By Karen Davenport and Judy Feder

The nation’s health insurance system is failing all Americans — men, women, and children — but it could certainly be argued that it fails women more. Our patchwork system makes women more vulnerable than men to high health care costs and coverage gaps that are built in to employer-sponsored coverage, individually purchased policies, and public insurance programs. Women can be charged more, denied coverage for services only they need, and even excluded altogether if they have been the victims of domestic violence. In short, women are in dire need of affordable coverage, in or out of the work place, with benefits that truly cover their health care needs provided without discrimination based on age, gender, or pre-existing conditions.

Let Down and Left Out
While women under age 65 are more likely than men to have health insurance, they are more vulnerable than men to high health care costs. Women are more likely than men to be underinsured and thus face high out-of-pocket expenses for cost-sharing and services not covered by their health plan. At the extreme, women are more likely than men to delay or go without care because of costs, and more women than men struggle with medical debt.

Like most Americans, women rely on employer-sponsored health insurance, but women are particularly vulnerable when their insurance is tied to the workplace. Women are more likely than men to work part-time or in low-wage jobs that lack health insurance. Not surprisingly, women depend much more than men on coverage through their spouses. But “family” premiums have skyrocketed, making coverage prohibitively expensive for growing numbers of families. Women with coverage through a spouse lose it, of course, if they become widowed or divorced. And they also lose dependent coverage when their older spouses turn 65 and become eligible for Medicare before they do.
 
Outside the workplace, women have a particularly hard time finding affordable health insurance coverage. The non-group insurance market is notorious for offering limited benefits and for enrolling only healthy people who don’t need care, while avoiding sick people who do. According to a 2008 study by the National Women’s Law Center, this market serves women particularly poorly. For example, most policies fail to cover maternity care, or offer it only at substantial extra cost. And even for benefits they do cover, insurers not only charge more to individuals with health problems, but also apply “gender rating” — with “huge and arbitrary” premium differentials between men and women for similar levels of coverage.

Public Programs
Women fare better then men in public programs, because Medicaid focuses on mothers. Three quarters of Medicaid-covered adults are women. In addition, unlike some private insurance, Medicaid covers the prenatal care, preventive services, family planning, and maternity care that women need, while cost-sharing is limited to amounts that are manageable for low-income families. However, Medicaid coverage varies by state in the best of times, and only the poorest of women are covered when they’re not pregnant. Women and men who are not parents of dependent children (and not so disabled that they cannot work) cannot qualify for Medicaid in most states, no matter how poor they are.

From Patchwork to Blanket
Policy changes can improve this insurance patchwork to provide women with greater protection from health care costs. But ensuring all of us access to health care when we need it requires comprehensive reform based on specific principles.

First, the insurance market needs drastic reform. Women and men must be able to buy insurance that treats everyone the same — in terms of benefits, prices, and guarantees of coverage. This means new rules for private insurers that require them to offer coverage to all applicants, and restrict how much premiums may vary between men and women, older and younger enrollees, and people who are healthy and people who are sick. 

Second, coverage must be affordable — with subsidies as needed — and thus must include good benefits.  Benefits must cover prevention and ensure access to necessary care, without exposing patients and their families to unmanageable out-of-pocket costs.

Third, coverage for everyone should build on, but cannot be limited to, workplace insurance. Employer-sponsored coverage will never reach everyone.

Fourth, we need to strengthen and expand the safety net for low-income individuals and families. Low-income people must have coverage whether or not they have children. A strong Medicaid program that covers all low-income people across all states, regardless of age, level of disability, pregnancy, or parental status, would provide a solid foundation for our health care system.

Meaningful health reform must embody these principles and provide women and families with greater health and financial security. The challenge before the new Administration and Congress is to make these goals a reality.

Karen Davenport is the Director of Health Policy at the Center for American Progress.

Judy Feder is a professor of public policy and, from 1999-2008, served as dean of the Georgetown Public Policy Institute. She is also a Senior Fellow at the Center for American Progress.

NCJW supports guaranteed access to high-quality affordable health care for all, and believes that a public health insurance plan option is central to that goal. A public plan would, through competition with private insurers, help lower costs and improve quality while providing women and their families with a range of options to select the best plan for their needs.