Millions of US Women Lack Adequate Healthcare

Troy Brown

July 13, 2012

June 13, 2012 — A new Commonwealth Fund report shows that women in the United States are in much worse shape, healthcare-wise, than women in 10 nations that have universal healthcare. Even insured American women are more likely to go without needed healthcare because of the cost and difficulty paying medical bills.

The report was published online July 13.

According to the report, the Affordable Care Act has brought coverage to millions of women already and is expected to improve women's healthcare in coming years.

The authors compared women's healthcare in the United States with that in 10 nations with universal healthcare: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom. "All other industrialized nations provide universal health insurance, generally with comprehensive benefits," the authors write.

The researchers used data from 3 surveys for their comparisons: the Commonwealth Fund International Health Policy Survey of Adults in Eleven Countries (2010), the Commonwealth Fund Biennial Health Insurance Survey (2003, 2007, 2010), and the March Annual Social and Economic Supplement to the Current Population Survey (2001 - 2011).

At a media teleconference held June 12, the report's authors described their findings and answered questions.

"We are on the cusp of a remarkable feat: providing comprehensive, affordable health insurance to almost all American women," Karen Davis, president of the Commonwealth Fund, explained. "It is crucial that state and federal policy makers and other key stakeholders actively work together to implement the reform law and take full advantage of all the benefits the Affordable Care Act offers so that all American families are able to benefit from the law's potential."

Ruth Robertson, MSc, a senior research associate for the Affordable Health Insurance program at the Commonwealth Fund explained, "Our focus on women is important because we know that women use more health services than men throughout their lifetimes, particularly during their reproductive years.

"They also have, on average, lower incomes than men, and this leaves them at greater risk of going without needed care because of its cost," she continued. "Women are also one of the groups that particularly benefit from the Affordable Care Act."

In 2010, 18.7 million women were uninsured, up from 12.8 million in 2000. In 2010, 16.7 million women were underinsured, up from 10.3 million in 2003.

Uninsured women in the United States were the most likely to have difficulty with medical bills and getting necessary healthcare, but even insured women in the United States were more likely to have these problems than women in the other 10 countries, according to the authors.

"Millions of women lack healthcare in the United States, but there are also an increasing number of women with health insurance who face such high out-of-pocket spending relative to their income, they are effectively uninsured," Robinson explained.

"From an international perspective, these high uninsured and underinsured rates in the United States are an exception," she added

Insured Women Hurting Too

The US women had the highest financial burden, with 43% of respondents reporting they had gone without needed care or failed to fill prescriptions because of cost in the past year. More than three fourths (77%) of US women who were uninsured during the year reported that they had foregone needed care. This was in sharp contrast to the other 10 countries, where that rate was no more than 28%.

The researchers found that after paying premiums, 39% of the US women spent $1000 or more out of pocket on healthcare in the past year compared with no more than 24% in the other 10 countries.

One quarter (26%) of the US women struggled to pay medical bills, more than twice the rate in 10 other countries. The proportion jumped to 51% among uninsured women.

Only half (52%) of US women were confident in their future ability to afford healthcare if they would become seriously ill. Most women in the United Kingdom (91%), the Netherlands (77%), and Switzerland (76%) felt confident about their ability to pay for future healthcare.

The authors write that a similar law implemented in Massachusetts in 2006 has been successful, with that state currently enjoying the lowest rate of uninsured in the country, at 5.3%.

"There are many provisions of the Affordable Care Act that specifically help women. Some are already helping women today," Robertson said. "Importantly for women, insurance companies will no longer be able to charge women higher premiums than men for identical policies, and all plans will be required to cover maternity care."

In 2011, 20.4 million women benefited from the Affordable Healthcare Act requirement that nongrandfathered insurance plans cover preventive care (such as screening for cervical, breast, and colon cancer; cholesterol checks; and osteoporosis and chlamydia screening without cost sharing) and provide direct access to obstetrics and gynecology services.

Medicaid now covers smoking cessation support for pregnant women and maternity care from free-standing birth centers, and firms with 50 or more employees are now required to provide new mothers with breaks to express breast milk.

Expanded Insurance and Medicaid Coverage

An estimated 6.6 million young adults aged 19 to 25 years remained on or joined their parents' health plans in 2011 who would probably not have been able to do so before the law; 3.1 million of them were women.

More than 2 million female Medicare recipients have saved $1.2 billion on prescription drugs because of the phase-out of the Medicare "donut hole," and 24.7 million women received preventive services without cost sharing.

Medicaid eligibility for adults was expanded in 7 states and the District of Columbia, covering an additional 600,000 people. The ban on insurers imposing lifetime benefits helped 39.5 million women, and the ban on rescissions helped another 5.5 million women.

Approximately 62,000 adults,(more than half women) enrolled in preexisting condition insurance plans. Such plans are available in all 50 states and are designed for individuals with health problems who have been without insurance for at least 6 months.

New subsidized insurance options will be available, including a significant expansion in Medicaid eligibility and premium tax credits for those with incomes up to $92,200 for a family of 4. This is expected to result in affordable, comprehensive coverage for nearly all women.

"The bottom line is that in 2014, women will no longer be disadvantaged in the insurance market and will have access to affordable, comprehensive health insurance. Insurers will no longer be able to vary insurance premiums by gender or health basis," said Robertson.

"This means that insurers will no longer be able to charge young women higher premiums than young men simply because of their gender. Insurers will also no longer be able to deny women coverage...because they've previously had a caesarean section or they've been a victim of domestic abuse," said Robertson.

Not everyone believes that the Affordable Care Act is the answer, however. J.D. Kleinke, a resident fellow at the American Enterprise Institute in Washington, DC, commented on the report in a telephone interview with Medscape Medical News.

"These women are going to get more benefits, but they're still being shoved into the existing system, with all its problems. Their copays aren't going to go away. Yes, there's preventive services and all that stuff, but this doesn't do anything about the out-of-control [cesarean delivery] rate, this doesn't do anything about ridiculously high copays, and other things that made the list," Kleinke said .

"This is better for women, but this is not health reform. This is health insurance market reform. They're very different things," Kleinke said.

"Oceans Apart: The Higher Health Costs of Women in the U.S. Compared to Other Nations, and How Reform Is Helping." Commonwealth Fund. Published online July 13, 2012. Full text

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