Womenstake

Pregnancy Is A Pre-Existing Condition for Expectant Dads Too

by Brigette Courtot, Policy Analyst,
National Women's Law Center

In the individual health insurance market, insurance companies are generally allowed to treat pregnancy as a “pre-existing” condition. In practice, this means that they can reject a pregnant woman’s health insurance application altogether or offer her a plan that excludes coverage for the care associated with her condition—in this case, maternity care.

Through our “A Woman is Not a Pre-Existing Condition” campaign, NWLC is working to raise awareness about this and a whole host of other discriminatory insurance industry practices that make it more difficult (or even impossible) for women to get the health care they need.

But lest you think that pregnancy complicates coverage only if you’ve got ovaries, I refer you to a recent Colorado news article featuring a healthy 41-year-old man who can’t get individual market insurance because he is an expectant father. His wife has job-based coverage, but it’s too expensive to add the family to her policy, and so he tries his luck—literally—in the individual market. He is routinely denied, and learns that the basis for his rejection is his wife’s pregnancy. 

House Health Reform Bill Delivers on Equal Tax Treatment for Domestic Partner Health Benefits

by Brigette Courtot, Policy Analyst,
National Women's Law Center

A while ago I blogged about my frustration over the inequitable tax treatment of health benefits for domestic partners.  To recap, job-based health benefits are generally tax-free, so that the health insurance that employers offer to their workers’ family members (i.e. spouses and dependent children) doesn’t count as taxable income.  In contrast, if an employee gets coverage for a domestic partner through his/her job, the cost of the domestic partner’s health insurance is considered taxable income. Because of this unfair tax treatment, workers receiving domestic partner health benefits pay an average of $1,069 more per year in federal taxes than their married peers.

The health reform bill that the House of Representatives passed on Saturday night includes a commendable provision that would eliminate this inequity in the tax code and make domestic partner health benefits tax-free.  Hopefully the tax equity provision will remain in the combined legislation when the House and Senate bills are merged during the process known as “conference.” (The Senate has yet to unveil the final version of its health care bill, but current versions do not include the provision.) It’s just one of the many ways that the House bill improves access to affordable health insurance.  As noted by the Human Rights Campaign—which is working on this and many other issues related to health reform’s effect on the LGBT population—if the unfair tax penalty is eliminated, “more people will be able to afford employer-provided coverage for their families, and more companies will be able to offer these important benefits.”

Her Ovaries, His Cigarettes: Which Costs More in the Individual Health Insurance Market?

by Brigette Courtot, Policy Analyst,
National Women's Law Center

For most of their lives, women are charged more than men for health plans in the individual insurance market. This is a consequence of “gender rating,” the common insurance industry practice of using gender to decide how much to charge for health insurance.

A new NWLC report shows that at age 40, for instance, women are charged as much as 49% more than men for individual health plans. Consider this scenario: a 40-year-old man is charged $250 a month for health insurance, while his twin sister is charged $375 for the exact same plan. Over the course of a year, she’s paying $1,500 more than he is! Shocking, right? 

But the truth is that the health insurance industry is rife with this sort of discrimination — and it gets worse. Imagine that our 40-year-old man is a regular smoker, while his twin sister steers clear of tobacco. Guess who pays more? (Hint: Abandon all sense of logic and reason before answering.)

Well, in most of the roughly 400 individual health insurance plans NWLC studied for our new report, a non-smoking woman is charged more for coverage, even when compared to a man of the same age who smokes. Yes, you heard that correctly: in the individual health insurance market, having ovaries could very well cost you more than having a pack a day.  And the difference in premiums can be considerable — we identified best-selling health plans that charged a nonsmoking woman as much as 63% more than a man who smokes.

The point of our analysis is not to endorse health insurance premium rating based on smoking status; NWLC advocates community rating — i.e. where all health plan enrollees are charged the same premium regardless of gender, tobacco use, and other factors. But it is reasonable to think that in our current health insurance system, men engaging in a behavior with significant health risks would be charged higher premiums than their female peers who avoid such risks. 

But reason doesn’t have much of a place in our current system. That’s why we need comprehensive health reform that includes strong insurance market rules prohibiting insurers from discriminating based on factors like gender and health status, regardless of whether they are selling coverage to an individual or to a group of any size.

