Being a Woman Is Not a Pre-Existing Condition
Insurance policies for young people that don’t include maternity coverage are a hot button for me.
On the other side of every pregnancy, there is a man who bears an equal responsibility for the cost of the maternity care. There is no excuse for offering coverage that does not include it because men who choose these policies run absolutely no risk that they can become accidentally pregnant, while women always have that risk as long as they are physically capable of pregnancy.
It’s very early, and I’m still a little sleepy, so my arguement probably isn’t as clear as I’d like it to be.
NPR has an article on the issue showing that women pay more: Framing Health Care Debate As Battle Of Sexes : NPR
A recent study by the National Women’s Law Center found that 25-year-old women have been charged up to 84 percent more than their male contemporaries for individual health plans — plans that specifically exclude maternity coverage.
Be informed. Get more information at
National Women’s Law Center: Nowhere to Turn: How the Individual Health Insurance Market Fails Women
The National Women’s Law Center’s new report, Still Nowhere to Turn: Insurance Companies Treat Women Like a Pre-Existing Condition, provides sobering new data about the inequities that women face in health insurance.
The extent of gender rating, in which insurance companies charge women more than men for the same coverage, has remained abysmal since the Center issued its landmark report in 2008, Nowhere to Turn: How the Individual Health Insurance Market Fails Women.
Tags: health, public policy
KIT
October 22nd, 2009 at 7:58 am
So it’s the insurance company’s fault? Or is it still individual responsibility? There was a report on CNN yesterday of an inner city Chicago school where 115 teen aged girls are pregnant. The whole focus was on educating the girls,NOT the teen aged boys. Underage pregnancy rates have quintupled in less than 5 years in inner cities like Chicago,Cleveland,L.A.,and Miami. Most of these pregnancies are carried to term and the cost is absorbed by medicaid,very few of these girls have parents that have private insurance. How does the National Womens Law Center address that issue? I’m just curious where they place the blame at for that?
October 22nd, 2009 at 8:55 am
Um… how did we go from talking about insurance coverage for women over 25 to teenage pregnancy?
October 22nd, 2009 at 9:01 am
I have tried to price out coverage that would be cheaper for me and none of them include maternity coverage — I realize that it is expensive but considering my hosp. bill was 25k alone, it is necessary.
October 22nd, 2009 at 9:04 am
Isn’t the ultimate goal of “health care reform” to get everybody enrolled? Wouldn’t that put us ALL into one group policy or another? Isn’t the goal of a GROUP policy to average out the risk among ALL people in the group? So how can they sell insurance based on the GROUP risk-sharing principle, then turn around and single out SOME in the group for individual treatment? I know it happens all the time, but to to me this just shows the hipocracy of the $%^&* insurance companies.
S
October 22nd, 2009 at 9:15 am
Puppy and Lowandslow - You both illustrate the point. Pooling risks means that everyone who might parent a child should be required to contribute to the pregnancy risk pool — at a minimum. Better, we make the pool bigger and don’t cherry-pick based on particular types of care.
I think the insurance case against different rates for women is particularly problematic from a discriminatory stand-point. Is it OK to raise rates based on race, if we know that statistically, one race has higher risks of certain diseases? It’s the same issue to me.
October 22nd, 2009 at 11:28 am
I gotta go with L&S…And the point I was making is exactly what L&S illustrated and exactly why Medi-Caid needs massive reform instead of those evil insurance companies,which have always pooled people according to risk factors. But I wouldn’t call it hypocrisy based on how they figure it. The ones I would call hypocrites are the ones that sit in the board rooms of those insurance companies and determine these factors,and it’s not all men that sit at those tables. Don’t direct anger at the companies,direct it at the individuals responsible for making policy.
October 22nd, 2009 at 12:06 pm
Insurance companies today use more than one “group.” Women cost more to insure because they access healthcare more than men do. It’s still risk sharing, but on a much smaller scale. I’m sure there are many people out there, like someone who isn’t able to have a child for instance, who would say, “Why should I have to pay more for my insurance for coverage that I don’t need, just because others who need won’t get it?” When insurance first started it was like one big group policy that distributed the cost across the entire group. Now there are several groups and the cost plus the desired profits of the insurance companies must be spread out among the various groups based on their risk and estimated usage. Also, more on topic and close to home to me is this little debacle. When my wife got pregnant with our first child (we weren’t married yet), she didn’t have insurance. My insurance wouldn’t cover prenatal care or the delivery, but would kick in at birth. She was able to get it covered by the state, but the state had the option of trying to get the money from me since my income excluded me from getting state coverage. Luckily they didn’t come after me for. Had a been in the same situation with my daughter, it could have been very bad since she spent 4 weeks in NICU. I think the bill for that was somewhere in the neighborhood of $40K. Also, I think this is pointing out a flaw in the current system, not in the proposed plan since that one is still evolving and is extremely flawed. I think before we can talk about serious healthcare reform and in particular, a government option, we need to develop a meaningful insured person’s bill of rights if you will. I think this should be done before we do anything else. The problem with that is, it will make insurance rates go up, because whether or not you think insurance companies are evil, they are profit-motivated and by virtue are seeking the highest obtainable profits. So if we make them do away with things like pre-exisiting condition clauses, include maternity care for all, and lump higher risk groups in with lower risk groups, we will all see our rates go up because the insurance companies are going to make the same profit at very least and likely will use it as way to increase their profits at our expense. I’m glad you see things this way Ben, because it illustrates exactly why the pure, deregulated capitalism doesn’t work for health insurance. Perhaps if we had more uniform coverage requirements at the national level, we finally could open things up to competition across state lines. That might help hold costs as they are, but the only way to lower costs is to take the profit seeking out of the equation. It’s simple math. C (actual cost of health care services provided) + E (expenses to offer coverage) + P (profits) = TIC (total insurance cost). That’s the basic equation for the total dollars spent on health insurance. Your Rate = TIC/Total number of people covered. There’s only so much you can do to lower any of the other variables, so only by removing the profit can you lower premiums.
October 22nd, 2009 at 12:07 pm
sorry that was so long, I took my adderall late today!
October 22nd, 2009 at 1:30 pm
**laughs at Jahm**
When I went for my post-partum exam our insurance refused to pay for it because they claimed it was a “pre existing condition.”
October 25th, 2009 at 11:26 am
Jahm - thanks for your thoughtful response. I know it’s common wisdom that women access health care more than men, but I would want the actual studies before I am willing to make (or accept) an argument based on that assumption. With high-cost events like motorcycle accidents, car accidents, and gun shots possibly more likely for men (again, I don’t have facts) - overall costs may be even between men and women.
Your problems with your first daughter’s birth show why universal single payer coverage has lower administrative costs. They only need to figure-out how much they are going to pay, and they don’t need to determine if you are covered. And if it’s covered, the care must be delivered and paid for by someone. With universal coverage, all the costs associated with fighting about who should pay go away.
The fact that all our rates will go up if we’re all lumped together gets to the central difference between health care as a right vs. health care as just another type of service we consume. How one feels about that issue colors how one views who should pay, and how much.
I agree with your comments about the profit motive in health care. I have a problem with any private system where the provider will make money denying me care, and there isn’t any down-side for them. I don’t care if it’s nominally called non-profit, or it’s for-profit. Although non-profits generally do a better job now than for-profits.
November 14th, 2009 at 10:48 am
That was a great post and I totally agree with you, you are so right.