New evidence emerged late last year of a widespread gap in the cost of health insurance between men and women, as women tend to pay more than men of the same age for individual insurance policies providing identical coverage, according to data from insurance companies and online brokers, and online reports.
Women’s advocacy groups have raised concerns about the differences, and members of Congress have begun to question the justification for them. In Oregon, there is supposedly a ban in place, but according to the Washington D.C.-based National Women’s Law Center (NWLC), which aims to educate the public about ways to make the law and public policies work for women and their families and claims to have reviewed hundreds of individual women’s policies, Oregon women without coverage are especially likely to experience cost-related barriers to care, and their health may be suffering as a result.
In 2007, 17 percent of all women in Oregon were uninsured, and women here earn just 77 cents for every dollar earned by men. They also use the health care system more, in part due to their reproductive health needs, according to the NWLC.
And in Oregon, insurance companies are allowed to reject a woman’s health insurance application for a variety of reasons including her medical history or her current health status. Insurers in Oregon can also exclude coverage for certain “pre-existing” conditions; if a woman has previously had a Cesarean section, for instance, insurers may refuse to pay for future C-sections or reject her application altogether, according to a New York Times report. In Oregon, where 28 percent of all births were by C-section in 2006, meaning thousands of women could face coverage exclusions or rejections because of this discriminatory practice, an NWLC report said.
Furthermore, according to Oregon Health Sciences University, women in Oregon and their families, suffer from a lack of access to health care. Because almost one in five women do not have health insurance here, Oregon received a grade of “Fail” in the 2007 edition of “Making the Grade on Women’s Health: A National and State-by-State Report Card.” This need for access to care is seen in Oregon’s poor grades in reproductive health, cancer, cardiovascular disease and stroke.
Since Oregon does not have presumptive eligibility for prenatal care, nearly 20 percent of pregnant women do not receive first-trimester prenatal care. Oregon should continue to ensure family planning coverage as currently occurs with the requirements that private insurance companies cover all FDA-approved forms of contraception and its Medicaid waiver to coverage of low income women for family planning services, an OHSU report says.
Oregon’s statistics for rates of screening, prevention and mortality of key cancers for women is also worrisome. According to OHSU, one in five adult women hasn’t had a pap smear within the past three years, and nearly one in three women over the age of 40 hasn’t had a mammogram within the past two years. Worse yet, Oregon’s lung cancer death rate for women is among the bottom six in the nation.
In cardiovascular disease and stroke among women, Oregon is not doing well either. More than one-third of adult women haven’t had a cholesterol check within the past five years and Oregon is in the top five states for highest stroke death rate.
According to the 2007 Kaiser Family Foundation Women and Health Care: A National Profile: two-thirds of uninsured women report delayed or forgone care due to costs, four times as high as women with private coverage or Medicare. Insured women also face barriers to care, including delaying or sacrificing care they need: one in six women with private coverage and one-third of women with Medicaid stated that they postponed or went without needed health services in the past year because they could not afford the cost. And 20 percent of women ages 18 and older did not fill a prescription because of cost.
Again, reports come back that women are at a disadvantage in obtaining and retaining health insurance. Uninsured women tend to be young, unmarried, low-income, be members of racial or ethnic minority groups, and in Oregon, more than 50 percent of Hispanic and 40 percent of American Indian women are uninsured.
More often than not, women in Oregon covered through their spouse’s employer-based health insurance, leaving them more vulnerable to loss of coverage if their spouse loses coverage, a spouse’s employer no longer covers dependents, or a spouse begins to receive Medicare before she is eligible for Medicare herself. Women are also more likely to work in small businesses, to work part-time and to earn less than men, and women have more out-of-pocket health expenses than men, whether in employer-based health insurance plans, individual policies or high-deductible plans, according to OHSU.
What are the immediate effects of inaccessibility to health care services? The OHSU Center for Women’s Health began offering a quarterly “Free Fridays” program in November 2007, where women obtain a pap smear, pelvic examination and clinical breast evaluation at no cost. Within three hours of opening the phone lines, all appointment slots were filled. OHSU saw more than 90 women at the first event and over 100 at its second event in March 2008. Officials asked women why they came, and their responses in a press release clearly show the range of issues women without health insurance face:
• “Like many people, my husband and I both work two jobs but have no health insurance. I have a family history of breast cancer and ovarian cancer, and when I saw the chance for a free screening, with a world-class facility like OHSU, I jumped at it.”
• “I had to cancel my Pap test appointment because they wanted $269 up front because I am uninsured. When I saw the event in the newspaper, I couldn’t believe my good fortune.”
A key aspect of access to care is health insurance coverage. But coverage without providers to supply health care is problematic as well. Just like all areas of medicine, reimbursement for car must adequately cover the soaring cost of indebtedness for health professional graduates – particularly in isolated rural and other underserved areas – and coverage alone will not guarantee care. To optimize access to care means attending to issues of health disparities, including those experienced by women with disabilities.
The Oregon Legislature recently passed a bill that requires insurance companies to cover the costs of the human papilloma virus vaccine for females age 11 to 26 years old. The governor’s office confirmed that Gov. Ted Kulongoski will sign the bill, and that it will take effect Jan. 1, 2010. And in Bend, women living in rural Wheeler County can ride the “mammogram bus” into town, and Debbie Boettner, a certified physician assistant with the sponsoring Asher Community Health Center in Fossil who started the program, says 90 percent of women tell her they would not have had the service without the bus.
“I feel convinced we’ve got the highest mammogram rate of any place in the world,” she said.
But much more needs to be done.
“Oregon needs to pass health reform that would expand access to care for all,” said Joanna Cain, director of OHSU’s Center for Women’s Health. “We concur with the American College of Obstetricians & Gynecologists that all women should at least be guaranteed a package of essential benefits that includes primary and preventive care, pregnancy-related and infant care, medically and surgically necessary services, prescription drugs, and catastrophic care.”
