Judul : Seven Hills Womens Health Center
link : Seven Hills Womens Health Center
Seven Hills Womens Health Center
(cross talk) nancy-ann deparle:am i supposed to presssomething here? a speaker:yes. when you're speaking,just press the red button. and when you're notspeaking -- [inaudible].
Seven Hills Womens Health Center, [laughter] nancy-ann deparle:this looks different than when i was in here before. i'm nancy-ann deparle, and i'mthe director of the white house
office of health reform. and i want to introduce mycolleagues and good friends, tina tchen and melody barnes. melody's the assistant to thepresident for domestic policy. and tina is director of theoffice of public engagement. a speaker:very good. nancy-ann deparle:is that right? ope, which is a new title andmeans exactly what you think, not just liaison butengagement in the public.
and also, we have neera tandenwho's at the department of health and human services. and where is dana singiser? you don't get outof this that easy. dana singiser, who's a deputy inthe office of legislation and who has been workingwith us here. and then a lot of otherwomen around the room. we'll go around and introduceeverybody in a second. we appreciate you all cominghere on short notice to sit down
and talk to us about healthreform and issues of women and families, with respectto health reform. we're here because health reformis one of president's obama's top priorities. and we want to hear from womenacross the country about how we can fix the way thesystem works now. all americans are sufferingunder the current system, but women, we think, arepaying a heavy price, both as patients and ascaregivers and as the glue
of the system. women have watched their budgetsstretch thin as their premiums have nearly doubled inthe last eight years. they feel the sticker shock ofclose to double-digit rises in premiums and drug prices. twenty-one millionwomen are uninsured. and women who try to purchaseinsurance often find that the private market isstacked against them. premiums in the private marketfor younger women are often
higher than they are for men. in some states, insurancecompanies can legally discriminate against women,leaving them with higher healthcare bills orno coverage at all. i know that the insurancecompanies recently offered to stop charging women higherpremiums because of their gender. and we obviouslywelcome that step, but we know thatwe need to do more. we need reforms that will makethat policy the law of the land
and that will bring down costsand improve healthcare quality for women and all the americans. a few weeks ago, the departmentof health and human services released a report called"roadblocks to healthcare" that shows how our current systemis leaving too many women struggling with high healthcarecosts and without the care they need. so i hope you'll take thetime to visit our website, www.healthreform.gov,to read the report. we know that healthreform can't wait.
and the status quo isunsustainable and unacceptable. and that's why we want to engagewith women all around the country in regional forums anddiscussion groups like this one and through our website wherethis discussion is being live-streamed today. and we're really lookingforward to hearing from you. i want to introducemy colleagues. and then let's just go aroundand introduce ourselves, get right into the discussion.
melody, you want to start? melody barnes:first of all, i want to thank nancy-ann and thank nancy-ann for herleadership on this issue. she has just really been awonderful leader and moved this process through the white house. and also neera and tina and danaand other colleagues as well, because this is certainly apriority for the president. and i think one of the thingsi am quite pleased about -- i guess it was in march, which insome ways seems like yesterday
and in some ways it seemslike about ten years ago, we launched this workwith the healthcare forum. and i know several of youwere here for that process. and we want to thank youfor your participation. but certainly since then,nancy-ann and i have had the opportunity to travelaround the country, to all parts of the country andengage with people and talk to them, in particular women, abouttheir experiences with our healthcare system and theirdesire to try and drive down
spiraling costs, to make surethat people were covered for themselves, for their family,and for their children. so this work is veryimportant to us. and we feel -- i know i do --that i bring those stories and those people into the office,into our work, everyday. so having the opportunity tonow engage with you and hear specifically about your concernsas we go through this process is very important and, i think, acomponent and a continuation of that conversation. from a dpcperspective, you know,
we are supporting nancy-ann andsupporting secretary sebelius as they lead this effort. and particularly, we have aninterest in the issues of women's health and also issuesthat affect low-income people. and jeff crowley in my officewho has expertise on the medicaid system and the medicaresystem has been actively involved in participating inthese conversations and this work as well. so i just want to thank you forbeing here and for working with
us and then turnit over to tina. tina tchen:well, thank you. and i won't take long becausewhat we really want to do is hear from all of you. my additional hat -- justbecause i think it has relevance to this meeting too --as many of you know, no one in the obama whitehouse does one thing. as the president says, wecan do multiple things. we can multitask here.
so in addition to being thedirector of the office of public engagement, i'm also theexecutive director of the white house council onwomen and girls. and looking at healthcare iscertainly something we are doing, you know,with the council, assisting nancy-ann 's office onthis and working with multiple agencies. secretary sebelius and i did anevent a couple of weeks ago with women small business owners herein the district that we also, you know, webcast to really hearabout what is confronting small
business owners, manyof whom are women, in these sort of great smallbusinesses that are in the engine of our economy and yetreally cannot afford to provide themselves and theiremployees healthcare, especially in thecurrent economy. and so this is obviouslya crucial issue for us. i think, as melody pointed out,this table is not the only time we've been getting input. and we urge all of you to stayin touch with us, you know,
through, you know, our office ordirectly to nancy-ann and her staff on -- if we don't touchupon all of the issues today, to continue to stay anddialogue with us on it. we're also looking at issueson health disparities. and we've tried to includewomen from across the country. and many of you representnational organizations, and so we very much want tonot only hear from, you know, what's going on here inwashington but provide us input on what's happening, you know,to your members, your clinics,
your clients and patientsfrom across the country. so thank you all again forcoming and for your work and your advocacy in this area. nancy-ann deparle:mary, you want to say -- (inaudible) mary:just briefly, i would say, again, we've been working with a lotof you and we really appreciate everyone's work. and i would just amplify onepoint which is we are really at the moment where a lot ofpeople's work over years in this room are coming to fruition.
and we very much appreciatehow hard everyone is working. but of course, as nancy-annwho is working the hardest can attest, it's only going toget harder from here on in. and we really need to hear fromyou about your concerns and your ideas now as we go through thesenext couple of weeks and months because this is really themoment where, you know, the rubber hits the road. so i look forward toa great discussion. and thank you allfor participating.
nancy-ann deparle:let's go around and introduce ourselves and then we'll getinto our discussion. wendy? wendy chavkin:i'm wendy chavkin. i'm a physician at columbia'smailman school of public health. susan wysocki:i'm susan wysocki. i'm the president and ceo of thenational association of nurse practitioners in women's healthhere in washington, d.c. and i'm also a women'shealth nurse practitioner. raul gonzalez:hi, i'm raul gonzalez.
i'm the legislative directorwith the national council of la raza here in washington. mike fraser:good morning. i'm mike fraser. i'm the ceo of the associationof maternal and child health programs here in d.c. cynthia pearson:i'm cindy pearson. i'm wearing two hats. i'm the director of the nationalwomen's health network here in
washington, d.c., a women'shealth consumer organization. and i'm also a cofounder ofa national initiative called raising women's voices forthe healthcare we need. marcia greenberger:i'm marcia greenberger, co-president of the nationalwomen's law center based in washington, d.c. eleanor hinton-hoyt:good morning. i'm eleanor hinton-hoyt,president and ceo of the black women's health imperative. sloane rosenthal:i'm sloane rosenthal with the national family planning
and reproductivehealth association here in d.c. susan wood:hi, i'm susan wood. i'm at george washingtonuniversity school of public health and health services anddirector of the jacobs institute of women's health. donna wagner:good morning. i'm donna wagner, and i'm hererepresenting the older women's league. and i'm a professor ofgerontology at towson university. karen kaplan:good morning.
