- - Tuesday, May 1, 2012

Choice is a word that generates powerful emotions, especially in America, and most notably when it concerns the freedom to choose in extremely personal settings, such as health care. This specific issue, choice in health care, is a fitting centerpiece of the presidential campaign because Obamacare in many ways directly restricts choices. Indeed, there may be no better issue to illustrate the stark difference between the Obama administration and the opposition - a dramatic disagreement about the role of government in the lives of American families. Furthermore, Obamacare most directly hurts women, an irony that receives little attention, given the great effort by the Obama campaign to paint its Republican opponents as being hostile to America’s women.

First, women typically are in charge of health care decisions for their families in America. According to the Kaiser Foundation, about 80 percent of mothers choose their children’s doctors and direct their children’s care in addition to their own. These choices inarguably will be restricted in at least four major ways under Obamacare.

Millions of families will lose employer-sponsored health insurance, according to both the Congressional Budget Office (CBO) and employers themselves. With that, they typically will lose their choice of doctor. Another 20 million Americans will move into Medicaid - clearly no choice of doctor there. That’s because nearly half of all doctors (and nearly 60 percent of obstetrician-gynecologists) already refuse to accept new Medicaid patients. The choice of consumer-driven health insurance with health savings accounts that covered about 21 million people in 2011 is essentially eliminated by Obamacare’s actuarial requirements and coverage mandates. Yet, those health plans are the fastest-growing choice among employees, particularly for women, considering that 56 percent of enrollees were female and just 44 percent were male in 2010, according to the Employee Benefit Research Institute.

Second, women use the U.S. health care system more than men. Younger women see doctors more often than men, for primary care and specialty reproductive and pregnancy-related care; older women have higher rates of many chronic diseases than men, more often harboring multiple conditions, according to the Kaiser Family Foundation. Clearly, women will be more subjected to the consequences of Obamacare edicts defining “essential benefits” coverage, treatment options and payments to doctors.

A case in point is cancer screening. American women use screening tests more often than men, according to the Centers for Disease Control and Prevention and the U.S. National Center for Health Statistics. Although not widely acknowledged, the fact is that before Obamacare, American women enjoyed the world’s best access to screening for cervical and breast cancer, proven by data from the Organization for Economic Cooperation and Development and numerous peer-reviewed studies, at younger ages through old age, better than any European or Canadian system offered. As a preview of the threat of Obamacare’s power shift to government, the November 2009 attempt to reduce mammogram screening by the federal government’s Preventative Services Task Force ruling evoked a strong outcry from patients and the medical community. While Obamacare subsequently decreed that all screening tests must be “free” to patients, the lesson is that the federal government has the power to giveth and to taketh away.

Third, women clearly are the most vulnerable to the impending damage imposed by Obamacare on employer-sponsored health insurance. In addition to their own employers dropping their insurance benefits, women are far more likely to be covered as dependents - double the percentage of men who are covered as dependents, according to the Kaiser Family Foundation and Urban Institute. If the husband’s employer drops insurance, their coverage is lost, too.

Fourth, women specifically are far more dependent on Medicaid and Medicare, government programs that face ill-conceived changes that hurt patients under Obamacare. More than half (56 percent) of all Medicare beneficiaries are women; among the oldest old (ages 85 and older), 70 percent are women. Obamacare cuts Medicare payment rates to hospitals and doctors by roughly 30 percent in the short term and by 2019 will be so draconian that payments will be even lower than Medicaid, a system in which doctors already lose money and therefore refuse to accept patients. We can foresee easily what will happen with Medicare under Obamacare, given that two-thirds of hospitals already lose money on Medicare, according to Richard Foster, chief actuary of Medicare in 2010.

Women also disproportionately depend on Medicaid. About 9 million non-elderly women and more than a third of all U.S. births are covered through Medicaid, with states already cutting funding to stay afloat. Shifting nearly 20 million more people to Medicaid in Obamacare is not only fiscally irrational but a cynical sham of the highest order. We know that millions of those patients will not even find doctors. But we also know that outcomes in Medicaid, with its restrictive guidelines for diagnosis and treatment, are a disaster, showing more deaths, longer hospitalizations and more complications from major surgery, cancers, heart disease and transplants. This is proved in top medical journals such as Annals of Surgery and Cancer and the American Journal of Cardiology, and patients are often worse off than having no insurance.

By the government’s own estimates, Obamacare does not address the single most important problem with America’s health care - cost. Even worse is the realization that Obamacare will destroy the best health care the world has ever known, rolling back the clock on access to specialty care and medical technology. Just as Secretary of Health and Human Services Kathleen Sebelius declared that all employers must include medical abortion coverage, Obamacare showed what we should have feared already. This is the essence of Obamacare - government has ultimate authority over health care decisions, because government decides what must be included in health insurance and who must pay for it.

The bottom line is this: When government has the power to control health care, the result is always rationing care by limiting access. In such systems all over the world, individual choice always takes a back seat to government dictates. Despite all the talk about this administration supporting women’s rights, America’s women ultimately might have the most to lose.

Dr. Scott W. Atlas is senior fellow at Stanford University’s Hoover Institution and author of the recently published “In Excellent Health: Setting the Record Straight on America’s Health Care” (Hoover Press, 2012).