a study from the National Womens Law Center.
The states are Idaho, Mississippi, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota and Wyoming. The study by the nonpartisan, nonprofit center focused on individual coverage, not group coverage.
Some of the states, particularly North Carolina, argue that other statutes on their books address the issue.
At least one of the health care bills circulating in Congress includes a specific federal prohibition on the use of domestic violence as a pre-existing condition. Other bills include blanket bans on pre-existing conditions.
Though domestic violence as a pre-existing condition isnt thought to be as widespread as it once was, lawmakers say its yet another example of the need to overhaul the health care system.
THE BOTTOM LINE
This is insane, said Sen. Patty Murray, D-Wash., whos been trying to convince Congress to address the issue for roughly a decade.
Murray said she couldnt remember exactly when she first learned of it, but sometime in the 1990s she recalls a private conversation she had with a woman who broke down as she explained that she couldnt flee an abusive relationship because her children were covered under her husbands health care plan and she couldnt get her own. Another woman told Murray that she didnt report that shed been battered because she feared losing her coverage.
It infuriates me an insurance executive can sit in his safe world and decide how to make money, Murray said. For them its all about the bottom line. Abused women dont have a voice.
First lady Michelle Obama also took note, saying in a speech last month that insurance companies continue to practice gender discrimination.
Much of the evidence that domestic violence has been a factor in denying coverage is dated.
An informal survey by the House Judiciary Committee in 1994 found that half of the 16 largest insurers in the country considered domestic violence in deciding whether to approve health coverage. The Pennsylvania Insurance Department reported a year or so later that nearly 1 of 4 insurance companies factored in domestic violence when deciding whether to issue or renew policies.
Lisa Codispoti, senior counsel for the National Womens Law Center, said it was hard to know whether insurance companies had changed because they closely guarded their underwriting standards, and battered women had always been reluctant to speak out publicly.
We dont know how many insurance companies still have that policy, she said, but we are talking about an industry that once charged a race-based premium.
Codispoti said that while insurance companies didnt mention domestic violence outright in health policy applications, they could piece it together from such things as medical records.
ANECDOTAL EVIDENCE
A spokesman for an insurance industry trade group, Robert Zirkelbach, said he wasnt aware of any companies that used domestic violence as a pre-existing condition.
We believe strongly that no one should be denied coverage because they are victims of domestic violence, he said. Yet Murray and others said there was plenty of anecdotal evidence to suggest that the practice continued.
We know there are abuses, said Kansas Insurance Commissioner Sandy Praeger, who heads a health care task force for the National Association of Insurance Commissioners. Many states have adopted a model law written by the association that prohibits the denial of health insurance because of domestic abuse or other pre-existing conditions.
We dont develop models unless there is a need, Praeger said. Its not a huge problem, but it got the commissioners attention.
North Carolina feels it was unfairly singled out in the study last fall from the National Womens Law Center.
We certainly dont allow domestic violence to be used as a pre-existing condition, said Kristin Milam, a spokeswoman for the North Carolina Insurance Commissioners Office. Milam said domestic violence as a pre-existing condition was specifically banned in a statute for group coverage and that a broader statute for individual policies also barred it, though not by name.
Codispoti said, however, that the North Carolina statute that covered individual policies at best is not clear. We dont read it that way.
On Capitol Hill, Republican aides privately dismiss that flap as a red herring drummed up by liberal bloggers.
Tell that to a woman who has faced this, Murray said.
The issue was first reported by The Huffington Post.
Murray remembers three years ago when the then-Republican-controlled Senate Health, Education, Labor and Pensions Committee blocked her effort to impose a federal prohibition on a 10-10 vote. All 10 who voted against her amendment were Republicans.
Clearly, the insurance industry influenced that vote, Murray charged.
The Republicans who voted against the measure had received nearly $6 million in campaign contributions from insurance companies, health care providers, the pharmaceutical industry and health care product manufacturers in the years leading up the vote, according to the Center for Responsive Politics, a nonpartisan group that tracks campaign contributions.
Les Blumenthal: 202-383-0008
lblumenthal@mcclatchydc.com
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