Secretary Kathleen Sebelius of Health and Human Services Kicked off BlogHer's Healthminder Day

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10 essential benefits mandatory for all people. It's a huge change for many Americans who have had years of frustrating experiences dealing with paying for insurance and yet seeing the word "denied" when they submitted a claim.

Secretary Kathleen Sebelius sat down with BlogHer founder Lisa Stone for a frank talk about the Affordable Care Act to kick off the preconference event, Healthminder Day. From changing the national conversation about mental illness to the controversial Plan B, Secretary Sebelius candidly spoke about many of the issues specifically facing women today, especially when it comes to insurance coverage.

Lisa Stone and Secretary Sebelius

Image: Melissa Ford

As Lisa Stone pointed out, "There's an enormous amount of shame involved in not being able to afford a family member's health care." Secretary Sebelius unpacked that concept of shame, adding that women are "more likely to be on uninsured or under-insured because of the jobs that on average have less insurance coverage."

To combat that shame, Secretary Sebelius not only proposed making health care affordable, but changing the way we treat our health issues, including mental illness. She stated,

"Mental health services is a huge missing piece of lots of policies. Lots of people have insurance coverage right now that has no mental health and or substance-abuse coverage at all Or very very limited. So when we look at the snapshot of the country with the change in both more people getting basic insurance but insurance covering mental health services and covering it on parity with health services. About 62 million Americans will have access to mental health services that don't have them right now and that is a brand-new day."

Afterward, I was also able to sit down privately with Secretary Sebelius and continue the conversation, hearing more about the options out there as we ramp up to the open enrollment period which will run this year from October until March.

Melissa Ford and Secretary Sebelius

Image: Melissa Ford

We considered a hypothetical couple where both people work yet don't have health insurance through their workplace. They make a lot of money on paper, but they live in a major metropolitian area where their dollar doesn't stretch as far as it would in other areas of America. They haven't accrued credit card debt, but every dollar goes toward living expenses. In other words, they haven't contributed to their 401k in years. They've priced it out and have come to the decision that it's cheaper to pay for doctor's visits every few years instead of paying for insurance on a monthly basis since they are generally healthy. I asked Secretary Sebelius what is out there in the Affordable Care Act for our hypothetical couple who makes too much money to qualify for certain programs but think that they don't have room in their budget for health care coverage?

Secretary Sebelius pointed out the inherent problem with this practice as well as the numerous options open for those who don't want comprehensive coverage.

"Those folks are taking an extraordinary risk with the rest of their lives. It's not just about their health but it's about jeopardizing their entire financial future ... As part of the new market, there will be programs available for the young and healthy, the under 30-year-olds who don't really want a comprehensive policy but want a more catastrophic policy covering events. There will be a way to come into the market at a very affordable rate and have a choice of less coverage ... There's a range of prices, there's a range of choices. People will be able to choose among three levels of plans -- more coverage to less coverage -- but also choose to pay a higher deductible in the event that something happens that will lower the premium."

The conversation also turned to the topic of infertility. The Affordable Care Act touches many facets of reproductive health -- from birth control coverage to pregnancy visits. Ensuring a healthy, well-timed pregnancy is a priority of the new plan. The one aspect of reproductive health missing from the conversation is infertility, a disease that affects 7.3 million Americans or 12.5% of the child-bearing age population.

With such an emphasis on preventative services, and mandatory coverage of infertility could mean also setting regulations that in turn help reduce the premature birth rate, why is infertility missing from a plan that covers everything from preventing pregnancy to protecting the health of pregnant women and unborn babies?

Secretary Sebelius pointed out that the conversation is far from over, and there is room to bring infertility into the health care system in the future.

"Infertility is a huge health issue and lots of couples are dealing with it. One of the discussions was what should be included in an insurance policy. There are 10 categories of services that have to be in every policy, essential benefits. And then rather than people in Washington picking and choosing what should go in a California policy or what should be in a Connecticut policy, we allowed the state market and the debate that had often taken place at the state level around state mandates to guide what was available in that marketplace ... The first two years that the market is up and running, this discussion will go on about whether or not there should be some more uniform coverage across-the-board. But at least to get started, it was thought to be better to capture the state structure."

Our interview ended on a sweet moment where the Secretary discussed picking up where her father left off through his work in Congress.

"For me, it's a bit of a full circle. My dad was in Congress when Medicare and Medicaid were passed. He actually helped to write the bills and voted for them. He's now 92 years old. And now this is the next generation. So this is very personal. I get to take the next big step of trying, for the first time in history, fulfill what has been a missing piece of the American dream saying everybody in America has access to affordable health care coverage."

And that is an enormous statement for all of us.

Melissa writes Stirrup Queens and Lost and Found. Her novel about blogging is Life from Scratch.

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