Women pay more for health care

Washington -- Women's groups, consumer advocates and lawmakers have come together under the belief that being a woman should not count as a preexisting condition. But they note that changing the current situation is easier said than done.

Women will continue to be denied maternity coverage or charged significantly higher premiums than men in the individual health insurance market until Congress adopts a national health system reform bill, witnesses said during an Oct. 15 Senate Health, Education, Labor and Pensions retirement and aging subcommittee hearing. Legislation adopted by Senate and House committees would end the practice of setting premiums and denying coverage based on gender, but negotiations to merge the bills before floor votes in each chamber continue.

Democrats increasingly have targeted alleged health insurance abuses to rally support for the legislation, with President Obama generally using the term "health insurance reform" since the congressional August recess. A House Energy and Commerce subcommittee held hearings on the perceived shortcomings of health insurance coverage on Oct. 15 and Oct. 20.

Sen. Barbara Mikulski (D, Md.), who chaired the HELP subcommittee hearing, said she intended for it to be a search for the "sensible center" on reform to which Americans can come together. The hearing focused on disparities between the disparities between the coverage offered to men and women -- as well as its cost -- in the nongroup insurance market.

Mikulski said she was shocked by the testimony of Peggy Robertson, a mother of two from Centennial, Colo., who said she was told she could not obtain an individual market health plan she sought because she had a cesarean section in 2006. The insurance company, in a letter to Robertson, said it was denying her application because state law prohibited it from charging enough to cover her risk of a repeat C-section delivery within three years of the first.

"They said if I would get sterilized, they would then be able to offer insurance to me," Robertson said.

"I found that bone-chilling," Mikulski said. "It put me on the edge of my chair."

Women also often pay higher premiums for individual health insurance, according to a 2008 report by the National Women's Law Center. For example, 25-year-old women paid between 6% and 45% more than 25-year-old men for the same individual market health plan. Older women faced similar disparities, based on online health plan applications submitted in 47 states and the District of Columbia between July and September 2008, according to the report. Also, 34 states offer no protections against using gender to determine premiums, according to a 2009 update.

The American Medical Association and the American College of Obstetricians and Gynecologists have policies opposing gender rating. They also oppose health plans citing past procedures -- such as C-sections -- as preexisting conditions and reasons for denying coverage.

Women in the group insurance market have greater protections. Federal and state laws ban most employers from charging different premiums for their health coverage based on gender, according to the National Women's Law Center report. Employers also must include maternity coverage in their plans.

Testifying before the subcommittee, America's Health Insurance Plans President and CEO Karen Ignagni said AHIP's member companies agree that women should not face higher premiums just for being women or face coverage denials based on pregnancy-related care. "Our industry is committed to making the experiences that we've heard about today a thing of the past." But she said these differences exist partly because not everyone is required to have health insurance to offset the higher costs of care for some beneficiaries -- another system change proposed in the pending legislation.

Sen. Richard Burr (R, N.C.) said Democrats were ignoring the influence of medical lawsuits in inflating health care costs and deterring obstetrician-gynecologists and other physicians dedicated to women's health from practicing. "It is the 800-pound gorilla in the room when it comes to affordable access to health care for women."

Diana Furchtgott-Roth, a senior fellow at the Hudson Institute in Washington, D.C., said health insurance should work more like car or home insurance -- it should be portable, customizable and have a competitive national market. The bills Congress is considering have too many tax increases and would raise premiums by mandating that people have a comprehensive package of benefits, she said.

This content was published online only.

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 ADDITIONAL INFORMATION: 

Click to see data in PDF.

Few premium protections for women

Women enrolled in individual market insurance plans on average pay more for coverage than do men, in part because most states allow health insurers to price policies based on gender.

Ban using gender as a rating factor in any insurance policy: Montana

Ban using gender to set premiums in small-group markets: California, Colorado, Iowa, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New York, Oregon, Washington

Limit how much gender can influence premiums: Delaware, New Jersey, Vermont

No gender protections: Alabama, Alaska, Arizona, Arkansas, Connecticut, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming

Source: "Still Nowhere to Turn: Insurance Companies Treat Women Like a Pre-Existing Condition" National Women's Law Center, September (action.nwlc.org/site/PageServer?pagename=nowheretoturn)

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