The bill unveiled by Speaker Pelosi today (H.R. 3962, the Affordable Health Care for America Act) is a momentous step in the right direction, towards health reform that meets women’s needs and ends unfair and discriminatory health insurance practices.

Gender Rating in Health Insurance: It's Not Just an Individual Market Problem

by Brigette Courtot, Policy Analyst, 
National Women's Law Center 

A home health care agency. A day care center. A nonprofit community-based organization. A dentist’s office. 

What do all these businesses have in common? They’re likely to employ more women than men — and to pay more for health insurance because of it. A new report released this week as part of NWLC’s “A Woman is Not a Pre-Existing Condition” campaign sheds light on gender rating — i.e. the insurance industry practice of using gender to determine health insurance premiums — as it occurs in the group health insurance market, where many businesses buy coverage for their employees.

In 2008, NWLC examined gender rating in the individual health insurance market, that unwelcoming place — and often last resort — where people try to purchase coverage directly from insurance companies. We found that gender rating most often results in women paying more than men for the same health insurance, simply because they are women.

But many aren’t aware that gender rating also happens in the group health insurance market. Insurance companies consider different factors when deciding how much to charge a group for its health plan, including the gender make-up of the workforce. A business is charged more for coverage if it employs women and businesses with a predominately female workforce — such as the ones listed above — could pay significantly more.  Protections against group market gender rating exist in some states, but typically only for small businesses (generally 50 employees or fewer) — check out our new report for details.

Gender rating affects the overall premium that a business pays; premiums for men and women within the same health plan aren’t different in this case, since employment discrimination laws prohibit employers from charging individual male and female employees different rates for coverage.  Nonetheless, gender rating can present a serious obstacle to affordable health coverage — if the overall premium is not affordable, a business may drop its offer of coverage altogether or shift more health insurance costs to employees.

Basing health insurance premiums on gender is wrong, whether it happens in the individual or the group health insurance market, and every woman should be protected against this discriminatory practice, no matter where or how she gets her health insurance. NWLC supports health reform that addresses this issue once and for all, and eliminates gender rating across health insurance markets, for individuals and for groups of all sizes.

Some Health Choices That Women Could Do Without

by Brigette Courtot, Policy Analyst, 
National Women's Law Center  

This post is part of a series on Women and Health Reform.

NWLC’s health and reproductive rights team does a lot of work around the importance of choice.  We advocate for reproductive choice, so that women can make important life decisions about whether and when to have children. We support choice in childbirth, because we believe that women and their families should be able to have a safe out-of-hospital birth if they so choose. And in our priorities for national health reform, we emphasize choice between public and private health insurance options, since women will benefit from the transparency, security, and competition that a public health insurance option promises. We support these choices because they promote a woman’s wellbeing.

But not all choices in health care are good.  When women can’t afford the health care they need, they are faced with choices that they’d be better off without.  In 2007, more than half of all women in the United States reported problems getting necessary health care because of cost.  They had a difficult choice between their own health care and other financial obligations, and the “other” won out.  Given the many responsibilities that women juggle every day, is this any surprise?  Imagine a young woman choosing between filling a prescription and making a student loan payment.  Or a mother choosing between a follow-up doctor’s visit and buying school supplies for her children.   Or a retiree choosing between a mammogram or paying this month’s electricity bill.  In a country with so many resources, that already spends so much on health care per capita, women should never have to make these sorts of choices. 

Stop Rewarding "Macho Men": Ban Gender Rating in Health Insurance

by Brigette Courtot, Policy Analyst, 
National Women's Law Center 

This post is part of a series on Women and Health Reform.