i'm karen kaplan. i'm the ceo of the ovariancancer national alliance. our office is here in d.c. cecile richards:hi,i'm cecile richards. i'm the president of the plannedparenthood federation of america. laurie rubiner:laurie rubiner, i'm vice president for advocacyand public policy at planned parenthood federation. christine brunswick:hi, i'm christine brunswick,
vice-president of the nationalbreast cancer coalition. randy schmidt:hi, i'm randy schmidt. i'm with the ywca usa. martha nolan:i'm martha nolan, vice-president of public policyat the society for women's health research. lisa tate:i'm lisa tate,chief executive with womenheart, the national coalition forwomen with heart disease. susan scanlan:i'm susan scanlan. i wear two hats as well.
i'm the president of thewomen's research and education institution. and as such, i'm interested inmilitary women's health and veteran women's health. i'm also chair of thenational council of women's organizations, an allianceof 230 women's organizations representing 12million american women. eleanor smeal:hi, i'm eleanor smeal, president of the feministmajority foundation. alta deshara:i'm alta deshara, a professor of law and bioethics
at the university ofwisconsin, madison, school of law andschool of medicine. sabrina corlette:hi,i'm sabrina corlette. i'm director of health policyprograms at the national partnership forwomen and families. vanessa gamble:good morning. i'm vanessa northington gamble. i'm university professor ofmedical humanities and health policy at the georgewashington university.
mary jean schumann:i'm mary jean schumann. i'm the chief programs officerat the american nurse's association. i'm also a nursepractitioner by education. and i have five daughters,so -- (laugther) a speaker:you win. (laughter) a speaker:no, they win. jerry joseph:well, i'm jerry joseph,
and i'm the president ofthe american college of obstetricians and gynecologists,also a practicing obstetrician and gynecologist for a number ofyears in new orleans, louisiana. i don't have five daughters, soi can only imagine what that's like. i have one, and that's enough. jerry joseph:it's a great pleasureto be here. and thank you forthe opportunity. priscilla wong:good morning. i'm priscilla wong with thenational asian-pacific american
women's forum here in d.c. nancy-ann deparle:all right. well, let's just geta conversation going. i can tell this isnot going to be hard. i'll just put on the table whatissues in our current system are of particular concern to womenin the healthcare system. sabrina, you're nodding.you start us off. sabrina corlette:sure. i think this was really --there's just this constant drumbeat.
and i think for us there'ssuch an urgency right now. seven-six percent of womensupport or strongly support passing healthcare reform. so women are with you. they are excited. and they appreciateyour leadership. for us, we have six main thingsthat we're really focused on with healthcare reform. one is affordability,particularly if we're talking
about having an individualobligation to purchase coverage. we need to have coverage thatis affordable to families. women need to be able topurchase coverage for their children, their spouse's, andthey need to know that it's affordable over the long-term. and that means too thatit's got to be sustainable. so one of the things that we'vebeen really focused on is bringing costs under control. and we think that that can be awin/win for women and families
and for the society as a whole. if we can get care to bemore patient-centered, particularly for people whohave chronic conditions, we think that that can reallylead to, overall, saving money. i was struck, i think many folkshave read the piece in the new yorker by (inaudible) and i thought, you know, whatreally hit home for me in that piece was, quite frankly, themedical community in osage county has lost sight of puttingthe patient at the center.
and i think if we start to dothat, we can bring costs down. susan wood:susan wood, i would like to respond to that because we've actually hoped to be releasinga report next week from george washington university thatactually talks about the direct cost of chronic illnessand women and how the -- essentially, you know, billion,tens and hundreds of billions of dollars that we do spend onchronic illness later in life are really best addressed earlyon through prevention and primary care and that if welook at primary care in a very
comprehensive way, the servicesare high quality and are appropriate during thereproductive years. the payoff really can be laterin life with reduction in heart disease, cancer,diabetes, and, you know, mental illness and depressionthat are really costing the system a great deal. so i think that sort of fit intoyour point about how some of the ways to bring down the cost isthrough primary care and that the costs that women incurin direct medical costs and
economic costs are quite highand really quite significant. and we have the opportunity,through high quality care early in life during reproductiveyears in the fair comprehensive manner, to make sure that we canbegin to prevent and mitigate the consequences of healthand disability later in life. a speaker:so picking up on what susan said, first, thanks for doing this. i think focusing on women'shealthcare is so important because obviously we havedifferent healthcare needs than
men and mainlybecause we reproduce. and i think this focus --for planned parenthood, we're primarily a preventativehealthcare provider. and i think what's important toremember as we go into reform, it's not simply justincreasing coverage. it's also where are folksgoing to get their healthcare. for most women, their primaryhealthcare provider is their ob. and that's for low-income women,women with insurance, you know. in fact, at planned parenthood,we see about 3 million women a year.
upward of 60% of them are women-- we're their only doctor. and i think the other thing,as we think about prevention, because it does save money forso many women -- for example, they come to planned parenthoodbecause they may need contraceptive services. but once they're in the door,then we can get them breast cancer screening orcervical cancer screenings. and a lot of services that theywouldn't necessarily go out, particularly ifthey're low-income,
they wouldn't go outand seek on their own. and so i think there's a way inwhich we can make sure that the kinds of providers -- thatthere are essential community providers for women like plannedparenthood and other healthcare clinics that women tend to go tothat are part of the coverage, part of the exchange. a speaker:vanessa? vanessa gamble:some of you are wearing two hats. i'm between two meetings today.
and the other meeting where iwas at this morning and where i'm going back is trying toincrease the number of women and minorities who are goinginto health professions. and that's been apassion of mine. and i think it's time thatwe wake up and smell the demographics in terms of whoare the young people today. and i think this brings up abroader question of who's going to provide the care so thatwe could have health reform, we could have payment.
but we need not just women andtheir families -- because women are the gatekeepers for theirchildren and their families, but who is going toprovide the care. because as massachusettshas shown us, people might have coverage,but they don't have providers. so i think as we go through thisprocess of talking about quality and cost, we also have to thinkabout who will be the providers. nancy-ann deparle:i'm sorry. i can't get everybody's names.
white jacket, yes. a speaker:let me piggyback on vanessaand just say one of the overall issues that i think is going tobe neglected in the reform is caregiving, particularlyfor the disabled, particularly forpeople in the military, but generally american families. who takes care of the sick? who takes care of thechronically ill, the disabled, the mentally ill? it's women. it's moms.
the older women's league iknow will join me on this. something has to be done for theunreimbursed cost that families, particularly moms or wives,sustain in trying to keep people out of permanent caresituations, nursing homes, those kinds of things thatare much more expensive. but it has to be recognized. nancy-ann deparle:and what would you recommend specifically? a speaker:i think some kind ofcoverage, some kind of, like a disability policy,something that acknowledges tax credits.
