Health Reform: A Huge Victory for Women

The following post originally appeared on the healthinsurance.org blog.

Women pay dearly for being women

The male body has long been considered the “standard” for health care coverage. Having a woman’s body is seen as an expensive anomaly, and women pay dearly for being different.

When they buy their own health insurance in the individual market, women must lay out an extra $1 billion a year, simply because they are women. Some argue that this is fair: after all, a woman could become pregnant, and labor and delivery are costly.

But the truth is that, even when maternity benefits are excluded, one-third of all health plans charge women at least 30 percent more, according to a report released just last month by the National Women’s Law Center.

In 36 states, “92 percent of best-selling plans charge 40-year-old women more than 40-year-old men,” the Center reports, and “only 3 percent of these plans cover maternity services … One plan in South Dakota charges a woman $1252.80 more a year than a 40-year-old man for the same coverage.”

Today, less than half of American women can obtain affordable insurance through a job, which explains why millions buy their own insurance in the individual market. In that market, just 14 states ban gender rating:  California, Colorado, Maine, Massachusetts, Minnesota, Montana, New Hampshire, New Mexico, New Jersey, New York, North Dakota, Oregon, Vermont, and Washington.

Pricing based on gender also plagues the small group market, where insurers frequently jack up premiums if a small or mid-size business employs too many women. This means that many of these employers just can not afford to offer insurance. Only 17 states address the problem.

Insurers explain that women cost them more, even if policies don’t cover maternity, because “they are more likely to visit doctors, get regular check-ups, take prescription drugs, and have certain chronic illnesses.”

In other words, women are penalized for taking care of themselves, As for those “female chronic ailments,” men also are more vulnerable to certain diseases – including many caused by smoking (23 percent percent smoke vs. 17 percent of women).

But insurers ignore male vulnerabilities. As Soraya Chemaly points out on BlogHer: “In most markets if you are a non-smoking female you will pay more than a smoking male of the same age because you possess ovaries and not testes.”

And that is if you can get insurance.

Pre-existing conditions: rape, C-sections, beatings?

All too often, a woman is closed out of the individual health insurance market because her medical history reveals a pre-existing condition.

For example, if a woman lives in North Carolina, Oklahoma, North Dakota, or Mississippi, and has been the victim of domestic violence, it is perfectly legal for a company to refuse to sell her a policy.

In 45 states, insurers can reject her because she has had a C-section – even if it was medically mandated.

Insurers see “Caesareans or beatings as pre-existing conditions that are likely to be predictors of higher expenses in the future,” the New York Times explains, pointing to Peggy Robertson, a 41-year-old Colorado mother who was denied insurance in 2007. A broker advised the Robertson’s to switch their insurance to Golden Rule (owned by United HealthCare), where they would get a better rate. But when they applied, the company spotted a C-section on Robertson’s record, and sent her a letter, explaining that if she wanted insurance she would have to be sterilized.

If a woman is raped she, too, risks being shunned. When Christina Turner was attacked by strangers, doctors advised that she take HIV medication “just in case.” Insurers then refused to cover her because the HIV drugs “raise too many health questions.” They told her they would reconsider her in three years if she could prove she did not have AIDS.

Turner went without insurance for three years. Other rape victims report being denied because they suffered from post-traumatic stress syndrome.

These are the most shocking cases. Other rules discriminate against millions of women for a long list of commonplace reasons:

  • If a woman has survived breast cancer, this is a pre-existing condition.
  • If she is pregnant when she applies, this also is considered a pre-existing condition, just like cancer. Most likely, she will be turned down.
  • If she is of child-bearing age and has children, this may well viewed as a pre-existing condition, leading to higher premiums.
  • On the other hand, if she is infertile, this too, can be labeled a pre-existing condition.

Not long ago, House Minority Speaker Nancy Pelosi summed up the hurdles: “If you’re a woman, it’s a pre-existing condition.”

Health reform: truly a BFD for women

When Vice President Joe Biden told President Barack Obama that health reform is a BFD, he wasn’t kidding.

When Vice President Joe Biden told President Barack Obama that health reform is a BFD, he wasn’t kidding. The Affordable Care Act (ACA) represents a major victory for women across the nation. Today, state law decides what insurers have to cover. Under reform, federal law will call for equal benefits in all states.

Begin with maternity benefits. In the 41 states where they are not mandated, a 30-year-old woman will find that only 6 percent of plans in the individual market now offer coverage. Guess how expensive those plans are. Under the ACA, maternity care will be considered an “essential benefit” that all insurers selling policies to individuals and small businesses must cover, without charging extra, beginning in 2014.

Some argue that women who want maternity benefits should pay more. “I don’t need maternity care,” Senator Jon Kyl (R-Ariz.) groused when the Senate Finance Committee debated “essential benefits.” Sen. Debbie Stabenow (D-Mich.) didn’t miss a beat: “I think your mom probably did.”

Enough said. One way or another, all of us benefit from prenatal care.