Intrigued by the news headline “For macho men, doctor visits are less likely,” I recently checked out a new study showing that men “most devoted to traditional beliefs about masculinity” are considerably less likely than other men to get routine, preventive medical care—such as a prostate exam or a flu shot.  Researchers assessed beliefs about masculinity by asking 1,000 men how much they agreed with statements like “When a man is feeling pain, he should not let it show,” and “When a husband and wife make decisions about buying major things for the home, the husband should have final say.”  They found that men who buy into the “macho man” bit are generally the same ones who don’t go to the doctor when they should. Granted, the new research doesn’t make a clear cause-and-effect link between men’s beliefs about masculinity and avoidance of health care, though the lead author suggests that “deep-seated masculinity beliefs are one core cause of men’s poor health, inasmuch as they reduce compliance with recommended preventative health services”

Now, let’s make some connections here.  First, we know that on average, men use less health care than women, including preventive care.  We also know that women are penalized because of this distinction.  Insurance companies typically justify the practice of “gender rating” (i.e. using gender to determine health insurance premium rates, often resulting in women paying considerably more than men for the exact same coverage) with statistics showing that women use more care than men. So gender rating, in effect, punishes women for using more care and rewards men for using less.  But why are men using less health care?  In some cases, they may not need it—they typically don’t have to go in for regular reproductive health visits, for instance.  But in other cases, as the masculinity study indicates, men might be skipping recommended care in part because of their devotion to “macho man” ideals. And do we really want to reward that devotion?  Access to health insurance should be fair and equitable, which is why we need health reform that eliminates gender rating and stops penalizing those who need and use more health care, and rewarding those who don’t need or use it. 

Young, Uninsured, and Ready for Reform

by Brigette Courtot, Policy Analyst, 
National Women’s Law Center 

This post is part of a series on Women and Health Reform.

If you’re between the ages of 19 and 29, you’re at increased risk of being uninsured—while young adults account for just 17 percent of the nonelderly population, they comprise roughly 30 percent of those without coverage. We examined this issue earlier in the year as part of our Reform Matters project, specifically focusing on young women and health coverage. But since the Commonwealth Fund released a new report on young adults and coverage late last week, it seems like a good time to revisit some key pieces of our analysis:

• Women ages 19-29 are more likely than any other age group to be uninsured; one in four young women lacked coverage in 2007.
• Racial/ethnic disparities in coverage are magnified for young women. Around 20 percent of white young women are uninsured, for instance, compared to nearly half (44%) of Latinas.
• Compared to other age groups, young women are more likely to be unmarried and to live in low-income households, and they are less likely to work full-time throughout the year—all factors that are associated with being uninsured.

Young adults are generally a healthy population, but it is still essential that they have coverage. Without health insurance, they’re less likely to get the preventive care they need to stay healthy, and they could be exposed to significant financial risk in the event of a major illness or injury. Health reform can ensure that young adults have access to high-quality coverage, through measures like requiring that insurers extend coverage to dependents up to age 26, or providing income-based subsidies to help people afford their health insurance premiums and out-of-pocket costs (since nearly three-quarters of uninsured young adults live in low-income households). Women of all ages have something to gain from health reform.

Failure to Protect? Yep, That's the Individual Market We Know

by Brigette Courtot, Policy Analyst, 
National Women's Law Center 

This post is part of a series on Women and Health Reform.

If you’re looking for more evidence that the individual health insurance market (that unwelcoming place where people buy coverage directly from insurance companies) is failing us in pretty much every way possible, add this new brief from the Commonwealth Fund to the pile. Aptly titled “Failure to Protect,” it uses findings from a 2007 survey to illustrate why the individual insurance market is anything but a reliable source for comprehensive and affordable health coverage. Consider these findings:

• Most adults who shopped for coverage in the individual market found it very difficult or impossible to find a plan that fit their needs—they were either denied due to a preexisting health condition or were offered a plan that was too expensive or that didn’t cover the care they needed.  The majority (73%) never ended up buying a plan.
• Adults who do purchase individual market plans spend considerably more on health care than those with employer-sponsored insurance (ESI); 51% of people with individual market coverage spent 10% of their income or more on out-of-pocket costs (all medical expenses, premiums, and prescription drugs), compared to 29% of those with ESI. Median spending for those with individual market coverage was more than twice that for people with ESI ($6,750 vs. $2,250).  
• Those with individual market plans also report higher rates of problems with their coverage (e.g. dollar or visit limits on covered services, or expensive medical bills that aren’t covered by their plan) and are more likely to avoid or delay needed care because of cost.

Health Reform Can't Come Soon Enough: New Findings on Medical Bankruptcy

by Brigette Courtot, Policy Analyst, 
National Women's Law Center 

This post is part of a series on Women and Health Reform.