there has to be somethingthat can be done, particularly for the severelyinjured veterans who are coming home now from the war and are ashealed as they're going to be and then are sent home for momand dad or the wife to take care of. that's not fair. a speaker:yeah. i think the -- you know, i wouldagree with all these folks, that one of the things that'sbeen spoken about least, in terms of the healthsystem reform movement, is the issue of the workforceand the workforce in terms of
direct-care providers, theability to have sufficient direct-care providers who aresufficiently educated and sufficiently reimbursed so thatthey can provide services, which most families cannotafford to purchase even if they can find one. and then to extendthat much more broadly. it's not just about coverage,although it starts there. but it is about workforce. it's about advanced practice,registered nurses who can provide that.
it's about all of those folkswho have a scope of practice that can be utilized toprovide those services. and i think we're missing theboat if we don't address that piece. nancy-ann deparle:marcia? marcia greenberger:well, it's great not to go first, because a lot of issuesgot raised already. but i have a listthat i've been making. and i'll try to be briefin some of these issues, either to amplify on some of thevery good points that have been
made before or justadd a few more. i don't think we can underscoreenough how important affordability is to womenand to their families. and affordability is not justthe issue of premiums but also deductibility,principles and copays, and all of the other elementsthat go into what actual costs there are insecuring healthcare. and when we think about thefact that women earn less, that they -- infact, unfortunately,
some of the data showed justthis month that in the rate of unemployment, women aresuffering more now over this past month with thedata just released. and then most specifically,for women-headed households, that really underscoresthe urgency of the issue, not only of getting healthcarereform -- which is really where i should have started by sayinghow important your efforts are and how much we support them --but also making sure that we can make this reform affordable.
and because healthcare costshave been so extraordinary, we've seen bankruptciesdue, in large measure, to healthcare costs thatwomen couldn't afford. even severe bankruptcy hasaffected women the most. in the context of affordability,both in terms of women earning less and having to deal withtheir family's healthcare cost and being thecaregivers as well, we've also seenunfortunately that, especially in theprivate market,
when women are forced to have togo secure healthcare themselves, they're actually charged morethan men in wildly different rates. in some states -- the national(inaudible) center did a study that documented that in onestate an insurance company might charge the woman with exactlythe same age as a man 20%, in another state 40% more, inanother state even 60% more. and that's excluding maternitycoverage where women have to pay even more for an extra riderto get the maternity coverage. and that rider will often havethe kinds of waiting periods
that could be as long as twoyears and make it virtually impossible to get the maternitycoverage to begin with that they need. so affordability can't beunderscored too many times. so in healthcarereform, to deal with it, we also need to make surethat we deal with some of the insurance market reforms thatare going to be very important in making sure that thesystem works properly. and we know there have been somediscussions about looking at this issue with respect toemployers who have a small
number of employees to be surethat they are protected from some insurance practices, genderrating as i mentioned for example. but we've seen this being aproblem for larger employers too. so we think it's very importantfor these insurance market reforms to include all employersfor the protection of the workforce in general,and especially women. the discriminationsometimes that women face, such as in the ratesthat they have to pay, can also affect their benefitslike the maternity benefits that i mentioned.
so i think we really need to besure that there are protections against discrimination inhealthcare reform so that women of color, those who facediscrimination on different bases, receive protection. and finally, as thesematernity special riders show, we need to be sure that we havecomprehensive benefits and that we don't segregate out women'sreproductive health needs. they're so important. and the idea that, as i say thatwomen in the maternity need to
cover those costs themselves,have cost not only those women and the families but also all ofus who are fighting so hard to make sure that wereduce infant mortality, that we have healthy children,that we have healthy families. by not covering thosereproductive needs, we really, i think, put ourselvesbehind in the future as well. a speaker:i would just add i absolutely agree. and this is a wonderfullistening session, probably not just foryou but also for us.
so we appreciate thatopportunity to be with each other. i think one of the things that-- there's a big difference between healthcare reform andhealth reform for our members. and health reform to us is abigger strategy to improve health, not just in a clinicalsession but what happens outside of the clinical setting. so we're very concerned aboutassuring that within health reform, not justhealthcare reform, we're also strengthening theprograms that happen outside of
the clinical setting, in thecommunities and different neighborhoods and states. and so one concrete that wewould love to share with you is the maternal and child healthblock grant to states that provide services to moms, kids,and family in states has been severely eroded overthe past many years. and that's one opportunityto really make a concrete, specific improvementin women's health, through the maternal andchild health block grant.
a speaker:susan? susan:yes, a couple of things. first of all, a number ofissues have been brought up. i think marcia's issue oflooking at the -- you know, when you don't havecoverage of maternity care, you have outcomes thatsomebody pays for. and that's us at the very end. and the kind of reform that weshould be looking at should be looking at much longer horizons.
the short horizon of savingmoney here by cutting out maternity services there is notwhat's going to save us money if we're looking at the long-term. we need to look at healthpromotion and disease prevention. and we also -- thatmaternal child block grant, planned parenthood,the title x program, all those programs where womenare of reproductive age and often don't have the means --but there are women of means who also go to the programs -- havesuffered over the last many
years because of, you know, noincrease in funding at all while healthcare costs go up. i also want to point out-- and i do represent nurse practitioners -- that it's nursepractitioners in those settings that are providing thecare in planned parenthood. it's nurse practitionersin those maternal block, child block programs, nursepractitioners in title x. that's where i got my feet wet,was as a nurse practitioner in a title x program providingthose basic services;
breast cancer screening,cervical cancer screening, diabetes screening, bloodpressure screening, all those things that are basicand giving women the tools to stay healthy. and i think thoseare very important. the other thing i want to justaddress is the issue that vanessa brought up interms of having, you know, a community basedhealthcare professional. one of the thoughts that weshould put into this is having people who are from thecommunity providing care to the
community because you can takeall the cultural diversity courses in the world, butnothing matches being from a community and being ableto provide care there. and i have much moreto say about that. the one thing i dowant to emphasize, when we look athealthcare reform, i hope we're notjust looking at cost. but this whole system reallyneeds to examine how we deliver that care. and it make sensewhen i hear, you know,
foreheads being smitted, whereare we going to find the physicians to provide primarycare when i know that nurse practitioners are -- and otheradvance practice nursing -- are ready to provide that care. and that's our passion, toprovide that kind of care. and looking at how do we getmore of those and what is the right mix of healthcareprofessionals that we should have to address the drasticneeds that we have today and, you know, look at a whole shift.
not just about money, but aboutthe mix and how healthcare is delivered to keep us healthy. a speaker:[inaudible]. >> nancy-ann deparle:great. yes? well, both of you. >> nancy-ann deparle:take turns. a speaker:we have a lot of the same issues, so we can speak in unison. this is so good,thank you very much. i have heard -- i think we'vecovered a lot of the key issues.
i would like toaddress just three. one is the insurance issue. two is the distributionof specialist physicians. and three is the issueof health literacy. and let me start there. i represent women interms of ovarian cancer. it is a disease for which thereis no early detection test. so we say until there's atest, awareness is best. we need to teach women howto listen to their bodies.
the symptoms are subtle, and wedo not have good communication programs that address theliteracy needs of underserved populations. that's very key. the second issue is thedistribution of gynecologic oncologists. there are very few of themcompared to the needs for them. and particularly, there arevery few in rural areas. they just don't exist for awhole variety of reasons. once a woman is diagnosed withovarian cancer or with other gynecologic cancers, they reallydo need the services of a gynec--.