But maternity benefits represent just one way that reform addresses women’s health. The Affordable Care Act (ACA) also calls for:

Preventive services with no co-pays or deductibles: New Policies (issued or renewed on or after September 23, 2010) are required to cover services that many women need  – mammograms, Pap smears, at least one well-woman care visit a year, contraceptive products and counseling, and screening and counseling for interpersonal and domestic violence. In 2018, these requirements will apply to all plans.

Essential benefits: In 2014, both all plans sold inside the new state-run health insurance exchanges and all new plans sold outside of the exchanges will be required to cover a specific set of essential health benefits. For women, these include maternity and newborn care; mental health services (including counseling for post-partum depression); preventative and wellness services; contraception; chronic disease management; and pediatric services for her children, including dental and vision care.

At the same time, the legislation bans:

Gender rating: In 2014, charging women more because they don’t have a Y chromosome will be outlawed both in individual and small employer markets. After 2017, if a state lets large employers into its exchange (and many will), the rule will apply to all large-employer coverage in the state.

Charging more for pre-existing conditions: Starting in 2014, insurers can not charge higher premiums, or deny coverage due to a person’s pre-existing conditions.

The bottom line: Under the Affordable Care Act, women’s bodies will no longer be viewed as exotic, but costly, deviations from the norm that just don’t fit into a health care system designed by, and for, men.

If the Court spares health reform, Congress may still attack

What happens if the Supreme Court overturns the individual mandate?

The Court might rule that if everyone is not forced to buy coverage, insurers shouldn’t be forced to cover everyone – especially if they are suffering from pre-existing conditions. (Without a mandate, the reasoning goes, many Americans will wait until they fall ill, and only then purchase coverage, secure in the knowledge that insurers will have to cover them, and can’t charge them more).

Even if you don’t like the mandate, you should consider what it would mean for women if insurers can charge patients suffering from a “pre-existing condition” whatever they like.

  • A recently divorced 62-year-old woman who is no longer covered by her husband’s insurance may find that she is closed out of the insurance market because she is a breast cancer survivor. Even if she can find an insurer who will take her, the penalty for having a pre-existing condition may well be more than she can afford.In insurance parlance, she will have to “go naked” until she is eligible for Medicare, keeping her fingers and toes crossed that her cancer does not recur or spread over the next three years. (If it does, she will have to spend down whatever savings she has, and perhaps sell her home, before she will be eligible for Medicaid.)
  • A young woman discovers that she is pregnant. She and her husband were not planning on having a child so soon. Suddenly, they find themselves facing thousands of dollars in medical bills. If the mother needs a C-section they may wind up owing as much as $24,400. (Five percent of U.S. hospitals actually charge more.) And that is if there are no serious complications.

Congress could vote to kill health reform

It is extremely unlikely that the Supreme Court will declare the entire Patient Protection and Affordable Care Act unconstitutional. Whatever the Court decides in June, women will retain protection against much of the sexual discrimination embedded in our current health care system – unless lawmakers set out to eviscerate the ACA.

As Soraya Chemaly points out on BlogHer: “The openly stated primary priority of the Republican Party is to overturn this law.” If that happens, “these discriminatory practices will continue and women will pay in complex ways.”

Even if President Obama is re-elected, Republicans and Democrats who oppose reform could constitute a majority in both houses, and might even have enough votes to overturn a veto on certain controversial issues – such as gender rating, or essential benefits. Many men believe that women should pay more. And they are not happy about covering maternity benefits, contraception, or post-partum depression.

Meanwhile, without the Affordable Care Act, we can not count on insurers to mend their misogynistic ways. Four years ago, the Women’s Law Center issued a national report titled “Still Nowhere to Turn: Insurance Companies Treat Women like a Pre-Existing Condition.”

Back then, the Center reached conclusions very similar to what it said in the report released last month. In 2008, “Some insurance executives “expressed surprise at the size and prevalence of the disparities,” Chemaly notes, but “apparently these executives weren’t surprised enough to do anything about it. . . By failing to rectify clearly discriminatory policies despite years of awareness, they continue to demonstrate their untrustworthiness.”

This is why, in the run-up to this fall’s election, voters should take a close look at their Senators’ and Representatives’ records when voting on major health legislation.

Not only women – but the many men who care deeply about their daughters, wives, mothers, and sisters – should think carefully about what repeal could mean for those they love.


Maggie Mahar is an author and financial journalist who has written extensively about the American health care system. Her book, Money-Driven Medicine: The Real Reason Health Care Costs So Much, was the inspiration for the documentary, Money Driven Medicine. She is a prolific blogger, writing most recently for TIME’s Moneyland. Previously she wrote and edited the Health Beat blog for the progressive think tank, The Century Foundation. Previous work for the Health Insurance Resource Center includes Ryan plan could deliver crushing blow to Medicare  She also provides background on Congressional health care legislation for HealthReformVotes.org, a special project of the Health Insurance Resource Center.

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