The longstanding practice of gender rating by health insurerscharging women higher rates than men for the same planis getting fresh scrutiny as lawmakers work to reshape the health insurance system.
New gender agenda
Push to eliminate insurance rate disparities intensifies
And it comes at a time when women are struggling to access care and pay down medical debt as they or their spouses lose job-based coverage and wages remain stagnant, according to a study released last week.
Sen. John Kerry (D-Mass.), earlier this month introduced the Womens Health Insurance Fairness Act, which would prohibit insurers from charging higher premiums to women with individual insurance plans, halt the practice of denying or limiting coverage based on current or past pregnancy, and require insurers to offer comprehensive maternity coverage on the individual marketcoverage that most health plans exclude today.
And the health insurance industry appears ready to give up gender rating. At a Senate Finance Committee hearing on May 5, Karen Ignagni, president and CEO of Americas Health Insurance Plans, said she agrees with Kerry.
We dont believe that gender should be a subject of rating, Ignagni told the panel. In our reforms, we have not recommended that that be continued.
Ending gender rating is one of the latest concessions offered by the insurance industry in exchange for a legislative mandate that every American carry health insurance. AHIP now says that it is agreeing to limit rating only to age, geography, family size and benefit design, said the groups spokesman Robert Zirkelbach. Insurers also say they will give up underwriting based on pre-existing conditions in exchange for an individual insurance requirement.
Today, women of childbearing age pay between 4% and 48% more in premiums than men for the same plan on the individual market, according to an October 2008 study by the National Womens Law Center.
Only about 7% of women receive health coverage on the individual market, and nine out of 10 applicants typically do not choose an individual plan, either because of cost or because they are rejected. Twelve states have banned or limited gender rating on the individual market.
But gender rating also exists in small group coverage, said Lisa Codispoti, senior adviser at the National Womens Law Center. Sixteen states have banned or limited gender rating in the small group market, while 34 states allow it, she said.
It just means its more expensive to offer coverage to your employees, Codispoti said. Women are more likely to work for small businesses that dont offer coverage, and small businesses dont offer coverage because of the cost.
Insurers have generally charged women more for health coverage, when possible, because women are more frequent users of the health system and because maternity care is a major cost-driver.
But these practices hurt women disproportionately, said Sara Collins, assistant vice president of the Commonwealth Fund.
In a new study, Collins and her colleagues found that in 2007, 52% of women reported problems accessing needed medical care because of cost compared with 39% of men. And 45% of women accrued medical debt or reported problems with medical bills compared with 36% of men.
The recession has exacerbated this gender gap. We can anticipate these problems have become worse, Collins said.
The unemployment rate among women has risen 65% over last year to 7.1% in April. Among men, the employment rate last month was 9.4% compared with 4.7% the year prior, according to the U.S. Bureau of Labor Statistics.
Although the unemployment rate for men has risen more sharply, more women are affected by the loss of health benefits, Collins said, because women are more likely to get their health insurance through a spouse. So not only are more women unemployed, more womens husbands are unemployed, meaning higher rates of uninsured among women.
Women with insurance are more likely to be underinsured than men. Whats striking about the data in our report is theres been a trend upwards in spending on out-of-pocket costs, but also a slowing of income increases, Collins said. This is hitting the middle class, with more women making between $40,000 and $60,000 reporting problems accessing services because of cost or paying medical bills, according to the report.
While both Collins and Codispoti applauded AHIP for its pledge to end gender rating, they were not sure it would help women much because of these larger problems of unemployment, rising out-of-pocket costs and stagnant wages.
Even if you eliminate gender rating, insurers could still underwrite you based on other pre-existing conditions, depending on the state, Collins said.
Today, only five states have laws that protect applicants on the individual market from rejection. Twelve states either ban or limit gender rating. For instance, the California Legislature last week passed a bill eliminating gender rating on the individual market. But California still allows plans to reject applicants for individual coverage based on pre-existing conditions.
with Matthew DoBias
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