WASHINGTON -- Eight states and the District of Columbia don't 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 Women's 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 isn't thought to be as widespread as it once was, lawmakers say it's yet another example of the need to overhaul the health care system.
"This is insane," said Sen. Patty Murray, D-Wash., who's been trying to convince Congress to address the issue for roughly a decade.
Murray said she couldn't 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 couldn't flee an abusive relationship because her children were covered under her husband's health care plan and she couldn't get her own. Another woman told Murray that she didn't report that she'd 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 it's all about the bottom line. Abused women don't 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 one out of four insurance companies factored in domestic violence when deciding whether to issue or renew policies.
Lisa Codispoti, senior counsel for the National Women's 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 don't 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 didn't mention domestic violence outright in health policy applications, they could piece it together from such things as medical records.
A spokesman for an insurance industry trade group, Robert Zirkelbach, said he wasn't 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 don't develop models unless there is a need," Praeger said. "It's 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 Women's Law Center.
"We certainly don't allow domestic violence to be used as a pre-existing condition," said Kristin Milam, a spokeswoman for the North Carolina insurance commissioner's 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 don't 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.
The 10 Republican senators included North Carolina Sen. Richard Burr, Georgia Sen. Johnny Isakson and Kansas Sen. Pat Roberts.
The chairman of the committee at the time, Republican Sen. Michael Enzi of Wyoming, said that if it were a problem, more oversight — not a new law — was needed, according to a transcript of the hearing.
Most recently, Enzi was one of six members of the Senate Finance Committee who spent months trying to negotiate a bipartisan health care bill. The bill that eventually emerged has no Republican support.
Enzi now supports eliminating pre-existing conditions, including any that involve domestic violence, Michael Mahaffey, a spokesman for the senator, said in an e-mail.
"Rather than doing this one condition at a time, Senator Enzi is going to keep working to end all discrimination based on pre-existing conditions," Mahaffey wrote.
Burr said in a statement that his record on domestic violence, including his support for the Violence Against Women Act, "is clear and consistent."
Burr said states were responsible for regulating insurance markets, but he added that it was "deplorable" to deny coverage to victims of domestic violence.
"Individual insurance markets are regulated by state governments and are thus subject to state law," he said.
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