Women's Health

Floor Speech

Ms. MIKULSKI. Madam President, I claim 10 minutes of the Democratic majority time. I come to the floor to speak about women's health. I come to speak about the issue of prevention, and I want everybody to fundamentally remember what we debated and what we did in the health care bill.

For the first time in a long time, our Nation is talking about women's health. Am I glad to hear that. It has mostly been happening on the morning talk shows and on the front pages of our newspapers. But, unfortunately, too much of the conversation isn't about women's health; it is politics disguised as women's health.

What should we be talking about when it comes to women? We should be talking about the top killers of women: cancer--that dread ``C'' word--including breast cancer, cervical cancer, lung cancer. They are the highest killers of women: lung cancer, cervical cancer, and breast cancer. Then there are the silent killers of women: undetected diabetes as well as the consequences of heart and vascular disease. What did we talk about in the health care bill to deal with these issues? We talked about the fact that we needed preventive services, that we believed in early detection, that we believed in screening for early detection so we could identify those consequences that would negatively impact women in terms of their health care.

One of the things we know is that many women don't have health insurance at all. Seventeen million are uninsured. Women are most likely to neglect their treatment because of cost. Women of childbearing age are also even more at risk because they are performing jobs that tend to be starting out and they don't pay for health insurance.

We tackled a lot of this in the health care bill. I am so proud that one of the first things we did was end general discrimination in health care--the punitive practices of insurance companies discriminating against women by charging more for women of the same age and the same health status as men. But we came together, united, and passed it as part of the affordable health care act, and we ended gender discrimination.

Then we saw that simply being a woman meant being treated as a preexisting condition. I held a hearing about this that was bone-chilling, when we listened to how women were discriminated against and aspects that had happened to them were viewed as a preexisting condition. In eight States if a woman was a victim of domestic violence, she could not get health insurance.

In another bone-chilling story, which was breathtaking, a woman testified at our hearing that because she had a C-Section, her insurance company told her they would drop her from their insurance plan unless she got sterilized. That was in the hearing. She had a letter from her insurance company. We were aghast on both sides of the aisle, regardless of how one feels about some of these reproductive issues. Nobody felt that should happen in America. So the people on the committee, led by myself, said: We can't have that. So we have ended discrimination against women getting health care on the basis of preexisting conditions.

We wanted to go further, and one of the issues we looked at was that of prevention. This is a subject of great debate. The very first amendment on the Senate floor during the health care debate was one to add preventive health care benefits. I offered an amendment, and the Senator from Alaska, Ms. Murkowski, offered a counteramendment. Her amendment was terrific. She had every preventive service that I would have ever loved. CBO, though, scored it at something such as $50 million. The CBO's score sunk the Murkowski amendment, but the Mikulski amendment prevailed, in which we said we will leave it to the Institute of Medicine to determine what would be some of these amendments for women.

So guess what we have. In our preventive health amendment, which is now the subject of such debate, such controversy and, unfortunately, such misinformation, our amendment said this: First of all, if a woman is over 50, she gets a free yearly mammogram, one of our highest risks. Second, if a woman is over 40, she gets an annual well woman preventive care visit. This then goes to the screenings that then go to the highest risk for the highest diseases we have.

We have early detection and early screening. For young women who are pregnant, we guarantee they can be screened for diabetes, but also in our prevention amendment we provided for maternity services. We provide for maternity services so these women can get proper prenatal care. Working with their doctor, we can ensure the health of the mother and survivability and the ability to carry her pregnancy to term. We looked out for those maternity benefits.

IOM also said that as part of prevention we should add contraceptive coverage. That was a recommendation not of Senator BARB and not of Senator Jeanne Shaheen; this was a recommendation of the Institute of Medicine. Why do they say that? First of all, there are over 15 or 20 percent of women who need to take birth control in order to deal with the medical issues associated with their menstrual cycles. This isn't the place to go into the biology of being a woman, but for many this is where people long before--young women and adolescents who were not sexually active were experiencing some significant hormonal problems. So it is not always about being sexually active.

So this whole thing about the preventive amendment being all about birth control is so exaggerated, so overblown, so out of context with what we wanted to do. I am shocked and--I am just shocked.

We looked at our bill, in addition to my amendment, and we included preventive services for men and women, those services that affect both sexes, including colorectal screening for adults over 50. That also includes prostate screening for men. We have diabetes and high blood pressure screening. There is also the ability to do alcohol misuse screening which, in many instances, is an undetected and silent killer not only of lives but of families.

So one of our major thrusts was prevention. We won maternity benefits so a mother can be safe and well herself and be able to carry her pregnancy to term in a way that ensures the health of both the mother and the child, when the child is born. The fact that we had these other screenings, including mammograms, prostate cancer, diabetes-- the things that are killers of us all--some of these will close the health disparity gap because so many African-American men face terrible problems with high blood pressure that leads to the terrible consequences of stroke. Diabetes is rampant in our country but particularly rampant among people of color. So that is what we were doing.

I find it troubling that instead of focusing on our preventive health services, we are focusing on birth control. Birth control was never the focus of health care reform. It was a recommendation to be included in the benefit that came from the Institute of Medicine.

There is another bit of confusion out there about mandating churches to do something against their will. I wish to draw a distinction between what the bill does and mandating the provision of service and providing insurance coverage. The bill does include insurance coverage. But there is no place in the bill that mandates a religious organization provide something against their principle in providing a service. So if you are St. Mary's Hospital, you do not have to give out birth control in your women's health clinic. If you are Notre Dame University or Georgetown University or a Catholic women's college, you do not have to give out birth control in your student health clinic.

What the Obama-Sebelius regulations say is that there has to be insurance coverage available, particularly to those who are non-Catholic. For all of us who go to these wonderful institutes and have benefited from their services, they are nondiscriminatory. One does not have to be Catholic to teach at a Catholic college. One does not have to be Catholic to work at a Catholic hospital. One does not have to be Catholic. So these institutions hire people of a variety of religious preferences.

I don't want to get into a debate on the first amendment, but I do welcome a debate on what the health care bill did and what it intended.

The health care bill, I felt, was one of the greatest social justice initiatives I have participated in in the Senate. It was going to work and organize in an effective way to make sure we were on the road that every American had access to affordable care. Then we removed the barriers that were not only financial but often these discriminatory practices, these punitive practices that often were directed against women and preexisting conditions or in gender discrimination and the way they set their prices.

The best care is preventive care, and one of the tools well known in the public health field is these screenings tests that we worked to provide, and we turned to the eminent and distinguished people in learned societies, in this case the Institute of Medicine, to tell us not based on politics but to tell us based on science what the benefits should be, and they added contraceptive coverage.

That is the history. I hope it clears up the misinformation. But we did work to move our citizens to greater health care and remove the financial and other societal barriers to getting health care in our society, with a fantastic emphasis on prevention. We have gotten off to the wrong debate and the wrong discussion. Let's get back to talking about how we improve the health care of women and how we can keep moving on our preventive aspects that not only help women but help the men who so love us and support us, and we want to return the favor by making sure they get their screenings too.

I yield the floor.

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