Karen L. Baird - Gender Justice and the Health Care System

HEALTH CARE
POLICY IN THE
UNITED STATES

edited by

JOHN G. BRUHN

PENNSYLVANIA STATE
UNIVERSITY - HARRIS BURG

Health Care Policy in the United States
John G. Bruhn, editor

Physician Participation in
Medicaid Managed Care

Sunday E. Ubokudom

Healing the Social Body: A
Holistic Approach to Public
Health Policy

Elizabeth R. Mackenzie

Directing Health Messages
toward African Americans:
Attitudes toward Health
Care and the Mass Media

Judith L. Sylvester

Gender Justice and the
Health Care System

Karen L. Baird

Who Cares for Poor People?
Physicians, Medicaid, and
Marginality

Margaret M. Hynes

I would like to thank the American Association of University Women Educational Foundation for providing me with an American Fellowship that facilitated this work when it was in the dissertation stage. Malcolm Goggin and Donald Lutz provided invaluable time for the discussion of ideas, as well as academic and personal support, and put incredible faith in my project. I will forever be indebted to them. I am grateful to Kathleen Knight and Cynthia Freeland who also provided assistance, time, and support. I would like to thank Zehra Arat, my research support group, and the Department of Political Science of Purchase College, State University of New York, for their academic and personal support. My family deserves special mention for their endless patience and encouragement.

These words are from the Executive Summary of the Report of the National Institutes of Health: Opportunities for Research on Womens Health (U.S. DHHS, NIH 1992, 7). Women live longer than men and thus experience more of the health problems that accompany old agefor example, osteoporosis and Alzheimers disease. But even in their younger years, the quality of womens lives is affected more frequently and more deeply by their health than is the case for men. Women have more acute symptoms, more chronic conditions, and more short- and long-term disabilities arising from health problems. In addition, more women than men die from strokes; women have a higher incidence of mental disorders than men; more women than men acquire sexually transmitted disease; and women are the fastest growing population with AIDS. But despite all of this, women have been systematically excluded from most medical studies. One example is the widely published study reporting that one to two aspirins a day could reduce ones chance of having a heart attack (Ameswith 1990). That study used 22,000 male subjects and not a single female subject, even though heart disease is the number one killer of men and women in the U.S.

Women also disproportionately constitute the poor or near poor and thus account for 60 to 70 percent of Medicaid recipients (many of the rest are their dependent children). Women are disproportionately segregated into lower-paying, lower-status, part-time jobs that are less likely to have health insurance as a benefit. The consequence of this is that women have to devote a disproportionate share of their income to health care costs. Women are also far more likely to provide care in the home to children, spouses, and parents. Unfortunately, the costs of health care fall disproportionately on women. The U.S. health care system results in many injustices for women.

1992 was labeled the Year of the Woman. The nation elected 24 new female representatives and five new female senators to the United States Congress.1 This is the largest increase ever in U.S. history. The nation also elected Bill Clinton as president, and by so doing the country gained the most powerful and active first lady. Hillary Rodham Clinton was appointed head of the Presidents Task Force on Health Care Reform, a group that labored for months to produce recommendations for improving our health care system. The resulting report and legislation, the Health Security Act, called for radical changes to the way we finance and deliver health care in the United States.

Since Clinton was inaugurated, the Family Leave Act was passed, mandating employers to provide up to twelve weeks leave to parents to care for newborn or ill children, as well as other family members. The Gag rule, which mandated that workers in Federally funded clinics could not give information about the availability of or procedures associated with abortions to patients, has been lifted. RU-486, which has been banned in the U.S. for years, is finally being tested for approval by the Food and Drug Administration (FDA), and the new female condom was approved in April 1993. Furthermore, the FDA, which had a policy forbidding the use of women of childbearing age in medical drug research, announced that any research submitted by drug manufacturers for new drug approvals will need to include data regarding effects on women. Moreover, in 1996, the Health Insurance Portability and Accountability Act limiting pre-existing condition exclusions and increasing the portability of insurance when one leaves a job, and the Newborns and Mothers Health Protection Act allowing women to stay in the hospital at least 48 hours after giving birth, were passed.