“A Woman Is Not a Pre-Existing Condition.” So declared the T-shirts sported by several of the (mostly female) audience members at Thursday’s Senate hearing addressing the urgent problem of gender-based discrimination in the health insurance system. During Congress’ struggle over the past months to pass effective health care reform, this is one vital issue that has been falling between the cracks. Stopping unequal treatment of women by health insurers seems like a no-brainer initiative – one that we should have dealt with years ago – but it has not gotten the public attention it deserves.

In thirty-eight states, it is legal for insurance companies to charge women astronomical premiums compared to those for men, and to treat pregnancy and domestic violence as “pre-existing conditions.” A 2008 report published by the National Women’s Law Center shows that “insurers who practice gender rating charged 40-year-old women from 4% to 48% more than 40-year-old men.” Additionally, in eight states plus the District it is legal for insurers to refuse coverage to a woman because she has been/is being domestically abused. This practice especially, in which women are punished for being victims, is a horrific measure of how unjust our current system is.

That is why it was so encouraging to see the Senate Health, Education, Labor, and Pensions (HELP) committee hold such a vital hearing acknowledging the urgency of the problem. In a multi-faceted discussion that also highlighted the ways in which employer-dependent insurance and birthing practices exacerbate gender discrimination, a handful of senators sought to find the most effective way to correct unfair policies. Witnesses and legislators alike drew attention to despicable discriminatory insurance tactics that stem from the classification that being a woman, and everything that implies, is a pre-existing condition.

One testimony showed the unjust way that insurers financially punish women for the biological necessity of pregnancy. Amanda Buchanan, a stay-at-home mom from Idaho, began her story with the fact that she was forced to obtain insurance on the independent market for an unheard of $280 per month. Then, when she and her and her husband began to discuss having another child, she learned that the deductible required to insure her maternity care and delivery would be an additional $5,000 dollars. Buchanan was furious “that an insurance company could set up a policy in a way that would either discourage women from getting pregnant altogether, or if they did become pregnant, force them to pay for basically the entire cost of a typical delivery.”

Senator Al Franken (D-MN), a champion for combating institutionalized women’s rights offenses, expressed how “ridiculous” it is that insurance companies also charge women higher premiums because they “might get pregnant”—A.K.A., for being female.

In another story that particularly incensed most of the women in the room, including Chairwoman Barbara Mikulski (D-MD), a testifier named Peggy Robertson told of how in 45 states, it is legal for insurance companies to refuse a woman coverage if she has had a cesarean-section birth. Robertson’s individual insurer told her that, because of her previous C-section, if she wanted any health coverage at all, she would need to show proof of sterilization. Sen. Mikulski responded that she “found that bone-chilling. It put me on the edge of my chair…. No one, no one in the United States of America, in order to get health insurance, should ever, ever be coerced into getting sterilization. I find it offensive, and I find it morally repugnant.”

Senator Bob Casey (D-PA) asserted in his statement that the practice wherein insurance companies assert that domestic abuse is a pre-existing condition is “horrific.” The other senators in attendance echoed his sentiments, eliciting hope from women nationwide that they will support a provision (like that included the HELP bill on health care) to overturn such disgusting tactics.

The only legislator present who acted out of concord with the gravity of the situation was Senator Richard Burr (R-NC), who seemed to support all of the discussed improvements, but insisted on berating one witness about her research as it applied to his home state. He exclaimed that he had called an insurance company in North Carolina, asking them if they had ever refused anyone coverage because of domestic abuse, because he would not have stood for it. Obviously, the insurer would not incriminate itself, answering “no”– but Burr seemed to think this was proof that valuable hearing time needed to be taken up with his misplaced doubts about one state.

However, aside from that outburst and the not entirely relevant or factual testimony of one anti-abortion advocate, all parties at the hearing were in agreement as to the atrocity of current gender-biased insurance practices. This issue must be one of the tenets of effective reform. As Senator Franken said, such policies are “immoral and unacceptable.” and reforming them will be a “huge step forward for justice in our country.”