so that's the second point. and the third point is when wetalk about insurance reform, i think we need to address theissue of portability in two areas. one is, for cancer particularly,it's a very expensive disease. it is also considered apre-existing condition which rules out a lot of women. and it's not portable. you can't take it fromone place to another. you can't take your insurance.
so if you have cancer andyou go to another place, that's just too bad. i think the other issue is thatmany women -- and i can't put a number on it -- but many womenare caught in situations that are not good for them, in anabusive difficult marriage, in an employment situationthat's very bad because they can't afford to losetheir health insurance. so these are issues, i think,that need to be addressed. a speaker:okay.
i would like to switch to thelater part of life and talk about follow-up on thecaregiving issue and the prevention issue, as wellas the workforce issue. i'll do it quickly. and thank you for giving usthis opportunity to share our thoughts with you today. today there's about one in everyfour households in america who are involved in caringfor an older person. they are the default long-termcare system of this country.
not only are they spending timeand making some sacrifices in terms of career and workand lifetime earnings, but they're also spending money. medicare does notcover everything. medicare is not theperfect healthcare system. it's great, but in a recentstudy that i worked on last year, about 15 to 20% of acaregiver's income was spent on things that the older personneeded, their parent needed. they did not want their parentto have to go, for example,
on medicaid to get theirlong-term care facility paid for. they did not want to put themin an assisted living facility. and a good chunk of that was onhealthcare issues that are not covered by medicare. so this is a big thing. the prevention is a reallybig important thing. and as a gerontologist, welove the idea of prevention, but we have to also face thefact that there's 78 million people who are going to becelebrating their 65th birthday in a few years.
and many of us arein that category. there's a few thingswe can prevent now, but we should have beenstarting on it earlier. and really, we arean aging society. and we have to consider theneeds, healthcare needs, of an aging population whenwe're talking about any of this. and finally, people havetalked about the workforce. and i have to say, one of thebiggest scarcities in this country right noware geriatricians.
and the primary care provideris the person who is giving the care to medicarebeneficiaries today. and those peopleare not trained, and there's a huge problem inthis country with pharmaceutical mis-prescribing for -- theycall medical misadventures, whatever it is. but a lot of it is really due tonot really having the training. so thank you. a speaker:thank you.
i represent black womenprimarily, poor women, and other women of color. so i could agreewith all of these. and i focus my remarks onnot only affordability but accessibility, accessibility toquality of care and the highest standards of care that we canget to poor women who cannot afford it and who do nothave access to treatment and alternative therapies becauseoften they're not referred to that kind of treatment.
so i think it's important tonot only focus on workforce, which is badly needed in orderto address some of the cultural differences that are evident inthe kind of medicine that we provide, but also how do weincrease the number of people of color in communities who canprovide the kind of care and attention that we need in theprevention and wellness model. so i would encourage us to thinkof how do we address all of the health disparities that women ofcolor bear, disproportionately, by addressing how do we achieveequity in health and healthcare,
by developing a community basedmodel that integrates the highest standards of care witheverything else that we support and appreciate you giving usthis opportunity to talk about. nancy-ann deparle:laurie and then alta. laurie rubiner:this is a little bit on that subject. but i just want to emphasizethe really important role that medicare plays for women,especially in the areas of family planning. it provides more coverage forfamily planning and births than
any other program. and we've been able to get somestate options for medicaid coverage and, for example,breast and cervical cancer treatment. and i think about 17states have picked that up. and just as we're thinkingabout coverage expansions, that's a really criticalprogram for women. so i hope that we keepthat in mind as well. alta deshara:thank you. you know, listening to all ofthe ideas -- and i suspect some
of the others that will come up-- it occurs to me that what we're really talking about istrying to see this as a life cycle phenomenon, as opposedto a series of very individual problems. and so there are five thingsthat occurred to me listening to everybody that might go intoflushing that idea out. the first is that, althoughwe've got tremendous expertise on reproductive health here, andwe all know how central that is, reproductive health shouldnot be misunderstood as only avoiding conceptionof childbirth.
but it really needs to includethe possibility of having children. and it's one way of defangingthat issue slightly when we recognize that for many womeninfertility or having a child is as much of a concern asavoiding it at the wrong time. but perhaps evenmore profoundly, we tend to skip right past a lotof the non-reproductive aspects of women's health because we areall so focused on the fact that we have uteri. for example, marcia greenberger,from the very beginning,
was focused on the phenomenonof women who were excluded from drug trials so that we now havethis huge unstudied natural history experiment on the useof drugs and women and an equal degree of ignorance about theway in which a variety of diseases affect women in waysthat are different than they affect men, regardless ofwhether it's drug related in terms of treatment. and so we've got huge knowledgegaps that we tend to overlook. the second thing about thenon-reproductive aspects,
i think, goes to what youboth were talking about, which is thedemography of women. we live longer than men, atleast we used to until we started smoking. and so we have a variety ofspecial issues in older age that are really not evennecessarily medical. a lot of lifestyle issues,home structure issues, hygiene issues that may makemore of a difference in health outcomes than in number ofspecific visits to a nurse or a
doctor, as importantas those are, that have to somehow be foldedinto our notion of healthcare. the third on cost, whicheveryone's very much aware of -- again, i think i'm pickingup on marcia who mentioned deductibles. there's going to be some tensionhere because cost control is often managed, isoften achieved, by having high deductibles inorder to incentivize kind of self-discipline inthe use of care. but since womendisproportionately access
preventative services, thosehigh deductibles really affect us much more and they underminethe goal of preventing disease in the long run, which iswhat susan was talking about. so just trying to keep an eye onnot allowing the cost measures and incentivizing measures to bein tension with women's needs. fourth of the five, on access. there have been a number ofmentions of being able to get coverage. i don't know that we'veconnected that yet to the way the employment situation hasbeen changing and the degree to
which part-time work fairlyoften omits benefits. and so this discussion about thepublic option versus no public option that's been going on isreally essential to our needs. because if we continue to haveprovider plans that are employer based, women willcontinue to suffer. in addition, for access -- andi'm assuming that somebody is going to talk about this,expand upon it because it was referenced -- almost all of ourreproductive needs in the areas of contraception and abortionand even in std screening are
often viewed as life-style needsas opposed to medical needs because we could avoid themby not having sex so often. so there's going to be atremendous temptation to drop those out of mandatorycoverage packages. this happens everyyear in every state, and it's something thatabsolutely has to be resisted. and last, it's great becauseeverybody's talking about this, the role of women in healthcare,not as the patients but as the providers. because it's true, we aredisproportionately the ones who
are providing healthcare, eitherprofessionally or informally as wives and daughters and mothers. and so the conclusionit brings me to, when i look at all ofthis, is that women are disproportionately theconsumers of healthcare, the purchasers of healthcare,and the providers of healthcare. and we live longer todo all of these things. alta:seriously, here's my question. why are we talkingabout women's health?
we should be the norm,not the special topic. we are the people that thehealthcare system is about. and if there's anyspecial group out there, it's men's healthcare becausethey use it less and need it less and use it for fewer years. so we should be changing thenotion of what is the norm around which we are building thesystem as opposed to thinking of ourselves as special. jerry joseph:i totally and absolutely agree with you.
