The Truth About Domestic Violence and the Impacts of ‘Trumpcare’

On the day that he was arrested, Dan Heyman was chasing down a rumor. Literally.

Connecting Science & Society

On that morning in early May, Heyman, a 54-year-old journalist with the Public News Service, was running down a hallway in the West Virginia State Capitol building, waving his cell-phone recorder at Thomas E. Price, the newly installed Secretary of Health and Human Services. He was trying to get an answer on whether changes to health care law proposed by Congressional Republicans would allow health insurance companies to consider domestic violence a pre-existing condition. Such a designation could allow insurers to deny coverage to victims of abuse — principally women — or to charge them higher premiums.

Audio of Heyman’s encounter with Price went viral. “I heard that domestic violence is going to be a potential pre-existing condition,” Heyman called out upon encountering the secretary in a public corridor. “Do you think that’s right or not?” The recording is notable for many things: for the rapid thud of footsteps, for Price’s stony silence, and for Heyman’s increasingly out-of-breath and ultimately unfulfilled requests for an answer. It is also notable for concluding with the reporter’s arrest on a charge of “willful disruption of state government processes.”

Much emphasis has deservedly been given to this latest example of contempt for democracy under the presidency of Donald J. Trump. (Price later commended the arresting officers.) But there’s another aspect of the encounter that also deserves attention: Heyman’s stubborn insistence on the issue of domestic violence. At a time when there are myriad troubling questions about the future of health care in the United States, “Why?” I wondered. “Why that one question?”

In a phone call, Heyman answered with some intensity. He told me about a horrifying interview he’d conducted with a local woman who recalled hiding in a bathroom with her two children while her husband tried to beat down the door. And he pointed me to a 2010 analysis that links one-third of all murders in West Virginia to domestic violence.

“I was shocked once I started reporting on it,” he said.

So was I. The National Coalition Against Domestic Violence estimates that in the average minute, almost 20 Americans are physically abused by a partner. Almost three-fourths of all murder-suicides in this country involve an intimate partner. More than 90 percent of the victims are women. For the survivors, it’s adding insult to injury to raise the possibility that a thin safety net — and one only recently provided through the Obama administration’s Affordable Care Act — may be undone under Trump.

When it went into effect, among other consumer protections, the ACA banned insurance companies from denying Americans coverage — or raising their rates — based on pre-existing conditions. It made a point of emphasizing that this protective layer specifically covers survivors of domestic abuse. As a summary prepared by HHS under President Obama explained it: “Beginning on January 1, 2014, the Affordable Health Care Act will prohibit insurance companies, health care providers, and health care programs that receive federal financial assistance from denying coverage to women based on many factors, including being a survivor of domestic or sexual violence.”

If you wonder why HHS added those emphatic italics, you need only consult a detailed report on the issue put together by the advocacy group, Futures Without Violence, which catalogued numerous instances of insurance pre-ACA denial. The anecdotes compiled in the report speak for themselves — and to Heyman’s question.

In 1993, a Pennsylvania woman was denied life, health and mortgage disability coverage by insurance giant State Farm, and life insurance by First Colony Life Insurance Company because her medical records revealed a single instance of domestic abuse. Around the same time, another Pennsylvania woman, covered under an employee health plan, was refused reimbursement for any emergency room costs related to a severe beating by her partner.

The group Futures Without Violence catalogued numerous instances of insurance denial. The case studies speak for themselves — and to Heyman’s question.

In 1995, a Santa Cruz, California woman was repeatedly turned down for health insurance because she had earlier been treated for injuries from a beating — a fact gleaned from medical records. And in 1997, an insurer told a Georgia shelter that it would not cover an employee under the group health plan because the woman had earlier had been shot by an abusive partner. In 2006, Blue Cross Blue Shield of New Mexico refused a woman health insurance because her ex-husband had assaulted her four years earlier. (She successfully appealed to state authorities and got that decision reversed.)

