All Denials of Coverage For Pre-Existing Conditions Deserve Equal Outrage

You’ve almost certainly heard: in certain U.S. states, insurance companies are legally calling domestic violence a “pre-existing condition” and are therefore refusing to cover any treatment related to it. If the person in question doesn’t disclose the domestic violence prior to taking on insurance, they can have their coverage dropped by the insurance company. And, in the cases that are making the most news, those who have previously been victims of domestic violence are being denied access to insurance entirely.

The story has been around for several weeks now. And seemingly, it’s not going away anytime soon. I keep seeing more details pop up in my Twitter feed. In my blog reader, someone shared an item at Jezebel about the Democratic plan to ban the classification of domestic violence as a pre-existing condition. Of course, this ban is a part of the plan to end the denial of coverage on the basis of pre-existing conditions, period — but for some reason, the issue of domestic violence deserves explicit mention. Indeed, we’re seeing it get all kinds of special attention at various feminist blogs — and by our First Lady.

The question that too few people are asking is “Why?” No, no, not “Why do insurance companies do this?” — I think we know that answer — but “Why does it deserve special attention and outrage?”

It’s a question I asked myself out of confusion and annoyance in a little rant over at my Tumblr when the news first broke and received a whole ton of coverage. I wrote:

Here’s the thing: under insurance company logic, domestic violence is in fact a pre-existing condition. You can acknowledge that while still being disgusted — and, I think, we do in fact need to acknowledge that to be properly and fully disgusted. The scandal here isn’t that insurance companies are being cruel-hearted and outrageously discriminatory by classifying this particular case as a pre-existing condition. The scandal here is the very notion of “pre-existing conditions” and how they are inherently discriminatory and cruel-hearted. How when insurance companies have the one and only goal of profit, they have to be.

I’m appalled by the misogyny and victim-blaming, yes, but no more than I am appalled by the ableism, racism and classism that is the overall health care system in America. And no more appalled than I am by misogyny and victim-blaming of the fact that many domestic violence victims also go without treatment because they don’t have insurance at all.

…

This story is absolutely fucked, yes. But it’s not fucked in a vacuum. And I think a lot of people are failing to connect it to the bigger picture.

But, you know, I didn’t really get it. I thought that many people were simply failing to see the forest for the trees. I just thought that it was really poor, ineffective and confounding strategy.

And then I read this post from Amandaw, and suddenly, things clicked:

So why are [domestic violence and c-sections being labeled pre-existing conditions] different? Especially outrageous?

I can’t identify any reason except one.

Because they apply to healthy women.

It’s understandable why health insurance companies would refuse care to women with arthritis. It makes sense that they would deny care to women with psychiatric disorders.

Because we, as a society, think it is OK to deny quality of life and societal access to people with medical conditions, disabilities and chronic illnesses. We have determined that it makes sense to discriminate against them. We get why these things are done. And they’re done to those people. Over there. Not to me and mine.

…

What justification is there for acting as though these practices are any worse than the practice of denying coverage to women who have lupus?

There isn’t any that isn’t rooted in a deeply ableist bias.

Undoubtedly, many people will not like to read what is written up above, but I think she’s absolutely right.

Those of us in the United States currently live under a ridiculously abusive health care system. Even the majority of those who have insurance and yet are not filthy rich know that it only takes the loss of a job or a denial of coverage to have the rug pulled out from under them. Americans live in a nation, in other words, that does not see health care as a human right.

It’s extremely difficult, even for those of us who believe it should be otherwise, to not absorb and internalize lessons from that. And among those lessons is don’t get sick.

We also live in a world that is filled to the brim with ableist bias, where disabilities and/or chronic health conditions are intensely feared. We are taught that a disability is the worst possible thing that can happen to you, and thus able-bodied people generally try to avoid acquiring one at all costs — and push out of their minds the fact that any moment, they can. In America, there is also a very rational reason to fear disability and/or diagnosis of a chronic condition (even if it’s not consciously recognized) — because we know very well that if we have one, there’s a damn good chance that we won’t be afforded the care we need.