There’s a new study out on medical bankruptcy, but if you’re in an otherwise good mood, read it at your own risk. The findings are dismal, disheartening…nearly any gloom-inspiring adjective will do. If the term is new to you, the medically bankrupt are those who have filed for bankruptcy and report illness or medical bills as factors in their filing. It turns out that in 2007, the majority of all bankruptcies—a whopping 62 percent—had a medical cause. For the most part, those filing for medical bankruptcy were well-educated, middle-income earners, and had health insurance when they filed. Researchers also found that being female significantly increases the odds that a person will file medical bankruptcy—no surprise there, since we have plenty of evidence that because women have lower incomes and greater health care needs than men, they are more likely to face unaffordable medical bills and debt, and to delay or skip necessary care because of cost.

The fact that a single medical event could leave a family in financial shambles demonstrates just how broken our health care system is. Fortunately, though, there’s some exciting news to balance these depressing new findings—in the coming weeks, we’ll begin to see the details of how Congress plans to fix our fragmented and failing health system. During this critical time, NWLC is advocating for the types of health reform that will guarantee that women and families won’t go bankrupt when they need health care. We’re calling for a reform plan that includes adequate subsidies to help moderate and low-income individuals and families obtain coverage; a minimum standard for health insurance benefits to ensure that everyone has comprehensive coverage; and, a limit on out-of-pocket spending (e.g. copayments, deductibles) so that families have the security of knowing they won’t face financial devastation when they’re also facing illness or injury. This new study reminds us that health reform is about peace of mind; for the millions of Americans living in fear of losing their homes/savings/kids’ college funds because of medical bills, reform can’t come soon enough.

Health Care Affordability Problems Persist for Women

by Brigette Courtot, Policy Analyst, 
National Women's Law Center 

A recent analysis by the Commonwealth Fund shows that women experience cost-related health access barriers at higher rates than their male counterparts. These new findings echo those of a similar study conducted by the National Women’s Law Center and the Commonwealth Fund two years ago. Though women are no more likely to be uninsured than men, they are more likely to skip or delay necessary health care because of cost, and they report more problems paying medical bills and with accrued medical debt. These inequities are a result of women’s lower incomes (in 2007, women earned 0.78 cents for every dollar men earned) and the fact that they need and use more health care than men. Women’s responsibility for their children’s health care is an additional factor, as women with medical debt or bill problems are more likely than their male counterparts to be single with children.

What is especially distressing about the new analysis is that the affordability problems women encounter in the health care system are only getting worse. In 2007, we reported that 43 % of nonelderly women experienced problems accessing health care because of cost; now, this figure has risen to 52% (the corresponding statistics for men are 30% and 39%, respectively). Reports of medical debt and outstanding medical bills have also increased — two years ago, we found that 38% of women (and 29% of men) had these problems, but now 45% of all women (and 36% of men) struggle with these financial burdens.

The study reveals that affordability problems are becoming more commonplace for women regardless of their income level or insurance status. While women who are uninsured or underinsured (i.e. insured, but with coverage that requires high levels of out-of-pocket spending relative to income) are most likely to have trouble affording health care, even insured women are struggling to keep up with health care costs. One in three women with health insurance year-round reported cost-related problems with accessing care. Similarly, a third of all women with annual incomes over $60,000 have trouble affording the health care they need.

What types of necessary health care are women are putting off because they can’t afford it?  The list includes cancer screenings, treatments or tests that a doctor recommended, follow-up care with specialists, and prescription drugs to help manage chronic diseases. Without this care, women are at risk of developing more complicated and costly illnesses or injuries later on. It’s exhibit #1 in the case for comprehensive health reform — when health insurance is unavailable or inadequate, people don’t get the care they need to stay healthy, quality-of-life suffers, and we all pay the price somehow, whether it’s in lower workforce productivity, poor health status for a significant — and growing — proportion of the population, added pressure on the health care safety-net, or cost-shifting to pay for increasing levels of uncompensated care. As the Commonwealth Fund authors aptly conclude, “the experiences of U.S. women highlight the fragmentation and failings of the nation’s health care system.” Women’s experiences tell us that health reform must place a high priority on affordability, by guaranteeing health insurance that sufficiently covers the health needs of women and their families, with built-in cost protections to ensure that both premiums and out-of-pocket costs do not impose a barrier to necessary care.