Evidence of domestic violence could cost a survivor more than health insurance, the report found. Some people lost everything from disability to property insurance. And in one example from 2009, an agent from New-Hampshire based MMG Insurance wrote to tell a Maine woman the company was cancelling both her homeowner and auto insurance policies after learning that she had taken out a restraining order against her abusive husband. Surveys by state regulators, commissioned after such events, found that in some parts of the country, such as the Midwest, more than 50 percent of the insurance companies considered domestic violence history in deciding whether to issue a policy.

Some states, such as New Mexico, had passed their own laws against such insurance discrimination. But, those laws varied in protection and eight states plus the District of Columbia offered no protection at all. In essence, the pre-Obamacare rules encouraged survivors of domestic abuse to keep their situation a secret, lest they be punished by the health insurance system.

When it became obvious that GOP plans to revise the health care law would weaken consumer protections, advocates for domestic violence survivors were almost instantly alarmed — even panicked. A press release from Rep. Gwen Moore, a Wisconsin Democrat and a long-time sponsor of the Violence Against Women Act, warned that under “Trumpcare,” being a victim of domestic violence or sexual assault would once again become a pre-existing condition.

And so Dan Heyman thought it worthwhile to chase the nation’s top health care official down the halls of the West Virginia state capitol. “I wasn’t trying to just get a comment or score some points,” he told me. “I was trying to find out some things that needed to be explained.”

There is — there was at the time — a simple answer to his query. The American Health Care Act, which passed the House earlier this month, is a legislative proposal and not a law. It still needs to be negotiated with the Senate and approved by the president. And it does not — despite rumor — name domestic violence as an allowable pre-existing condition. When I emailed the Department of Health and Human Services for comment, a spokeswoman, Alleigh Marré, quickly wrote back referring me to “this recent Washington Post fact check which found that claim completely inaccurate.”

On that specific point, it’s true. As noted in a separate analysis by Politifact the GOP bill “does not single out any specific medical event or diagnosis as a pre-existing condition.” The legislation as currently written also would preserve Obama-era protections forbidding heath care providers from denying coverage for pre-existing conditions.

But that’s where the good news ends, and why Heyman was right to push for more. Under the GOP bill — which the Trump administration has already endorsed, and whose presumed passage is baked into the president’s current budget — states would once again have the option to allow insurers to charge higher prices to people with an existing condition, possibly making coverage altogether out of reach.

And as any domestic violence researcher will tell you, there are multiple ways for an insurer, left unfettered, to discriminate against victims of abuse — even if they never mention “domestic violence” in their policies. A recent analysis of electronic health records of domestic violence survivors by Gunnur Karakurt, a professor at Case Western Reserve University, for example, included chronic pain, neurologic disorders, gastrointestinal disorders, migraines and other headaches, physical disabilities, post-traumatic stress disorder, depression, anxiety, substance abuse, and suicide among the many health outcomes related to domestic abuse.

If just a few of those fall onto an insurance company’s pre-existing condition list, the impact on abuse survivors (and let’s face it, the rest of us) could be devastating.

Karakurt is now looking more closely at the relationship between headaches and traumatic brain injury. “Women in these situations tend to be hit repeatedly in the face area,” she said. “And if that happens multiple times over a few years, then the headaches and memory dysfunction may be a symptom.” Researchers are still trying to find the critical patterns, she adds, but it’s obvious already that domestic violence is a health concern. “It’s a crucial topic and if we are not dealing with effectively, we’re doing a great disservice to very many families.”

In other words, behind Heyman’s one question stands a history of discrimination against survivors of abuse, and the potential for its return. Acknowledging that reality would have required Price, a physician himself whose own biography at HHS touts his “dedication to advancing the quality of health care in America,” to give an honest and compassionate answer. Obviously, he didn’t have one.

No wonder he kept walking.

Deborah Blum is a Pulitzer-Prize winning science writer, the director of the Knight Science Journalism Fellowship Program at MIT, and the publisher of Undark.

Deborah Blum is the director of the Knight Science Journalism Fellowship Program at MIT and the publisher of Undark.