Denial of a Safe Haven: Domestic Violence as a Means of Denying Healthcare

By Jason Richie‡

Although the intense debate surrounding health care reform has drawn attention to a variety of important issues, there has been little discussion regarding the denial of coverage to victims of domestic violence. Eight states—including North Carolina, Idaho, Mississippi, Oklahoma, North Dakota, Wyoming, South Carolina, and South Dakota—and the District of Columbia still allow insurers to deny health care coverage to victims of domestic abuse – a practice known as “pinklining.”

Although insurers do not ask applicants directly if they have been victims of domestic violence, they often review emergency room visits, doctors’ records, and even court-issued protection orders for grounds to deny care. The very agencies victims of domestic violence turn to for help, support, and guidance are in many cases being used against them, often with tragic consequences.

Georgia is one of eleven states that has modified its state laws on this issue since 2000, but it took the Georgia General Assembly nearly three years to makes these modifications. The bill passed unanimously 169-0, a feat that, according to Law Professor Rebecca Brannan, was in large part due to publicity surrounding the denial of coverage to a staff member at a Georgia domestic violence shelter after she was shot multiple times by her abuser.

More recently, Kaiser Health News, a subset of the Henry J. Kaiser Family Foundation, profiled the 2006 experience of an Albuquerque, New Mexico, attorney, Jody Neal-Post. Ms. Neal-Post, who herself advised victims of domestic violence, was rejected by her insurer after the insurer learned of counseling she had received following her own domestic abuse experience with her ex-husband. New Mexico’s Public Regulation Commission intervened, forcing the insurer to reverse its decision as required by New Mexico’s Domestic Abuse Protection Act.

Insurers use risk as a shield to deny care. Reasons for denial range from interpretations of domestic abuse as a pre-existing condition to the view that the abused person is somehow participating in a dangerous or alternative lifestyle. Fern Shen of The Washington Post quoted one insurance executive, saying, “Whether it's battering or breast cancer or HIV or a sky diver or a person recovering from breast cancer, if we fail to take these things into account, it could lead us into bankruptcy.” An insurer can tailor its risk. A sky diver can choose his or her own risk. However, a victim of domestic violence or a patient suffering from breast cancer cannot choose her risk, despite the best intentions and the most stable circumstances.

Within North Carolina, county agencies and programs receiving funding from the North Carolina Council for Women/Domestic Violence Commission handled 101,076 crisis calls in 2007-2008, which are the most recent years that these numbers are available. While there are no figures as to how many of these callers were denied care, North Carolina's history of pinklining puts these callers at further risk. Not only does the denial of health care coverage harm those trying to escape violent family members, but it also jeopardizes the lives of the millions of children who accompany their parents into newly formed family units. This denial further intensifies the victimization of those who have fought courageously in these often private struggles.

The North Carolina State Legislature enacted a statute banning the treatment of domestic violence as a pre-existing condition in 1997. However, the same statute also attempts to prevent a denial based on disability, medical condition, or past medical care – a measure that has proved largely ineffective. In an attempt to fill the void, North Carolina’s Insurance Commissioner, Wayne Goodwin, recently filed for a new addition to the North Carolina Administrative code that would explicitly prohibit the classification of domestic violence as a pre-existing condition.

Although Mr. Goodwin’s efforts are a step in the right direction, we need to guarantee that insurers do not continue to use domestic violence to deny health care coverage, a practice which routinely occurs with other items mentioned in the statute, including disability and medical history. North Carolina can use the health care reform movement as an opportunity to ensure that no adult or child is denied health care coverage for seeking help and a safe haven.

Jason Richie is a law student at the University of North Carolina School of Law.

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