It’s extremely difficult for able-bodied and healthy people, even those of us who believe it should be otherwise, to not absorb and internalize lessons from this kind of socially ingrained prejudice. And among those lessons is that able-bodied concerns should be considered to be wholly separate from and superior to the concerns of people with disabilities.

What this all adds up to is the idea that none of us really deserve health care — but that if anyone does deserve it, able-bodied people deserve it more. And I think that is what is being expressed in these conversations.

I’ve heard a couple of rebuttals to the kinds of objections expressed up above. The first is that it’s legitimate to consider domestic violence being classified as a pre-existing condition to be more egregious than other conditions because women are in far more instances the victims of domestic violence requiring medical care, and thus such a policy shows a deliberate gender bias.

Does it show a deliberate gender bias? Well yes, yes I would say that it does. Absolutely. Issuing denials of care on the basis of previous domestic violence is certainly misogynistic.

But doesn’t the entire current health care system disadvantage women and show a gender bias? Women are charged more for health insurance, thus limiting access further to those who most need it. Certain disabilities and chronic, medical and psychiatric conditions which qualify as pre-existing conditions also tend to fall heavily along gendered lines — off the top of my head, I know for example that fibromyalgia affects far more women than it does men, as does depression — so isn’t the whole system working off of a gender bias? Why should that only count when we’re talking about violence? Further, why does a gender bias count for more than the racist, classist and supremely ableist biases of the entire system of pre-existing conditions?

The second rebuttal I’ve heard is that by denying a woman care on the basis of what another person has done to her, it’s holding her responsible for his actions — in other words, such a policy blames the victim.

Does it blame the victim? Oh, hell yes! Saying that someone who has been abused no longer deserves care is certainly punishing them further for something that was not their fault and not-too-subtly indicating that it was their fault.

But is it another person’s fault when they develop a medical condition and/or disability? Did they bring the diabetes on themselves? Did they ask for the heart condition? Should they have known better than to develop arthritis? Did they go and get themselves in a situation where they need access to pain medication, or oxygen, or a wheelchair? Some certainly would in fact say yes. Indeed, we see the argument frequently from people who oppose health care reform. (“I don’t want my tax dollars paying for fat people!”) And I think the argument that domestic violence as a pre-existing condition is a special case because the abuse is not the victim’s fault is also implying that people who develop a serious and/or ongoing condition do bear some blame — and also that if they bear blame, they don’t deserve care as much as those who don’t.

As we know, the fact is that many people also believe that victims of domestic violence bring it on themselves, that something they did was a “provocation.” I’d say that both attitudes are pretty equally wide-spread — and are also really the same attitude, rooted in different forms of oppression.

Aren’t all of the excuses really just ones that are, like Amanda says up above, rooted in ableist bias? Aren’t they all about expressing some way in which able-bodied women deserve special treatment over women with disabilities? (Please Note: I am of course in no way saying that women with disabilities are not also sometimes victims of domestic violence! Simply that these women are not who I believe are being thought of when the outrage strikes.)

No, victims of domestic violence do not deserve less consideration than people with disabilities — especially since these groups overlap, this would be patently nonsensical. I’m simply saying that they do not deserve more consideration, either — and that focusing the conversation in this way is setting up an “us vs. them” mentality that is not only ableist, but also incredibly unproductive if we’re seeking out real change to our health care system, and if we actually want a country where health care is a right rather than a privilege. And I’m also not saying that those who are focused on domestic violence as a pre-existing condition are necessarily acting maliciously against people with disabilities and deliberately promoting a system where able-bodied people are privileged. I’m talking about arguments and actions, not the people behind them — and also making strong note of the fact that intentions don’t mean a whole lot with regards to outcomes.

Be upset that these people, primarily women, are not receiving care, certainly. But be upset that it’s because we live under a system where a “pre-existing condition” is considered a legitimate reason to deny treatment and coverage at all, not because of this one particular — and within the context of the abhorrent system, entirely rational — application of the rule.