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How Our Health System Screws Over Women

To be sure, no group is doing well under our network of private insurers. But women fare particularly badly.

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.


Many of women's problems stem from the fact that to get anything close to decent private insurance, you usually need a full-time job, which women are less likely than men to have -- 52 percent versus 73 percent. (The flip side of this problem is that linking jobs to insurance leaves many women tethered to full-time jobs they'd rather not have, given their other responsibilities. In fact, 60 percent of full-time working mothers would prefer part-time work, according to a 2007 Pew poll. While some keep their full-time jobs for the income, many others stay because they have no other way to get health benefits.) Many women who work part-time or stay at home have become a sort of medical underclass, stuck without insurance, paying dearly for it out of their own pockets or, as was Jemilla Mulvihill's experience, begging desperately, and unsuccessfully, for the opportunity to pay dearly for it out-of-pocket.

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.

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