as someone who has spent hisentire professional career dealing with women, i haveoften said, tongue and cheek, that i love women. and it's not a physical thing. i just think women are neat. i just gave a special addressa month ago saying how much i respect women for all of thethings that they end up doing in life, all of the things thathave been brought up today. specifically, i just want to besure people have touched on it,
we really need to be sure thatwe have mandatory maternity care in any package for allwomen who get pregnant. period. it's the start of life. people have made points beforeabout the importance of a good start. and you just can't replace that. nancy-ann deparle:so you're a practicing ob/gyn. do you see thatin your practice, where women come in that haveinsurance coverage but they don't have coveragefor maternity care?
jerry joseph:absolutely. small employersdon't have to do it. and you know the exclusionsmuch better than i do. but there are a lot of womenthat are in working families who don't have maternity care. and that's just wrong. and just like you made thepoint, which is very valid, we, all of us tax payers,end up paying for this, one way or the other.
and there are so many thingsthat are preventable, if we can get to them earlyenough, in prenatal care, that will mitigatea life-long misery. and to the government andto all of us tax payers, it means money. and that's what muchof this is about, not only the human side of itbut also to be able to deliver healthcare that's affordableand that's good healthcare to everybody. and i appreciate theopportunity to be here.
and i do think the same thinghas to do with the insurance reform. too many little loopholesfor women in reform. and we need reform for that. and portability,that was mentioned. that's very important. thank you. a speaker:priscilla? priscilla wong:thank you. i just wanted to highlight threepoints in particular to the
population that we servewhich is asian american, native hawaiian andpacific islanders. we are a highlyimmigrant population. over 60% of us were foreign bornand tend to be from mixed-status families where our parents orour grandparents also came to this country. and so as such, asothers have mentioned, immigrant womenare also, you know, the gatekeepers and theconsumers and the providers for their families and face theadded responsibility and burden,
unfortunately, of waitingperiods or excessive documentation requirementsor, if there's an individual mandate, perhaps not beingeligible for subsidies. and so i wanted toemphasize that, you know, immigrants want topay into the system. it will help withthe cost sharing. they will pay into the system,and as such they should be treated fairly so that they canget coverage for themselves and their families. two other points to piggybackoff of what eleanor and others
have raised aroundhealth equity, obviously as acommunity of color, we are extremely committedand concerned and hope that healthcare reform is ableto address some of these iniquities, particularlyin the delivery system, around language access,cultural competency, workforce development issues. we do not think it'sappropriate that currently, as is the case for a lotof immigrant families,
the children are doing theinterpretation for their parents. they should not be in theroom with the ob or gyn in translating their mother'ssexual and reproductive healthcare needs. and then lastly, many folkshave mentioned the need for comprehensive maternalhealthcare coverage. again, i just want to emphasizehow much that's needed for immigrant womenand their families. we know that there was a studydone by the american journal on obstetrics and gynecology thatshowed that for every one dollar
spent on immigrantprenatal coverage, we save three to fourdollars in post-care issues. and so i just want to emphasizethat all immigrant women should have access to prenatal coverageat that crucial period. nancy-ann deparle:cynthia? cynthia pearson:thank you. nancy-ann deparle:maybe we should startlosing this system. cynthia pearson:well, i mentioned i got smiles from all of you when i said we were partof a project called raising
women's voices for thehealthcare we need. so the way we encourage womento raise their own voice is by, first, listening to them. and we've done a series oflistening groups and speak-outs to ask women to tell uswhat are their experiences. and from that we draw policyrecommendations for change. and many of them havealready been said, so i'm not going to repeat. i'll mention one that hasn't yetbeen said and then one that's
sort of a larger thingwe've heard from women. the one specific is womenreally don't like it when their provider says they don'tdo what the person needs, the refusal clauses. and that is something that wewould like reform to tackle as a change because reform,how ever it goes forward, will be making some parts ofhealthcare that have been, you know, itemized atindividual or state levels, have some oversightat the federal level.
and women would reallyappreciate it if, when they were talking to anurse, nurse practitioner, physician, they knew that theirmedical needs were first in that practitioner's engagement withthem and not the practitioner's personal religious beliefs. so that's one specific thingthat hasn't been said yet. everything else that's beensaid, we hear as well. but i want to also speak aboutthis larger thing that we hear which is -- and i think it'simportant to say in this room
because all of us haveheard the research findings, the survey findings, that saypeople are a little scared of change. they do want affordability. they do want to make sure theircare is always available, they can't lose it, it'saffordable, it's good quality. but they're a little afraidof a dramatic change. so i want to talk to you aboutwhat women have told us about how much they not only wantchange in the system but they want to be part ofmaking that change.
and it's around disparities,outcomes, respectful treatment. i've got here, justfrom one speak-out, women's stories about times intheir healthcare experience when that went wrong. they were treatedwith disrespect, they were treated ina bad quality way. so women very much want, inaddition to that affordable coverage that'salways available, they want it to improve.
and they want it to improve inways that are very nitty-gritty, not much as, you know, thosehealthcare quality standards are gray, but that's not thenitty-gritty experience that women have. and the reason why i wanted touse my time to talk about that is because when women see theopportunity to change healthcare in a way they want,big changes happen. i just need to remind us all, inthis country in the last forty years, women have been part ofthe biggest changes to transform the healthcare system.
they broke down the quotason women in medical schools. they established the rightof patients to have written information aboutthe drugs they take. they solidly got behind and werepart of the growth of nurse practitioners and advancedpractice nurses as legitimate providers in their own right. and they created the culture ofinformed decision making that every american should be able toexpect at their birthright now. that's what women can do whenthey see the possibility to
change the system. and the women who are talking tous in our raising women's voices program, they see this not onlyas a chance to get affordable coverage that isalways available, but a chance to make it be whatthey really want it to be for themselves and fortheir families. so i share that with you becausei know you've got a tall order. you've got legislative languagethat you need to see go forward and be part of and think wouldwork and be able to be paid for.
and you've gotcontinued notarization, as you opened up by saying,that you've been out talking to people. so, you know, it's therefor you to tap into. and the more you can talkabout what women will get from healthcare reform in a waythat touches the day to day experience of women, themore women will be with you, your strongest partnersin moving this forward. nancy-ann deparle:i'm going to ask everybody to keep your comments to a couple minuteshere so we have plenty of time.
i want to get to what you wantus to do and what you're going to do to make sure to help us. a speaker:i'll be brief. thank you so much forbringing us together. this is such a wonderful group. thank you so much. i think the echos that you'rehearing about workforce concerns and the ways those play intopeople having meaningful access to healthcare only highlightsthe need to do both sort of
immediate steps to make surethat when reform happens people can see providers immediatelyand also to take the long-term steps that are so sorely neededto make sure we address the nursing shortage, theprimary care shortage, to make sure we have culturallycompetent care over time. i think it's really necessaryto do both of those things. and cecile mentioned protectingessential community providers. there's an enormous network offederally funded healthcare providers that providehigh-quality culturally
competent care that taketime to do counseling, that have those resources thatare able to see patients if they're included inthe reform package. so i think those are sort ofwonderful steps we can take, if those immediatethings happen, in addition to the seriousneed we have for the long-term workforce changes thatwe need in this country. a speaker:i would like to just bring upevidence based medicine because we haven't talked about that.
