October 8, 2009 — Certain states allow health insurers to consider domestic abuse a pre-existing condition as a basis for denying coverage to women who have experienced abuse, but health reform legislation under consideration in Congress could ban the practice nationwide, Kaiser Health News reports. Although many states have laws in place prohibiting the practice, eight states and Washington, D.C., do not have such statutes. The states include Idaho, Mississippi, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota and Wyoming. According to KHN, the states that do bar the practice sometimes cannot prevent carriers from initially rejecting applicants who have experienced domestic violence.
Although there have been no recent surveys to suggest how often women who have been abused are denied coverage, an informal 1994 survey by a Senate Judiciary Committee subcommittee found that eight of the 16 largest U.S. insurers used domestic violence as a factor in deciding whether to offer coverage and at what price. Follow-up surveys in 1995 by the insurance commissioners of Pennsylvania and Kansas found that one in four responding insurers reported considering domestic violence when deciding whether to issue or renew health, accident or life insurance policies.
KHN conducted its own study on the frequency of the coverage denials because of previous abuse, contacting departments of insurance in the states that have not banned the consideration of abuse as a pre-existing condition. According to KHN, the majority said they had not heard of the issue or seen a question on an insurance application specifically asking about domestic abuse. None said they found records of complaints from domestic abuse survivors who were denied coverage. Several of the states said they have stop-gap measures in place to prevent women from being denied coverage.
However, Nancy Durborow, health projects manager for the Pennsylvania Coalition Against Domestic Violence, said that state insurance departments do not know about the problem because "they're not looking in the right places." According to Durborow, insurers do not usually ask about abuse status on an application but instead find evidence of it in medical records, interviews with applicants, Protection from Abuse Orders on file at courthouses and reports of domestic disturbances in newspapers. Because insurers are not required by law to explain their rejection decisions, women might never know why they were denied coverage, KHN reports.
Insurers' practices might also cause women to avoid telling their physicians about domestic violence for fear that they will be unable to secure insurance in the future. According to Lisa James, director of health for the Family Violence Prevention Fund, the possibility of being denied insurance coverage could discourage women from leaving an abusive partner, especially for women with children who worry their children might lose access to insurance.
Health Reform Could Offer Solutions
Advocates say that a federal law prohibiting insurance denials because of domestic abuse would be the best way to protect women from discrimination, and the issue is emerging as part of the health care reform debate. Since 1995, several attempts to pass measures in both the House and Senate have failed. Durborow said that the current reform efforts are "the first real glimmer of hope" for a nationwide ban on the practice. At a press conference Tuesday, House Speaker Nancy Pelosi (D-Calif.) told leaders from women's groups that the practice of denying coverage for abused women will end under reform legislation. According to KHN, the reform bill released by the Senate Health, Education, Labor and Pensions Committee bars insurers from denying coverage based on domestic violence.
Industry trade group America's Health Insurance Plans has supported laws at the state level to prohibit denials based on abuse. AHIP spokesperson Robert Zirkelbach said the group has encouraged states to adopt a "model law" developed by the National Association of Insurance Commissioners.
KHN also profiled Jody Neal-Post, an attorney whose coverage was rejected because of medical treatment she received after a domestic abuse incident (Gold, Kaiser Health News, 10/7).