Being a Woman is not a “Pre-Existing Condition”
Why Women 18-35 Pay the Highest Price for Health Care
Did you know that women, especially 18-35 year old women, pay up to 31% more than men for insurance? And, not because they have more “complicated” health care needs. I’m talking about apples-to- apples coverage unrelated to, say, pregnancy.
According to a comprehensive national report, Turning To Fairness, released by the National Women’s Law Center last week and reported on in the New York Times, a 30-year-old woman will pay 31% more than a man the same age, for identical coverage. For 25-year-old women the gap is even more shocking: for individual healthcare plans (not including maternity coverage) women are charged up to 84% more than men. So, for example, 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. Insurance companies practice “gender rating” which is defined in the study as:
“the practice of charging same-aged women and men different premiums for identical health coverage; exclusions of coverage that only women need, like maternity care; and rejecting applicants for insurance coverage for reasons that include status as a survivor of domestic violence.”
The practice, the incidence of which has gone UP since the last study conducted in 2008, exists because of discrimination, pure and simple. The old fashioned kind. You know, that women like me (I make sure to wear clunky shoes and thick glasses when I type about sexism) grouse about. Women pay more for insurance for no other reason than because they are not men.
The gender-based cost gap varies from state to state, but it exists pervasively across the country and applies in differing but substantively equal ways to large, group and individual insurance coverage. Just about now you might be thinking “but women need more health care services…” This gap is unrelated to additional costs tied to “exceptional” things like reproductive and maternity related care. In aggregate terms it means women are spending $1 billion dollars a year more than men on insurance plans.
If you know only one thing about the Affordable Care Act it should be that it makes this discriminatory practice illegal. It is 2012 in case you are scratching your head having read that sentence. The act makes gender rating, and discriminatory pricing, illegal starting in 2014.
Some insurance executives “expressed surprise at the size and prevalence of the disparities” a few years ago when a 2008 national report that reached the same conclusions was completed. Apparently these executives weren’t surprised enough to do anything about it. These executives, by failing to rectify clearly discriminatory policies despite years of awareness, continue to demonstrate their untrustworthiness.
Secondly, the study found that the VAST majority of individual health care plans, which many women rely on, do not cover services related to pregnancy and other maternity-related services. Not only do women pay more just because they are women, but we are then effectively charged and additional “gender-fee” for health care that is non-male specific, namely health care related to maternity services. That’s a double-whammy. Insurance benefits are androcentric – the male body being considered the “standard” for coverage. Having a woman’s body and female health care needs is, for all practical and fiduciary purposes, considered a “pre-existing condition” like, say, cancer. Pregnancy is a “disability.” Last time I checked, women make up the majority of the species and having a uterus and ova and mammary glands isn’t really that exceptional at all. Except when it comes to things like paying for insurance coverage it seems. Oh, and getting paid fairly. Sorry. Thanks for playing though.
I don’t know about you, but I’m not comfortable being considered an “exception” to a “standard” that means I pay more for insurance because my biologically-based healthcare needs are considered a “pre-existing condition.” And that’s if I can even get coverage for maternity related health care, which many women cannot.
Thirdly, in addition, to higher premiums and a denial of provisions for basic female reproductive health care (‘cause you know, not having a penis makes every woman an exception), in some states insurers can legally reject coverage, get this, to women who are survivors of domestic abuse. So, for example, if you live in Oklahoma, North Dakota, Mississippi or North Carolina and you are the victim of abuse, an insurance company can still deny you coverage on the basis of that fact.
If you know a second thing about the Affordable Care Act it is that it ensures that women will have basic access to the healthcare that is relevant to their bodies and specific needs. The act ensures that preventative care specific to women and their bodies – including birth control, annual exams, and screens – are covered.
Regardless of how the Supreme Court rules on the Affordable Care Act, the openly stated primary priority of the Republican Party is to overturn this law. If the Act is overturned, these discriminatory practices will continue and women will pay in complex ways. For the life of me, I cannot understand why any woman or a man who cares for the girls and women around him, can vote to elect people who will overturn this without at the very least addressing the multi-dimensional discrimination against women that it seeks to ameliorate. Women in particular who vote for representatives dedicated to overturning the Act are acting against their own interest in fundamental ways. In a perfect world, the insurance companies would have already self-corrected and proved in good faith that they would not discriminate on the basis of gender. But, that hasn’t happened and I have very little faith that it ever would without this Act.
To recap: until 2014 when the Act goes into effect, if it goes into effect, being a woman - with reproductive needs that are different but equally relevant from men’s - is a “pre-existing condition” that results in women paying EVEN MORE (in addition to the baseline gender payment gap described above) to get coverage for basic female-health related services. The Affordable Care Act provides redress and helps women in need of affordable health care for women in the following ways:
1. It makes pricing discrimination illegal for the purchase of insurance.
2. It prohibits the denial of coverage on the basis of the following “pre-existing” conditions: prior pregnancies, having had C-sections, being the survivor of breast or cervical cancer, or being the victim of domestic or sexual violence. Putting aside the issue for the moment of cancer, yes, having been pregnant, having had a C-section and having been a victim of domestic violence are “pre-existing conditions” currently used by insurance companies to not insure women.
3. By the terms of the Act, benefits related to basic maternity and newborn care are included. This means that cost and live saving preventative services like annual mammograms, cancer screenings, prenatal screenings will be covered with no additional "gender tax" costs to women and girls.
If you are a young woman, between the ages of 18-35, you are part of a large cohort of undecided voters to whom affordable health care is critical. Not voting means that you are essentially voting to
- Perpetuate pricing discrimination used against you and against other women and the families that depend on them.
- Maintain unfair gender-based practices that exclude basic health care services specific to your own body and needs. By doing this you support the misgynistic idea that the male body is the only standard baseline for healthcare, thereby excluding the needs of half the
- Ensuring that the health care needs of girls and women will not be adequately and equally met and we will all continue to pay in more ways than one for this discriminatory
The National Women’s Law Center, along with 30 other groups, has launched the “I Will NOT be Denied” campaign to educate women about this issue.
*Variations on the persistent and ubiquitous gap exist from state to state. Only these 12 states have banned any type of gender rating by insurance companies for the small group market: California, Colorado, Iowa, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New York, Oregon, and Washington. Only ONE state bans insurers from using gender as the basis for any type (large, small group, individual) of rating: Montana. I want to openly salute that state for it’s recognition of women as fully unexceptional human beings with health needs that they should not pay “extra” for by virtue of their gender.