How Individualized Health Plans Discriminate Against Women

Health Care providers- please read this post!!!
The last day of the Health Action 2009 Conference was probably my favorite! One of the sessions that I attended was meeting the health care needs of women. The talk was given by several organizations including the National Women's Law Center (NWLC). I've interacted with NWLC during several coalition meetings and at the conference and they are a strong group. Their mission is to protect and advance the progress of women and girls at work, in school, and in virtually every aspect of their lives. They do a lot of good work with equality issues and reproductive choices. I'm going to focus this post on the Individual Insurance Market with links to that, but will post more useful information from the Center in another post.


In some reform plans there is a push to move to an individualized market where the consumers (patients) shop for and purchase their own health insurance from competing companies. Also, some employers are replacing employer-sponsored coverage with fixed sums to buy insurance through the individual market. We will discuss why this option is MUCH more expensive for women.

Women are more likely than men to use health services. They have reproductive health needs, are more likely to take a prescription drug, are more likely to have a chronic condition, and certain mental health problems affect more women than men. Women are also more likely to spend more than 10% of their income on out-of-pocket costs, to avoid necessary health care due to cost, and are more likely to be underinsured. Employers are not allowed to charge employees of different sex different premiums. However, the insurance company will charge the employer different premiums due to the make-up of their employees. So if two companies each have 50 employees and one company is comprised of 90% women this company will pay much higher insurance premiums than a company that is comprised of 90% men. (Though I've seen no data, I can't help but wonder if this doesn't influence hiring practices in small companies?). This difference is called "gender rating". In the individualized health plans gender rating is legal in most states and women of reproductive age are charged between 4% and 48% more than men of the same age for the same coverage. At first it was thought that this difference was for maternity care- but guess what? 59% of the programs offer no maternity coverage and an additional 20% offer a supplemental maternity coverage. An example of supplemental coverage is an additional $100 per month (in addition to the base premium for the general plan) and covers the first $2,000 of maternity charges for the first two years. The average cost of a vaginal delivery is about $7,500 and the average cost of a cesarean is about $13,000 so as you can see, this $2,000 in coverage leaves a women terribly underinsured. Ten states have banned gender rating and two states have limited gender rating, but women are not protected in the other 38 states, or in D.C. Only 5 states are have laws requiring insurers in the individual market to include maternity coverage.


Here is the part I found the most disturbing and the most shocking. Women who shop the individual market can be rejected for health insurance for having a prior cesarean section (it's a previous condition- what kind of predicament would that put us in as ob/gyns if in addition to the regular VBAC questions we had to wonder if we were setting women up to be ineligible for insurance?). And in 9 states and D.C. women can be denied insurance for being survivors of domestic violence!


So you can see that if women are expected to purchase their own insurance directly they will pay a significantly higher premium than men and if employers offer a flat sum to purchase insurance with, rather than provide health insurance, that money will be worth less for women than for men. Also, there are proposals to open the insurance markets so people in one state can buy insurance from a company in another state. However, then the insurance company is only held to the state mandates in effect in the state where the company is located. So a company can locate itself in a state with minimal regulation and sell to people all over the country.

While a majority of women are covered by employer-based insurance at this time, more women than men are insured through a spouse making their coverage dependent not only on the spouse keeping their job but also on the marriage remaining intact. As mentioned above, there are proposals that push the individual market, which is not susceptible to the same anti-discriminatory laws that the employer-based market it. This is bad news for women. These are also things to keep in mind when you are casting your vote for a State Insurance Commissioner!

For more information read the NWLC Nowhere to Turn: How the Individual Health Insurance Market Fails Women. (Click the Title, it's the link).