Kelli Garcia, Senior Counsel

Kelli Garcia, Senior Counsel, first joined the Center in 2009 as a law fellow and was promoted to Counsel, focusing on health care reform implementation and preventing discrimination in health care. She subsequently worked as a law fellow at the O'Neill Institute for National and Global Health Law, where she worked on scholarship related to global health and human rights, health care reform and the Family and Medical Leave Act. Kelli returned to the Center in April 2012, and now oversees the Center's efforts to address religious restrictions on women's access to reproductive health services, including its work on hospital mergers and crisis pregnancy centers. Kelli holds a law degree from Yale Law School, a Ph.D. in social psychology from the University of California, Los Angeles, and an A.B. from Princeton University.

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My Take

Health Status Discrimination by Any Other Name is Still Health Status Discrimination

Posted by Kelli Garcia, Senior Counsel | Posted on: January 13, 2010 at 08:38 pm

by Kelli Garcia, Fellow,
National Women's Law Center

I spent six years in graduate school trying to design health prevention and promotion programs that actually work. As a health psychologist I am, generally speaking, a fan of wellness programs, but I am also well aware of their low success rates and potential for unintended consequences. So, I was somewhat skeptical when I learned about new large scale health promotion programs, but the “wellness promotion” provisions in the Senate health reform bill deserve more than skepticism. There is little about them that will promote health and much that will likely harm health, especially for women, minorities and low-income individuals. In fact, the “wellness promotion” provision is really just health status discrimination in disguise. 

Under this provision, employers will be allowed to provide financial incentives to employees who either participate in a healthy lifestyle promotion program or who meet a specified health status standard. Healthy lifestyle programs could include things such as going to a gym regularly or participating in a smoking cessation or weight-loss program.

A health status standard could be a Body Mass Index (BMI) target or a specified cholesterol level. If the reward is predicated on achieving a health status standard, then the reward cannot exceed 30% of total cost, including the employee’s premium and the employer’s contribution, of the employee’s health insurance. This amount could be increased to 50% in the future. Although promoted as a discount, these provisions really penalize those who are unable to participate in wellness programs or who cannot achieve the health status standards.

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Tags: Health Care Reform, Health Care & Reproductive Rights | Add new comment

The Medicare Buy-In Option: What We Would Like to See

Posted by Kelli Garcia, Senior Counsel | Posted on: December 14, 2009 at 08:04 pm

by Kelli Garcia, Fellow,
National Women's Law Center

Although NWLC strongly supports a real public option, the alternatives under consideration by the Senate nevertheless require scrutiny. One such alternative, the Medicare buy-in for Americans between the ages of 55 and 64, has important implications for women, who currently comprise 51% of the uninsured in that age group. Under the proposal, people aged 55 to 64 would have the option of purchasing health insurance coverage through the Medicare program. 

Although the specific details of the program are currently unknown, it is likely that until the proposed health insurance exchanges are in place, the coverage would be available for purchase without subsidies, but once the exchanges are active, federal subsides could be used to purchase the coverage through the exchanges. The Medicare buy-in could address some of the barriers to health care access that currently plague older uninsured adults, who are more likely than younger uninsured adults to be in poor health and have a one-in-five chance of having two or more chronic conditions.

Women in particular could benefit from the increased access to health care. Even among the insured, women are more likely than men to report having difficulty obtaining needed health care because of cost. In contrast, compared to those with employer-sponsored insurance coverage, Medicare beneficiaries report that they have easier access to physicians, have fewer billing problems and are more likely to get needed tests and medications without facing costs or access problems. In fact, they are generally more satisfied with their insurance coverage than those with employer sponsored plans.

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Abortion Coverage Matters: The High-Stakes in the Fight Over the Stupak Amendment

Posted by Kelli Garcia, Senior Counsel | Posted on: November 16, 2009 at 03:18 pm

by Kelli Garcia, Fellow,
National Women's Law Center

Some proponents of health-care reform are urging those who support abortion rights to accept the restrictions imposed by the Stupak Amendment in the name of the “greater good.” What is health insurance coverage for abortion compared to extending coverage to 35 million Americans, they ask? According to Washington Post columnist E.J. Dionne Jr., the whole debate is a bunch of fuss over nothing much. He cites a 2001 study by the Guttmacher Institute that found that only 13 percent of abortions in 2001 were billed directly to providers as support for the notion that the Stupak Amendment will have little real impact on women. Of course, as the Guttmmacher Institute notes, this number is misleading for two primary reasons.

First, the study looked at all women who obtained abortions in 2001, including women on Medicaid and those who were uninsured. Obviously, women who are uninsured will not have abortion coverage and current law restricts federal funding for abortion services for Medicaid recipients (although some states do use their own funds to pay for abortion coverage). According to the Guttmacher Institute, had they looked only at women with private insurance, the percentage of abortions billed to insurance companies would be “substantially higher”.

Second, the study did not include women who obtained reimbursement from their insurance company directly, which is relatively common, because many abortion providers are not part of private insurance networks. The Gutmmacher Institute also found that in 2002, 87 percent of typical employer-based insurance policies covered medically necessary or appropriate abortions. Notably, “the 87 percent of plans that covered abortions did not include those plans that offered abortion coverage only in very limited circumstances, such as rape and incest, or to protect the woman’s life.”

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Tags: Health Care & Reproductive Rights | 5 comments