health care,
education and
social services

health care,
education  and
social services

Healthcare Access For Women: The Battle’s Not Over Yet

Access to healthcare remains a challenge for many women in Washington DC. As we mark National Women’s Health Week (May 8-14), Mary’s Center’s Chief Nursing Officer, Dara Koppelman, addresses the important issue of health disparities and explains why she supports the District’s plan to implement the Convention of the Elimination of All Forms of Discrimination Against Women (CEDAW).

The District of Columbia (DC), a city without voting rights, has taken many steps to improve the health of its community. Mary’s Center is proud to have contributed to the health improvement of communities in the DC metro region for almost three decades. But the battle for better health equity is not yet over as health disparities clearly remain in segments of our population, including immigrants and women. This is why I support the Council of the District of Columbia’s bill to implement CEDAW.

At Mary’s Center, we have worked to help women and their families since 1988. Initially this was through prenatal care for Latina women, but over the years, our work has organically expanded to include primary care for all – children, adults, seniors, and of course, women – regardless of their ability to pay. Additionally, we practice a social change model of care, combining health care with social services and education, understanding that healthcare alone is often not enough to truly help individuals and families build a better future for themselves and their communities. Our model has proven to be very successful. For example, we have employees whose mothers came to us for prenatal services and their grown children are now healthy and successful adults rendering care as Family Support Workers to our next generation of patients. 

Our city is very progressive, but there is still so much we need to improve upon, especially when it comes to equal healthcare access for women. The birth outcomes in DC are some of the lowest in the country, with Low Birth Weight (LBW) hovering around 9.4%, far above the Healthy People 2020 goal of 7.8%. I am very proud of the fact that of the 1,155 births at Mary’s Center in 2015, only 6% were LBW, (this figure includes twins), proving that the Center’s commitment to providing early, quality prenatal care to women, regardless of their socio-economic  or immigration status, pays off.

Here are some of the measures that I believe will increase access to healthcare for women in the District of Columbia:

1.  Medicaid Coverage For Prenatal Care For All

We applaud the District’s provision of emergency Medicaid to cover the cost of labor and delivery and their generous coverage of prenatal care with city appropriated dollars, for women who are poor and not U.S. citizens. Nonetheless, there is no women’s health services coverage for women who are working and are not US citizens, truly our working poor. They can’t even buy coverage in the ACA insurance exchange.  These women must rely on the limited resources of safety-net clinics and charity care to get the vital services they need for the health of not one, but two people. 

2.  An Increase In No-Cost Family Planning Resources

Research has shown that when cost and access are not barriers for women, they will often choose the most effective methods of contraception for themselves – long acting reversible contraceptives (LARCs). LARCS include implants and intrauterine devices (IUDs), which can be inserted by a clinician and remain over 99% effective at preventing pregnancy for up to 10 years (depending on the device). Regardless of income level, a woman should be able to choose if, when, and how she wants to start a family. By increasing resources, training, and reimbursement for LARCs, more providers can offer this option to women throughout the District.

3.  Insurance Coverage Regardless Of Immigration Status

Despite the expansion of coverage through the Affordable Care Act, many immigrants are unable to get insurance coverage, ineligible for both public and private insurance due to their undocumented status. Sadly, those who are not linked to safety nets and medical homes such as Mary’s Center often wait until their health conditions are so bad that they have to go to the ER, resulting in extremely high bills that they often cannot afford to pay, ultimately becoming a financial burden for local and federal governments. Not only is it more cost-effective to promote preventive health services for all, but I argue that unnecessary human suffering is un-American.  Access to healthcare is a human right meant for all people.

4.  Medical Services For Senior Citizens Not Eligible For Medicare

Mary’s Center also sees women over 65 who are US citizens, and who are slightly above the income level required to receive Medicaid. They are ineligible for Medicaid, and they are also ineligible for Medicare coverage because they were never employed in our country.  This affects stay-at-home moms and grandmothers who have cared for their children and grandchildren, who are now elderly and are forced to go without any insurance coverage. The ACA insurance exchange does not cover individuals over 65.

I am confident that through the implementation of CEDAW, the District will be able to assess, understand, and act upon these health disparities that still profoundly exist amongst women in our community and that are costing our healthcare system too much money unnecessarily. Without the proper assessment and acknowledgment of these disparities, we cannot expect to reduce or eliminate them. At Mary’s Center, women comprise approximately 63% of our patient population, and they are helping to raise our future generations. It is imperative that we give women an equal chance to a healthy life in our community.

About Dara Koppelman, RN, BSN, BA

Dara Koppelman, Chief Nursing Officer of Mary’s Center, received her nursing degree from Johns Hopkins University. She also has a Bachelor’s Degree in Psychology and Spanish from the University of Maryland, College Park.  Prior to coming to Mary’s Center, Dara had experience in both the hospital setting and the public health field, working in labor and delivery and then at a local health department doing home visits for high-risk pregnant women and children.  She also spent time abroad, doing volunteer work in a community center and farmer’s cooperative in Costa Rica, and studying Spanish in Spain. Her nursing interests include public health nursing, women’s health, nursing leadership, working with underserved populations, and teaching and mentoring nursing students. 

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