and i think that goes towardboth quality care and affordability of healthcare. and there are many examples inthe breast cancer community where evidence basedmedicine was ignored, from hormonereplacement therapy, autologous bonemarrow transplants, and now we see screeningbeing proposed for much, much younger women, which webelieve is inappropriate. but we think that any healthcarereform needs to include and be
cognizant of the importanceof evidence based medicine. a speaker:thanks. i would like to quicklymake two points, sort of broaden two thingsthat were brought up earlier. one is the incredible importanceof research that is going to be needed in thishealthcare reform, because you're going tohave, as we all know, limited dollars to actuallychange or transform our healthcare system.
and, therefore, what servicesand care the women receive need to be what they reallyneed to be receiving. and as society has fought foryears for women to be studied, there's still a great dealmore that needs to be done. and, you know, we feel that theresearch needs to be translated quickly into practice, that theunderlying research needs to be done correctly. and that's in addition to thecomparative effectiveness research being contemplated orbeing done now and being done as contemplated underhealthcare reform.
i sort of view those as twodifferent things because we don't know what's goingto happen in the bill. and in that research, we need tomake sure that women have been appropriately examined, that thesex differences have been looked into in order that, you know,the various drug issues that are raised, the various diagnoses,that you're appropriately diagnosed, diagnosed early, thatyou get the right treatment, the practice is correct. it all ties into variouschallenges because often with
issues regardingdisparities, you know, they don't diagnose youcorrectly on heart disease or -- (inaudible). and the second piece i would --because i can go on a lot about that. i'll just leave it there. and then the other piece goes tosomething that susan brought up and others. we keep talking about screening. but if we cut reimbursementdramatically to imaging and diagnostic tools that not onlyexist or are going to be in the pipeline, the access to thosetools will be enormously cut,
using the term twice. in essence, you will not be ableto get what you need if not only the doctors don'thave the equipment, aren't willing to do it becausethey're not getting reimbursed correctly, and because of thevarious screening tools that are coming out more, this isimpacting women in particular. thanks for the intro. just to follow upon what martha said, particularly about access toimaging for microvascular
disease and heart disease, it'sa specific example that if imaging is not available forsome of these more specific tests that it will have adisproportionate impact on women. so just to reiterate that. in terms of prevention, justechoing what everyone has said here about access to primarycare and prevention, a couple things thathaven't been said. one is the importance,particularly for young women, related specificallyto heart disease.
the good news about heartdisease is that heart disease death rates have leveled off forboth men and women slightly. that's good. but the only cohort where heartdisease is increasing is in women age 35-45. i mean, that's frightening. and with the obesity epidemic,we're likely to see more of that. so i think sometimes when youthink about heart disease, you only thinkabout older women. and in terms ofprevention and screening,
it's so importantfor younger women. the other issue that i haven'theard brought up, i don't think, is easy access and low barriersto referrals to specialists. if you're a womanwith heart disease, you need access toprevention and primary care. but unfortunately, too oftenwomen are not diagnosed by their primary care physician. they're not getting detectionearly enough, being diagnosed, so they get thetreatments they need.
they can go to all the greatprimary care physicians in the world, but if they'renot being diagnosed, they need to be ableto go to a specialist. so for a woman with heartdisease or the precursors of heart disease, they have to beable to get to a specialist to actually be able toget the diagnosis. that's what the data shows.so thanks. kelly smith:hi, kelly smith. i want to go backto nursing care.
i don't think theyreally said this, that we must increasehome care, home nursing, at-home nursing care. i think it's viewed asan increase in cost, when actually it's asavings in dollars. what we're doing is, afterserious operations, whatever, people go home, there'sno home nursing care, especially for the elderly. they fall down, break a hip.
and there's all kinds of datashowing that without home nursing care that's appropriate,there's more visits to the hospital and more costs. so i think that if we reframethe debate on some of these things that havebeen cruelly cut off, we would actually see a savingsin cost and more humane treatment. now, to do that though, we mustincrease the number of nursing training slots. there is a shortage of nurses. and so i think that nursing caremust be included in the package.
and it should be astandard of care. and we must acceleratethe training of nurses, which obviouslywould reduce costs. and why they think everythingthat women do increases cost, it's a bias in the system. and back to bias, if there canbe a standard on insurance discriminationthrough all packages, especially those thatare causing, you know, no prenatal care, et cetera,it would be a cost savings.
and i think you could putthis in as cost savings. the other thing is, i think thepublic school systems -- and i don't know if this is in here --should be used as part of this nursing healthcare reform. kids are in school. there is a way toincrease -- for example, i think past a certain age maybefolic acid should be a part of standard preparation, that weknow now that folic acid is a prevention of allkinds of disease.
so i mean there's got to be abetter use of the public school system for preventative care andshould be a part of the whole package. now, one other thing you said,how can we work together? what is the game? is it going to -- i mean, allof us are experts on different parts of healthcare. but how can we be more effectivein this reform effort? nancy-ann deparle:actually my question was, what are you going to do to helpus get health reform this year?
kelly smith:well, we're all going to obviously encourage it. but we've got to have a littlemore knowledge of the game. i mean, how many healthcareplans are going to be suggested? is there going tobe a public one? are there going to be standardsall across all of them? i mean, just give usa little clue here. kelly smith:and also, give us some suggestions how we can help. every group here wants to. there's no question about it.
we're all geared up. but i think we could be moreeffectively geared up if we knew exactly the gamewe were playing. i think most of us are a little-- i'm speaking for myself. i would love it if we could getsome standards across all the healthcare plans, you know, sothat there's some basic package. everybody's saying, oh, wedon't want to hurt what is. well, the inadequacy ofcurrent coverage is big. i mean, we act as if the systemthat is there -- we talked about
all those millions that are notcovered, which is horrifying. but of those who are covered,they're underinsured. i mean, there's so manyexceptions and deductibles. and they don't even know what itis until something hits them. so if we could have somestandards throughout to prevent these loopholes, we wouldactually have less bankruptcies, more effective healthcare,and, in my opinion, less cost in the long run. a speaker:i'm going to call on twopeople who have not had a chance
to talk before. and to your question, i thinkmost people know that the president set forth,during the campaign, a plan to address both loweringcosts for businesses and families, and gettingbetter coverage. and then the house andthe senate are working, starting with those principlesthat he laid forth, working on detailsand bills right now. so this is really the crucialtime to engage with congress as
we are doing, certainly wearound this table are doing, to make sure thatyour voices are heard. and by having this webcast, idare say that they're hearing from all of us. a speaker:sure. thank you. actually, i think it's veryhelpful to have a focus on women from the latino perspective,because hispanic women are the most uninsured. and they're concentrated in jobsthat don't provide healthcare coverage. and they're alsodisproportionately small
business owners who would beaffected by any mandates on providers. so it's important for us, thisis a very resonant conversation. what i would like to maybe lookat in this brief time is just a couple frameworks forus that are important. one is access, theother is quality. when we talk about access,clearly any healthcare reform has to increase the numberof people who are covered. if we go through this processand we don't have fewer hispanics and hispanic womenuninsured, then it's failed.
