Women’s Stake in the Health Care Debate

“The Republican platform and the speaker lineup for the Republican National Convention demonstrate a fundamental disregard for women and women’s health.”

Spoken by the president of the Planned Parenthood Action Fund, we can safely assume that the speaker is most interested in reproductive health policy. I argue that too often we conflate attention to and improvements in women’s health with liberal policies on birth control and abortion.  Actually, the Republican health care platform is problematic for women in more ways than this.

Although we point to the poor and the ill as the benefactors of the Patient Protection and Affordable Care Act (PPACA), women have much to gain from the reform’s success– and the most to lose if the bill is overturned with a change in the White House. Among the many voices competing for space and authority in the health care debate, the group with the most to lose from the weakening of health care reform must take a stance this November.  We’ve heard a lot already about access to abortion, but what’s missing is the discussion of parity in payments and coverage for women.

Although medically needy women will most tangibly experience the reverberations of the reform outcome, the payment for and delivery of women’s health care should be on every taxpayer’s mind.  Women’s health care drives 60% of overall health care spending nationally, women are the largest users of the government money spent on health care, and make up 75% of Medicaid beneficiaries. Addressing women’s health care needs will disproportionately reduce health care spending.

Although rates of insurance coverage are roughly equal between men and women, women absorb much more of their health care costs out-of-pocket.  Reproductive age women spend 68% more out-of-pocket than men. Women are more likely to work for small companies or in low-wage jobs where coverage is low in quality or incomplete.  This pay gap is rarely spoken about in terms of benefits, but the gap in coverage is just as significant as that in salary.  The out-of-pocket expenses that women absorb are even larger when we think about the role women play as caregivers in their families and their communities. Because there are more single mothers than single fathers, it is also women who absorb the costs for children that the children’s health insurance program (CHIP) fails to cover.

The personal financial burden of care makes both insured and uninsured women more likely to delay preventive care measures.  This ultimately drives up our system’s costs in the form of increased acute care treatments.  14% of women with private insurance report that they have delayed treatment due to the cost of care.The pattern of delaying preventive care is particularly problematic for non-communicable diseases such as cancer and cardiovascular disease, which become more common after the onset of menopause. Late stage diagnoses and treatment generate the highest spend and also exhibit the largest inconsistencies in quality of care.

Several elements of PPACA would begin to address the issues of the disproportionate financial burden on women and the correspondingly lower rates of preventive care, which ultimately burden all taxpayers.  Given that nineteen million women are uninsured today, relaxing eligibility requirements for Medicaid will be a start.  Broader and more comprehensive insurance coverage for everyone is also likely to decrease the burden felt by women, who often coordinate the care for their families.  PPACA will also begin to assist women often referred to as the “under-insured”, who receive inadequate benefits.  The bill’s ban on coverage limits and refusals based on preexisting conditions, as well as the requirement for essential health benefits (including maternity care) will benefit both women and men. Rating insurance premiums based on gender, now allowed in 42 states, will also become a figment of the past. A right- wing president would weaken many of these provisions and would threaten the benefits women are positioned to gain.

The bill would unlock huge benefits for women, even in its weakened state after the Supreme Court ruling, which supported the transfer of authority to the states to take or leave what the government can provide to assist in the expansion of Medicaid programming.  The 18 states that have expressed intent to decline the program expansions have some of the highest rates of uninsured women in the nation.  Compared to the national average of 18% for women aged 19 to 64, Texas and Florida would leave 26% and 24% of women uncovered, respectively.   PPACA can still make huge strides, though women’s voices will need to be heard at the state level as well as the national to realize the bill’s full potential.

Women are hit harder than men by the shortcomings in our system of healthcare payment and delivery.  Although maternal and reproductive care is central to a woman’s health over her lifetime, the disadvantage women face in the current system is more complex than access to birth control and prevention.  Reform policy should be on the agenda of every woman, and the female voice should ring at both the federal and the state level to fight for parity in healthcare payments.

Guest contributor Stephanie Marton is a consultant at the Boston Consulting Group, where she specializes in the healthcare payer industry. She recently graduated from Yale where she focused on cognitive science and economics. She holds strong interests in both medical economics and women’s health.
Image via iStockPhoto/Baris Simsek
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