In November, Women Will Vote With Health Care in Mind

Women vote for health care, and with good reason.

Today, women across the country are being forced to make impossible choices in the name of health care; sacrificing life and limb so that they can get coverage for ... a broken limb, or prenatal care. They resign themselves to unhappy marriages in order to keep their husbands' health insurance, reports the New York Times. They step out of line at the pharmacy when they realize that they can't afford to pay the cost or even the co-pay on their prescriptions and fill up the tank. Indeed, in 2004, according to the Kaiser Women's Health Survey, one in five women did not fill a prescription because of the cost.

The nation's health care system is in crisis, and women are bearing the brunt of its failures. Throughout their lives, women have greater health care needs and responsibilities than men. Reproductive health needs require them to get regular check-ups, whether or not they have children, and women are more likely than men to suffer from a chronic condition or disability. Meanwhile, eight in ten mothers are primarily responsible for taking their child to doctors' appointments and organizing follow-up care.

In other words, health care is a woman's issue.

Yet 18 percent of all U.S. women are uninsured. Latina, African American, and Native American women are dramatically more likely than white women to be among these 17 million who lack coverage. And while women have greater health care needs than men, they also, on average, have lower incomes and are more likely than men to be underinsured: forced to spend more than 10 percent of their income on out-of-pocket health care costs. Women also face significant difficulties paying for their care, whether they have insurance or not. Nearly 40 percent of women report medical bill problems.

Women who do not have access to employer sponsored health insurance or are ineligible for public coverage like Medicaid or Medicare are left with no option other than to try to buy health insurance directly from insurers, known as the individual market. But women face unique challenges in this arena. They may be denied coverage based on a (so-called) pre-existing condition -- such as ever having had a Caesarean section, as reported recently in the New York Times. When women are offered insurance, they are often forced to pay higher premiums than men, as it is legal in 40 states and the District of Columbia to consider gender when setting insurance premiums. Furthermore, the benefit package a woman receives may be woefully inadequate; even something as fundamental as maternity care is often excluded from the basic plans available in the individual market.

The upcoming elections are providing a platform for policy makers and candidates alike to discuss their proposed solutions for the health care crisis. At the National Women's Law Center (NWLC), we have developed a list of questions to ask when looking at health reform proposals -- whether at the state or federal levels -- to determine whether the proposals help ensure that all women have access to health care that meets their needs:

  1. Does the plan expand access to ensure that health coverage is available to all? Access or lack of it should not depend on income, age, gender, family status, disability, immigration status, or employment status.

  2. Does the plan provide care that is affordable? The cost of care (including premiums and out-of-pocket costs) should be affordable relative to income.

  3. Does the plan ensure comprehensive health coverage? Covered services must include preventive care, treatment for chronic conditions, and the full range of reproductive health services.

  4. Does the plan adopt insurance market reforms to end unfair insurance practices? Reform proposals must provide a strong role for government to end unfair insurance company practices such as charging different premiums based on health status, age, or gender.

  5. What is the role of employer-sponsored health coverage? Proposals that rely on the current employer system must help employers and workers alike. For example, does the plan help small business owners who want to provide health coverage to their employees? Does the plan capture contributions from employers who don't provide health coverage? Given that more than 20 percent of uninsured women work part-time, does the plan help part-time employees?

  6. Does the plan address health disparities faced by women of color and women who live in rural and underserved areas? Health reform plans should promote equity in health care access, treatment, research, and resources for all people in order to improve health and life expectancy for all.

  7. Does the plan take steps to control costs, while ensuring quality care? Plans should promote effective cost controls that will also improve care, including secure electronic medical records, an emphasis on preventive health care, lower drug and device prices, and better management and treatment of chronic diseases.

Findings from a new poll by NWLC and Peter D. Hart Research Associates show that 84 percent of women say it is extremely or very important for Congress and the next administration to guarantee access to quality, affordable, comprehensive health care. As the debate over health care reform continues to take shape, it is critical that women's advocates ready themselves to be active and vocal participants in the fight.

A Note on Sources: Unless otherwise indicated, the data in this article come from the U.S. Census Bureau and these NWLC reports: Women and Health Coverage: The Affordability Gap; Making the Grade on Women's Health: A National State-by-State Report Card, 2007.

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