so we have to make sure thatwe get more people covered. obviously, cost is an issuewith regard to access. and there's lots of really goodideas on how to reduce cost here today. we talked about another issuewith regard to access is the immigrant issue. i would like to piggybackon what priscilla said. it's not a black and white issueas far as immigrant status. you have tons ofmixed-status families. and the presumption should bethat any child, any woman, any family is eligible if theymeet criteria based on income
and other criteria setby healthcare reform. clearly, having more people inthe risk pool when we talk about private options isgoing to reduce costs. it's not going toincrease costs. and we need to makesure that it's clear, that having more peopleparticipate is less costly. and the fact that if you lookat small business owners, having them to have to gothrough extra verification processes, it's not just goingto hurt them and their ability
to engage in the system. but it's not going to end upwith more people covered. and briefly, on quality, lots offolks talked about cultural and linguistic competency. that's an easy one, we think, todeal with because that -- it's not as high cost and,at the end of the day, you're going to get morepeople willing to go to get preventative care and gettingbetter care when they're at the doctor. and so looking at an accessagenda, a quality agenda, we think, is the way to go tomake the system work better for latinas.
a speaker:i would like to suggest someof the angles that accrue to this framework of looking atwomen's health across the lifespan, in addition to theones that have been mentioned which is not only all the onesthat have been mentioned about sort of a rationale,preventative, you know, cost-containing benefits andhealth magnifying benefits. but reproductive health is notonly important because of the next generation, because it'sbeen a source of discrimination and all the rest of it,but because actually it is
inextricably linked to beingin women's health across the lifespan so that when women goin for their prenatal care or their family planning care, it'sa magnificent opportunity to use the screening and detection thatyou discover then to plan for their much later life. we could be intervening in thehypertension that's discovered during pregnancy so that whenshe's 65 she's not a chronic hypertensive. and to cut to the chasein the interest of time, what we would like to see isan evidence based well women's
standard of care that addresseswomen's health across the lifespan. and i will leap toyour next question, which is what can we do for you. lots of folks here can bringyou different constituencies. we've already brought you thedeans of schools of public health. almost all of them across thecountry are supporting this, been working with acogwho's also supported this. happy to rally the physician andpublic health and other medical provider troops, because asidefrom everything else, you know,
it's really no fun to be aprovider whose providing fragmented and irrational care. it's not emotionally gratifying,and it's not intellectually gratifying at all. nancy-ann deparle:sabrina? sabrina corlette:thank you. i'm going to touch on somethingthat i don't think has been mentioned. but i'm going to add to the listthat alta gave us around women's roles. and one of them is healthcaredecision maker for their kids,
for their spouses, andfor their aging relatives, and a couple things i urge youto think about in terms of, as you are working with the hillto craft legislation around the idea of an exchange. quite frankly, i think forthe majority of families, it's going to be women thatare going to be gathering information about theplans, comparing them, and making the choice. so as you think about thedesign of the exchange,
there needs to be transparency. families need to know what theirfinancial liability is going to be over the courseof the year up front. there needs to be standards. i think we learned from medicarepart d that having 60 or 70 planned choices is not that-- it's paralyzing to people. for low-income women, womenwith cultural barriers, there needs to beone-on-one assistance. a lot of women don't have accessto an internet connection.
being able to go toa one-touch shop, knowing what theireligibility is, they may be eligiblefor medicaid. their kids might beeligible for chip. these are things that shouldbe up front, you know, made easy for people. and the only other point i wantto make -- and it's something that i don't know -- i hope youguys are thinking about this. and neera, i'm looking at youbecause i think you're going to
be in charge. i hope this bill issigned on october 1. and we're going to be one of theloudest voices cheering when that happens. on october 2, there needs tobe a massive public education campaign becausepeople need to know. the idea of an individualobligation or family obligation to purchase coverage isa huge paradigm shift. and people need to knowwhat their options are. they need to be educated.
and they need to have theresources available to them to make informed choices. that's all. nancy-ann deparle:you're going to be on implementation. i'm still trying to get peopleto help us get this done. vanessa, yes? vanessa gamble:two quick points. one is that we've heardabout home nursing care. but there are also a group ofmostly women in this country whose work is devalued.
and that's home health aids. and these are low-incomeand immigrant women. and so that in terms of --meaning their work is devalued, financial reimbursement, andhow we consider their work. this is cost savings too. so i think we have toput that on the table. and then briefly, people havetalked about the issue of equity. and i think that we will befooling ourselves if we think for certain communities inthis country, people of color,
gay and lesbian people, that ifwe just have the card and the coverage that -- that's not it. there's a whole body of researchthat talks about what happens once you walk in the door. and the institute of medicinereport on equal treatment in 2002 has shown that for -- withthe focus mostly on african americans -- that you can havethe insurance but you don't get the quality of care. and it's just not aboutcultural competence.
and so that we really haveto deal with that issue, that what happens onceone gets in the door. nancy-ann deparle:mary jean? mary jean schumann:yes. i would like toaddress two things. first, i would like to thankcynthia and ellie for talking about the issue of making surethat women have all of their options and the educationabout all of the options, that's not being judgmentallyprovided in one way or the other.
nurses have a code of ethics. physicians have a verysimilar code of ethics. we believe that they need tohave full knowledge so they can make the best choice forthem and for their families. but secondly, let me go on tosome things that i don't think we've talked about. and that is really looking atalternative delivery models. and one of the things thatana is pulling together is a conference for nurses to look atpolicy around alternate delivery models.
we've talked a little bit,touched a little bit on delivering in-schoolbased healthcare. nurse-run clinics, i think, isanother important piece of that. we need to look at careagain in the communities. geriatric folks, you know, it'shard for them to get on buses an travel to go access this care. we need to have the care in thecommunity that they can access readily and not have to have allof those additional barriers. another piece of that -- and wewould support the healthcare
home, medical home concept. we would urge you to think aboutthat being an all-provider concept. another piece of this that'snot been touched on at all is, i think as a motherof five young women, intimate-partner violence isan issue that nobody's really talked about here. but it is key to so much of wellwomen care in terms of mental health issues, obesity issues,alcohol and substance abuse issues. all of these pieces follow onwhen we start to address the
whole issue of intimatepartner violence. so i would urge youto think about that. nancy-ann deparle:okay. susan and then cecile. susan:and i too wanted toadd to what mary jean said about bringing up the whole concept ofthe refusal and the importance of making sure that people doknow who they're going to for their care and donot get care refused, and to be treated with dignity.
it is part of ourcode of ethics, and it should be supported. that code of ethicsshould be supported. and i know theadministration is doing that. i also wanted to add to whatmartha was saying about the reimbursement forcertain technologies. if we, for examplewith dexa screening, do not have reimbursement, thatwill mean that a community physician's office or a cliniccan no longer offer dexa
screening in the community, thatthe individual can only go to a large healthcare center. they're not going to travel. you know, i think about my ownmom who drove until three months before she died at 92. but she was not about to driveout of that five square mile area that she drove. and she would not have gottendexa screening if she had to go past that. and i also do want to, again,re-emphasize -- ellie talks
about school nurses. school nurses is probablynot what we all remember, where we have a school nurse whowas taking care of us when we got a cold. these school nursesare, first of all, fewer of them takingcare of kids with ivs, multiple medications,inhalers, sick kids. and there are fewer of them. we need to boost that system.
and also to get people in thehomes so we can prevent that elderly person from fallingbecause they cannot see the fact that there's a bump in the rugor other things that could potentially cause themto fall, break their hip, and then be in a nursing home. i used to work inone of those too. and i can tell you what getswomen into nursing homes. and it's a lot of thosefalls and accidents. a speaker:randy?
