How Our Health System Screws Over Women

By Sharon Lerner, The Nation. Posted August 24, 2009.

To be sure, no group is doing well under our network of private insurers, which is more holes than net. But women fare particularly badly in terms of health, being more likely than men to leave a prescription unfilled; forgo seeing a needed specialist; and skip a medical test, treatment or follow-up. Financially, women are worse off, too, in large part because they earn less money. Despite the fact that they skimp on their care to cut costs, three in five women are still unable to pay their medical bills. All of which makes it surprising that men and women support health reform in almost equal numbers (38 versus 40 percent consider it a top priority, according to a recent Kaiser poll). Odder and ickier still is the sight of Sarah Palin, Betsy McCaughey and other women leading, or sometimes blindly following, the wacko town hall movement against reform.

A 38-year-old yoga instructor and personal trainer, Mulvihill was uninsured when she recently discovered she was pregnant. She had made do without coverage throughout her adult life, relying mostly on luck and over-the-counter remedies. This time, she knew she needed something more. Even without the cost of prenatal care, a standard in-hospital delivery typically runs between $7,000 and $10,000. If anything went wrong, the costs would be way higher. So Mulvihill resigned herself to buying private insurance, hoping to put it on a credit card and pay it off at some point in the distant future. Yet, after spending hours calling private insurance companies, she found none would take her. The reason? Private insurers can legally reject pregnant women on the grounds that their pregnancy is a pre-existing condition. While federal law forbids group health plans from playing this sleazy trick, on the individual market, companies face no such restriction. Given the loophole, seemingly all insurers jump through it. Even though not getting prenatal care is a technically a violation of the law (according to family law experts, women could be prosecuted for neglect, though they rarely if ever are), private insurance plans for individuals aren't required to help them get it.

When looking for real help, many uninsured pregnant women encounter this utterly useless advice: get a policy before conceiving. Yet planning ahead doesn't necessarily solve women's insurance problem. Many women couldn't afford whatever care they find, since companies often charge women more -- in one case as much as 140 percent more -- for the same health coverage, according to a 2008 study by the National Women's Law Center. And only the lucky have the privilege of paying even these high prices, since companies can simply reject women for anything from having been subject to domestic violence to having had a C-section. Meanwhile, the vast majority of individual plans don't even offer maternity coverage. Only 7 percent of women get insurance through the individual market, yet its unwelcoming practices clearly contribute to the fact that another 18 percent are uninsured.

So what's a pregnant woman to do if she can't afford insurance? Some women take their chances, skipping the doctor's visits and hoping for the best. (A startling 15 percent of American women receive no prenatal care in the first trimester, a fact that contributes to our appallingly high infant mortality rate). Other women "spend down," forgoing income to qualify for Medicaid. Even then, they can wind up without prenatal care for long periods, since twenty states lack laws allowing pregnant women to receive time-sensitive coverage while waiting for approval of their Medicaid applications. Mulvihill took this route, and is still grateful to the benefits worker who granted her a Medicaid card, despite the fact that her income was slightly above the cutoff in New York City at the time. "I wanted to give her a hug," Mulvihill said later. "It was either have an abortion, or I'm going to have this child and the decision was in this woman's hands."

See more stories tagged with: women, health care, health reform

Sharon Lerner is the author of The War on Moms: On Life in a Family-Unfriendly Nation, which is due out early next year.

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