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1
No Where to Turn: Women and the Individual Insurance Market:
Lisa Codispoti, Senior Counsel National Women’s Law CenterFamilies USA • Health Action
January, 2009
2
Overview
Women and the individual insurance market
• Brief background on women and health coverage
• Overview of challenges women face getting coverage in the individual market
• Practice of Gender rating• Availability of Maternity coverage• How health reform can help
Insurance Coverage Patterns: Adults 18-64, 2006
Source: 2007 CPS Data
Insurance Coverage Patterns:Uninsured by Age
Percent Uninsured by Age
26.1%
23.0%
16.5%
13.0%
32.4%30.7%
21.0%
16.5%
14.1%
12.5%10.0%12.0%14.0%16.0%18.0%20.0%22.0%24.0%26.0%28.0%30.0%32.0%34.0%
18 to 24 25 to 34 35 to 44 45 to 54 55 to 64
Per
cent
Uni
nsur
ed
Adult Women Adult MenSource: 2007 CPS Data
Insurance Coverage Patterns: Uninsured Women by State
Source: NWLC analysis of 2006 &2007 7 CPS Data
Insurance Coverage Patterns: Uninsured & Employment
Status
Source: NWLC Analysis of March 2005 Current Population Survey
Uninsured Men Uninsured Women
Full-Time69%
Full-Time43%
Not working
35%
Not working
18%
Part-Time22%
Part-Time13%
Women and the Affordability Gap
On average, women use more health services than men
• Reproductive health needs• Prescriptions drugs• More likely to have a chronic
condition (38% vs. 30%)• Certain mental health problems
affect twice as many women
Women and the Affordability Gap
Regardless of insurance status, women are more likely than men to:
• Spend greater than 10% of their income on out-of-pocket costs
• Avoid necessary health care due to cost
• Face medical bill problems
9
Where Do Women Get Their Health Coverage?
Women's Health Coverage, Ages 18-64 2007
7%
18%
65%
15% Employer-Sponsored
Uninsured
Public
IndividualMarket
Source: U.S. Census Bureau, Current Population Survey’s 2008 Annual and Social Economic Supplement
10
Why Understand the Individual Market?Only a modest number of women are currently
covered that way, BUT1. Many more try to find individual market coverage
without success – nearly 9 out of 10 people who seek policies do not ultimately buy a plan
2. Some employers are replacing employer-sponsored coverage with fixed sums to buy insurance through the individual market
3. Some proposals would expand the individual market4. There are critical differences between employer-
sponsored coverage and individual market coverage
11
Nowhere to Turn: How the Individual Health Insurance Market
Fails Women
Some Definitions
“Medical Underwriting” = Insurance companies decide
1)Whether to offer coverage 2)What to cover and2) What premium to charge
“Gender Rating” = Insurers charge women and men different premiums for the same health insurance coverage
“Actuarially Justified” = Based on actual differences in providing health insurance to women versus men (insurance industry defense for gender rating)
13
Challenges Women Face in the Individual Market
• Rejection based on health history– Insurers in 9 states and D.C. can reject applicants
who are survivors of domestic violence– Insurers can reject women for coverage based on
a previous Cesarean section
• Rating based on age• Rating based on gender
• Rating based on health status
• Pre-existing condition exclusions
14
State Efforts to Protect Against Gender Rating
Bans gender rating: ME, MA, NJ, NY, OR, WA, MN, MT, NH, ND
Limits gender rating with rate band: NM, VT
State does not have protections against gender rating
Key Findings – Gender Rating• Gender rating is prevalent throughout the country
among similar plans:– At age 25, women are charged between 6% and 45%
more than men.– At age 40, women are charged between 4% and 48%
more than men.– At age 55, women are charged between 22% less and
37% more than men.
• Wide variations across and within states undercuts insurance industry defense of gender rating as actuarially justified – and raise questions of arbitrariness
• Maternity coverage does not explain the difference
n=3,512 policies (offered in 47 states and D.C.)
12%
9%
20%59%
ComprehensiveMaternity Coverage
Less-than-ComprehensiveMaternity Coverage
SupplementalMaternity RiderOffered
No Maternity CoverageAvailable
Key Findings – Maternity CoverageMost Individual Market Insurance Policies Do Not Cover
Maternity Care
*Comprehensive maternity coverage includes coverage for prenatal care, labor, delivery, and postnatal care, for both routine pregnancies and in case of complications.
*
17
Maternity Riders: A Bad Deal for WomenExample: A woman pays $106 per month for a maternity rider, in addition to her
regular health insurance premium. Her rider requires 20 % coinsurance and covers just $2,000 of maternity charges for the first 2 years she is enrolled.
Uncomplicated Vaginal Delivery (2006 Average =
$7,488)
Cesarean Section with Complications (2006 Average =
$16,996)
Rider Covers $2,000 $2,000
20 % Coinsurance
$1,498 $3,399
Over Benefit Limit
$3,990 $11,597
Annual Rider Premium
$1,272 $1,272
Woman Pays At least $6,760 At least $16,268
State Efforts to Ensure Access to Maternity Care
• 5 states have passed laws requiring all health insurers in the individual market to include maternity coverage– MA, MT, NJ, OR, WA
• Other states have adopted laws that are more limited in scope:– Only certain insurers are subject to the law– Insurers are merely required to offer the
coverage
• Some states have enacted public programs to fill in the gaps
Some recent developmentsGender Rating: • Several states with possible legislative
proposals to ban gender rating• MT legislation filed to repeal gender rating
ban• Litigation: CA (filed by city of San Francisco)
Maternity Coverage: • CA: Maternity coverage mandate legislation
vetoed by Governor
20
For More on Women and Health Reform…
Visit our website www.nwlc.org/reformmatters to:
– Download a copy of our report No Where to Turn– Download or request a copy of our Reform Matters
toolkit for advocates– Participate in our monthly conference calls– Request technical assistance on health reform
Contact us at [email protected]• Lisa Codispoti [email protected] 202/588-5180