randy schmidt:as many people know, the ywca usa is a providerof services to women, girls, and families across the country. and a number of women thatwe serve are low-income. and we're very concerned aboutwhat's happening to low-income women across the country becausethey may not be eligible for medicaid, medicare, schip. they may not be able to getemployer based coverage. an individual insurancemarket just completely is not
accessible to these womenfor a number of reasons. so we're obviously concernedabout coverage for these women as well as any sort ofout-of-pocket cost that they may ensue because they do not havethe discretionary income to cover substantial cost. but i primarily wanted to touchon a topic that was addressed most recently, and that'sregarding implementation. and as someone who used to workdirectly with low-income women, it's completely feasible thatwhen the people who are going to
be critical to helpinglow-income women navigate any sort of system where they haveto determine coverage for themselves and their familiesare going to be direct-service providers. they're going to be the keywomen that low-income women trust, they respect, theyhave relationships with. they're going to be the samewomen that these individuals go to for help in fillingout housing applications. and so i think part ofdiscussing implementation needs to be how can we really insurethat those people on the front
lines already working withlow-income women can help these women navigate this system. we saw this with regard tosocial security privatization a little bit that, if wecreated private accounts, how would women who have noexperience navigating -- excuse me, investing in the stockmarket be able to navigate the stock market. the same can be said fornavigating an insurance industry or deciding on plans when theyhave no experience doing so. so i think it's critical toconsider how do we work with
people on the front lines whoare going to be helping these women make these decisions. nancy-ann deparle:cecile, and then i'm goingto let marcia have the last wordand we'll wrap it up. cecile richards:okay. i'll be fast. i just wanted to respond to yourvery good question which is, what can we do to actuallyget this to happen. nancy-ann deparle:thank you.
cecile richards:i think there's enormous enthusiasm in this country forhealthcare reform. and i think women, asbeing very practical, are very excited aboutthe opportunities. i would just wantto say, comment, from the plannedparenthood point of view, one in four women come toplanned parenthood in their lifetime. so we have a huge constituencythat is very interested in what the outcome is.
and we are sort of prepared tomove heaven and earth to have this happen. and i'm grateful to have anadministration that understands this is not justa top down deal, this is a bottom updeal effort also. we have to have the publicbehind this whole concept. so the only twothings i would say is, i think women -- to alta's verygood point -- i think women's healthcare has to be seenas sort of part of it, not an outlier.
and that's just astruggle we all deal with. and making sure that folks whoare providers to women are seen as part of the system and thatwomen's healthcare isn't worse off after reformthan it was before. and that seems likemaybe a laughable point, but i think it's actuallysomething really fundamental as we think about the constructof what's provided for, what care is given,and how it's given, that that will bean essential part.
but we're ready to dig in anddo the work on the ground. thanks a lot. marcia greenberger:two smaller points and a bigger one. with all of the concerns thathave been articulated around this table -- andthey're all so important. they get translated obviously atthe end of the day into the kind of technical language of whetherthese major life issues will be dealt with well or not. and so i have a couple of thosevery technical things to say.
for example, we've heardabout domestic violence. we know from some of our reportsand studies and elsewhere that women who are victims ofdomestic violence often wind up finding that that's beingtreated as a pre-existing condition. so when people hear about thepublic policy debates of how to deal with pre-existingconditions, which sounds so technical, byeliminating those kinds of issues, women who havecesareans for example, c-sections and delivery, that'streated by insurance companies
often as a pre-existingcondition for coverage all across the board. so those are fights that weneed to engage women in in the nitty-gritty of how these plansare ultimately -- and the legislation isgoing to come out. and we want to be your ally inmaking sure that we get the kind of healthcare reform thathas those protections in it. and we know that that meanswe need to fight with you. it means that, for a publicplan which is going to be very
important for women. and when we get tothe benefit package, we know how important it is notto politicize the decisions about what is covered and whatis not because women will often find themselves somehowmarginalized if the decisions aren't made on the basisof medical need, evidence, professionalism. so we also want to be areal ally and advocate, not only for someof these details, but also in the design andmaking sure that we do have the
kind of independent commission,medically based, evidence based, not politicized, to decidewhat is cover and what isn't. so i want to say, for thepurposes of the national women's law center -- and i know thatthat's been echoed by others in this room, that we too wantto be allies and partners in getting into the actual fight tobe sure we get the healthcare reform that we know theadministration and you all are fighting for and that it ishealthcare reform that has those kinds of details in place.
so we -- and i'll give alittle plug for nwc.org. we'll have action alerts. we have organized telephonecalls with state based groups all over the country. we have the details that we hopepeople will get informed about to speak out, andto, in essence, really get into the legislativeprocess and fight for these victories so that we get thereform and it's the reform that women need for themselvesand for their families.
nancy-ann deparle:great. thank you, marcia. you're one of the many people inthis room who has been working for this for years. and we thank you. and on behalf of melodyand tina and myself, we appreciate everythingyou're doing to help us get to healthcare reform that's thelowest cost for families and businesses and getseverybody covered. that's what we all want.
and the next six to eight weeksare going to be critical in that. so we really look forward tocontinuing to hear from you and working with you. tina, i'm going to letyou have the last hoorah. tina tchen:well again, thank you all for coming. i want to introduce twopeople on the side there who, if you don't know them already,you know them by e-mail no doubt. karen richardson. karen richardson works in theoffice of public engagement
doing our healthcare outreach. so she will be the point person,and she has been in terms of pulling this meeting together. but then lots of the issues herewere also issues affecting women and girls which is why in myrole on the council of women and girls, even outside ofhealthcare, like the issues, domestic violence,intimate partner violence, i think some of the -- trying toget more women and girls into health care. and the sciences are issues thatwe're looking at in the council.
so i want to introduce jeannieyaeger as well who is my special assistant on women's outreachand on the council of women and girls. and then finally, foreveryone around the table, those who may be watchingthis on the webcast, let me give you an e-mailaddress to stay in touch with us. you may use this to sendadditional reports. some of you have referred toresearch that you've done. i think it would be veryhelpful for us to have it. and we will get it tothe healthcare team.
or if you have other issuesor you want to be involved, either ongoing updates andwhat's happening with healthcare or ongoing contact with us, whatthe council on women and girls is doing, we have an e-mailaddress that we use for the office of public engagement thati promise you is always checked, in fact all the time. it's the wordpublic@who.eop.gov. so it's the word, public, @,who for white house office, eop for executive officeof the president, .gov
you may use that address for anyof these issues because that's why we -- you know, you canjust remember the one address. we will then get thematerial to neera, to nancy-ann if it'shealthcare related. we'll look at it, if it'scouncil on women and girls, you can send usimmigration materials. we cover actually thatentire waterfront. and so we want to thank youfor your continued support and efforts, as nancy-ann said, aswe move through this critical period.
a speaker:i would be remiss from mydepartment if i don't mention www.healthreform.gov which is aplace where you can get really up-to-date information on thedebate, what's happening, how health reform needs to pass this year. why the costs have been actually too high. we have a myriad number of reports to report. nancy-ann mentioned at the beginning about the impact on women is on
healthreform.gov. and we really hope and urge people to use that as a regular resource. nancy-ann deparle:thanks everybody for coming.
Demikianlah Artikel Seven Hills Womens Health Center
Anda sekarang membaca artikel Seven Hills Womens Health Center dengan alamat link https://yanderatjen.blogspot.com/2017/06/seven-hills-womens-health-center.html
0 Response to "Seven Hills Womens Health Center"
Posting Komentar