Bills, barriers and bias--women's health care stories show need for action on costs and quality.

OFELIA SIERRA STOOD BEFORE A ROOM OF MORE THAN 120 PEOPLE and told her story, first in Mixteco and then in English: "When I got sick a few months ago, I had a very high fever. I waited and waited, but finally I went to the emergency room. I felt like if I didn't speak the language well, I had no voice. They asked me why I had children if I didn't speak the language. They took my temperature and blood pressure, but didn't give me any medicine. Later I got a bill for $1,000 for that visit."

Sierra was speaking at the April 1 Speak Out for Action on Health Reform in New York City organized by Raising Women's Voices for the Health Care We Need (RWV). That same night, 20-year-old Red Samaniengo also rose to tell a story familiar to many young women, about how a frightening and painful accident catapulted her into a financial crisis. "Like most students, my college health insurance doesn't cover me when I'm not in school," she said. "Last summer, I went with friends to a lake, and I made a mistake. Everyone was jumping off high rocks into the water, but when I jumped I landed wrong, and the impact peeled the skin off of my legs. My friend's parents took me to the emergency room, even though I kept telling them I couldn't pay the bill. I said the same thing to the doctors and nurses who treated me, but they said I had to get taken care of. A month later I got a $7,000 medical bill. What am I supposed to do with that?"

LINKING STORIES TO SOLUTIONS

Sierra and Samaniengo are two of the many women who came together for the first RWV Speak Out, one of many being held around the country to highlight women's need for quality, affordable health care. The New York event opened with a welcoming performance by the InterChurch Center Gospel Choir, followed by a chorus of stories describing the frustration that women experience when dealing with the current health care system. Moderator Dr. Nancy Snyderman, NBC News Chief Medical Editor, directed responses from a panel of experts who made the links between the stories and health policy changes that could address the unmet needs illustrated in the stories.

Almost every woman who spoke on April 1st told a story that demonstrated the devastating effects that the high cost of health care is having on women and their families. But other important commonalities came through as well--about the need for higher quality care provided in ways that are more respectful of the circumstances of women's lives. Reacting to Sierra's story and others like hers, policy expert Deborah Reid of the National Health Law Program spoke about some of the elements that contribute to quality health care. "We are talking about a conversation between patient and provider. With language and cultural barriers, there can be no meaningful communication, and therefore no quality care," Reid explained.

Launched in New York, the RWV Speak Out campaign is training and supporting local advocates and coalitions to organize similar events in communities around the country. From Wisconsin to Georgia to California to Illinois, these gatherings are attracting diverse participants who describe the wide scope of problems faced by women seeking health care for themselves and their families. The experiences recounted highlight the terrible personal consequences of the health care dilemmas women face:

* Conditions getting worse as uninsured and underinsured women avoid seeking help they can't afford to pay for;