Healthy balance: New measure aims for gender equality for health insurance

It’s a gloomy picture for women trying to buy health insurance.

According to a study released by the National Women’s Law Center last year, women are less likely than men to have jobs that offer group health insurance, so they are more frequently pushed to purchase an individual policy for their health care needs.

At the same time, women are paid 78 cents to every dollar their male counterparts earn, according to the same study, so it’s more difficult for them to afford individual insurance.

To add insult to injury, the women are charged as much as 39 percent more for the individual policy than men with a similar health profile.

That last piece is about to change.

Legislation by state Sen. Mark Leno, D-San Francisco, and Assemblyman Dave Jones, D-Sacramento, and was co-sponsored by San Francisco City Attorney Dennis Herrera will prohibit health insurers from charging a different price based on the insured person’s gender.

The practice is called “gender rating.” Federal laws prohibit employers from charging men and women different rates for employer-sponsored health insurance; additionally, California law specifically precludes gender rating for employer groups of 2-50 employees. Although 10 other states prohibited gender rating of individual health insurance rates, it was still permitted in California.

The California Healthcare Foundation, which tracks individual market trends, reported that gender-based health insurance rates just popped up in recent years.

According to the law center study, the change suggested that it might not be based on statistical need, but rather is a recently discovered loophole that some insurers are taking advantage of.

AB 119 was among hundreds of bills signed into law by Republican Gov. Arnold Schwarzenegger on Oct. 11.

Herrera had also filed a lawsuit against the state in January challenging the constitutionality of gender-based pricing, charging that statutory provisions which allowed the practice denied women their right to equal protection under the California Constitution.

Passage of AB 119 will help more than 1 million Californians obtain affordable coverage, Herrera said last week, adding that the legislation also averted the need for the litigation.

“It [also] offers a much-needed assist to our already overburdened public health system,” Herrera said.

The legislative change was opposed by most insurance companies and by the California Chamber of Commerce. In a letter to the California Senate about the bill, the Chamber’s policy advocate Marti Fisher said the bill would ultimately lead to “increasing the ranks of the uninsured and increasing the cost of coverage to everyone.”

Leno said that resolving the discrimination against women was a small step in the right direction.

“It makes good public policy sense, given the obvious inequity and unfairness of such discrimination,” he said.

Had the legislation not passed or if Schwarzenegger had vetoed the bill, the City Attorney’s Office would have followed through on its litigation threat, Deputy City Attorney Erin Bernstein said. Resolving the problem will encourage more women to purchase insurance — which will relieve the burden of taxpayers, she said.

“It’s pretty clear from studies that even marginal increases in health care can really dissuade people from purchasing it,” she said. “It’s also harmful to the public health system, because those women wind up coming into San Francisco General when they get sick, and it really costs The City time and money.”

In an effort to reduce the number of residents in San Francisco — both men and women — who are going without standard health care, city officials launched a citywide affordable health care program for the uninsured in 2006. Now called Healthy San Francisco, the program resulted from legislation authored by Assemblyman Tom Ammiano, D-San Francisco, when he was on the Board of Supervisors and championed by Mayor Gavin Newsom. Today, approximately 47,000 uninsured residents participate in the program, 48 percent of them women.

Expecting mothers delivered bad news

Women’s health care advocates cheered after learning Gov. Arnold Schwarzenegger passed a law prohibiting insurance companies from charging women more than men for the same policy.

But they simultaneously let out a weary sigh as the governor vetoed a measure for the third time that would have required insurance companies to cover maternity care.

While most group insurance plans — plans provided through employers — have been required since 1978 to cover pregnancy care for women, individual insurance plans are not required to do so.

Of 106 individual health care plans available in California, just 26 provided comprehensive maternity coverage; another 7 provided partial coverage, according to a study by the National Women’s Law Center.

In his veto message, Schwarzenegger said he’d vetoed AB 98 because “while the perfect world would allow for all health conditions to be covered, including maternity, I cannot allow the perfect to become the enemy of the good.”

“Because I continue to have serious concerns about the rising costs of health care and believe the potential benefits of a mandate of this magnitude will translate to fewer individuals being able to afford coverage, I cannot support this bill,” Schwarzenegger wrote.

Bonnie Castillo, government relations director for the California Nurses Association, chastised the governor for holding onto this line of thinking, which she said only served the insurance companies, and ultimately costs the public health system — and taxpayers — dearly. She said many individually insured women assume their insurance covers maternity care and only discover they do not when they’re denied pregnancy-related services.

“That’s what’s really sad, because then they’re sort of stuck, because if you suddenly need maternity services, it’s next to impossible to buy insurance for it,” she said.

A mother’s health

California does not require individual insurance plans to cover maternity care.

$7,488: Cost of uncomplicated labor and delivery

1964: Year when the federal government outlawed most employer-provided insurance plans from charging women more than men

1978: Year when federal government required most employer-provided insurance plans to cover pregnancy

6 percent: Gender-rated health insurance plans that cover maternity care

106: Individual health care plans available in California

26: Health care plans in California that provide comprehensive maternity coverage

A woman’s burden

Findings from the 2008 National Women’s Law Center report, “Nowhere to turn: How the individual health insurance market fails women.”

66 percent: Women aged 18 to 64 who have health insurance through an employer

16 percent: Women aged 18 to 64 who have health insurance through a public program such as Medicaid

18 percent: Women aged 18 to 64 who are uninsured

6 percent to 45 percent:
The increase in price for 25-year-old women from insurers who practice gender rating

4 percent to 48 percent: The increase in price for 40-year-old women from insurers who practice gender rating

22 percent less to 8 percent more: Premiums charged 55-year-old women from insurers who practice gender rating

Source: National Women’s Law Center

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