Nursing News:
Study on womenıs health Ŝnds small gains, key setbacks

While states are making some progress in improving health care for women, they are taking a two-steps-forward-one-step-back approach that fails to meet the health care needs of women. That is the conclusion of the 2004 edition of Making the Grade on Womenıs Health: a National and State-by-State Report Card, a comprehensive study on the status of womenıs health and health policies released today by the National Womenıs Law Center (NWLC) and the Oregon Health & Science University (OHSU).
Making the Grade is the third report by NWLC and OHSU to grade and rank each state based on 27 health status benchmarks developed largely using goals set by the U.S. Department of Health and Human Services Healthy People initiative. The report gives the nation a grade of ³Unsatisfactory² for meeting only two benchmarks - the percentage of women receiving regular mammograms and the number of dental visits. No state receives a ³Satisfactory² grade for womenıs health status, although eight states receive ³Satisfactory minus.² Minnesota ranks first overall followed by Massachusetts, Vermont, Connecticut, New Hampshire, Hawaii, Colorado, Utah, Maine and Washington. Six states receive failing grades. The ten states ranking the lowest were: Mississippi, Louisiana, Arkansas, West Virginia, Oklahoma, Texas, Alabama, the District of Columbia, Kentucky, and Tennessee. In addition to grading and ranking each state, Making the Grade evaluates whether states have adopted 67 key womenıs health policies. Only Medicaid coverage for breast and cervical cancer was met by all the states ­ up from 40 states in the 2001 Report Card. Three states, New York, California and Rhode Island, met a majority of the policy goals (over 35). Idaho, Sound Dakota and Mississippi met the fewest policy goals. Preventing tobacco sales to minors was the most consistently improved policy with 18 states now meeting the policy goal as compared to only 5 in the 2001 Report Card.
³State policy makersı piecemeal approach to our health care crisis has resulted in a complex and ineffective system that fails to meet the health care needs of women,² said Judy Waxman, NWLC Vice President for Health. ³Lawmakers need to take a comprehensive, long-term approach to meeting womenıs health needs and tackle this serious problem that plagues so many families.² ³The outlook for womenıs health is grim and no where near approaching the nationıs goals for 2010 set by the U.S. Department of Health and Human Services Health People initiative,² said Dr. Michelle Berlin, Associate Professor at the Oregon Health & Science University. ³There is a great distance to go with the nation meeting only two out of 27 benchmarks graded in this report. Failing to meet these goals undermines not only the health and well-being of women, but the well-being of our country as well.²
Given that women need better access to health insurance to get the health care they need and that nearly nine percent of all women are on Medicaid, Making the Grade focuses on access to health insurance, particularly on those policies that improve or weaken Medicaid coverage. Unfortunately, Making the Grade finds improvements in state polices off-set by the weakening of other key policies:
€ States made improvements in expanding Medicaid eligibility for pregnant women and working parents, but moved backward in covering poor childless adults with only seven states meeting this goal compared to eight states in the 2001 Report Card.
€ Sixteen states improved their Medicaid enrollment process by adopting a mail-in application, however, fifteen states weakened their policies and imposed co-payments to their prescription drug coverage under Medicaid.
€ For those unable to obtain insurance through their employer or Medicaid, only five states provide adequate protections for people seeking to purchase private individual health insurance. The majority of states have minimal or no meaningful regulation on this market. Making the Grade finds that a womanıs health greatly depends on where she lives:
€ For example, nearly 18 percent of women ages 18-64 are uninsured, but in top ranked Minnesota, only 7.9 percent of women are uninsured, while in Texas 28.3 percent of women are without health insurance.
€ In Hawaii, 84.5 per 100,000 women die of coronary heart disease (the number one killer in the United States), but in the District of Columbia, 210.6 women die from this disease.
€ In New Hampshire, 91.5 percent of all pregnant women receive prenatal care in the first trimester of pregnancy, but in New Mexico only 69 percent of women receive this care. Despite the important role of preventive care in improving womenıs health, Making the Grade finds states falling short when it comes to the nationıs goals for screening for key diseases and requiring insurance companies to cover these screenings and treatments:
€ While 43 states meet the national goal on mammograms for women age 40 and older, only 3 states meet the national goal for pap smears, and only 19 states meet the goal for colorectal cancer screening.
€ Since the 2001 Report Card, only one state added the requirement that private insurers cover annual mammograms for women over 40, three more states required coverage of colorectal cancer, and no state added coverage of annual pap smears.
€ Smoking is the leading cause of preventable death among women, yet only one state meets the national goal for achieving a low percentage of women who smoke and no state mandates private insurers to cover smoking cessation.
Making the Grade reveals setbacks for women when it comes to gaining access to full reproductive health services: € Only 17 states provide public funds for safe abortion procedures for women.
€ Since the last Report Card, three more states added requirements for parental notification and four more states have established waiting periods before an abortion procedure.
€ Only three states have adequate laws that facilitate womenıs access to emergency contraception and only 20 states require that private insurers cover contraceptives as they do other prescription drugs. The report also measures womenıs health by looking at their economic security in the states. Unfortunately, little progress has been made in this area:
€ Alaska is the only state with a minimum wage that allows a family of three to reach the federal poverty threshold.
€ California is the only state to enact a paid family leave policy that allows workers to take paid leave to care for a new child or ill family member.
€ Four states weakened policies that ensure children on welfare receive the child support collected on their behalf. The Report Card is being distributed to policy makers and womenıs health advocates nationwide. The first two Report Cards, issued in 2000 and 2001, prompted activities around the country including legislative hearings, town meetings, forums, and new materials on womenıs health. It is funded by the Bristol-Myers Squibb Foundation and the Open Society Institute, with additional support from the Ford Foundation, Richard and Rhoda Goldman Fund, George Gund Foundation, William and Flora Hewlett Foundation, Huber Foundation, Moriah Fund, David and Lucile Packard Foundation and Turner Foundation.
For more information about the National Womenıs Law Center and to view the full Report Card please visit their web site at http://www. nwlc.org/details.cfm?id=1861§ion=health.