(WOMENSENEWS)--For some women, it's good news: a first shot at health coverage for themselves or for their children.
For others, it's a mixed blessing: insurance that is affordable, but that could carry deductibles or fees that either stretch their budgets too tightly or jeopardize their careers in small business.
That's the word on California Gov. Arnold Schwarzenegger's proposal to make health insurance mandatory in his state, a proposition being closely watched by other states as they work to expand their own residents' coverage.
"Overall, this plan is a step in the right direction for women because universal coverage is so important to us," says Judy Waxman, vice president for health and reproductive rights at the Washington-based National Women's Law Center. "Women use health care more than men, so our out-of-pocket costs are higher."
Last year, Massachusetts made health insurance mandatory and other states have recently approved near-universal coverage or measures to boost coverage.
But by promising universal coverage in the nation's most-populous state (where one-fifth of residents are now without insurance), Schwarzenegger's is the largest-scale plan since President Clinton's failed 1994 federal proposal.
Forty-seven million Americans currently have no health insurance. Among these are an estimated 16 million women, representing 19 percent of women under 65, a group that does not yet qualify for government-sponsored Medicare, which is provided mainly to the elderly.
That figure is from the Kaiser Family Foundation, based in Menlo Park, Calif., which also finds women 30 percent more likely than men to require ongoing treatment and 50 percent more likely to go without care because they can't afford it.
Subsidized Insurance Pool
The new plan would expand access to Medi-Cal (the state's version of Medicare) and would create a subsidized insurance pool from which uninsured, low-income residents could draw. That pool would be bankrolled by individuals, employers, health plans, health professionals and the government.
Insurers that participate in the pool would agree to certain cost caps. "The minimum health insurance benefit would be a $5,000 deductible plan with maximum out-of-pocket limits of $7,500 per person and $10,000 per family," says Herb K. Schultz, senior health policy advisor for Schwarzenegger. "For the majority of uninsured individuals, such coverage could be purchased for $100 or less per month per individual and $200 per month for two persons."
If approved by the state Legislature, the proposal could take effect as early as January 2008, providing coverage to 6.5 million uninsured or underinsured state residents.
Those who currently have insurance--either through their jobs or as individuals--would be unaffected unless living below 250 percent of the poverty level, at which point they could dip into the government-subsidized pool.
"This plan covers low-income women who aren't pregnant and don't have children," says Cathy Hoffman, associate director for the Kaiser Commission on Medicaid and the Uninsured, adding that this group has not had the government-sponsored insurance available to pregnant women and mothers.
Women who have been denied coverage by California insurers will also benefit. These include those in high-risk occupations and with pre-existing conditions such as arthritis (which is more common among women than men) and heart disease (the No. 1 killer of U.S. women). Schwarzenegger's plan would eliminate these restrictions among all insurers in the state.
Many mothers would also be helped because the state's 750,000 uninsured children, including those of undocumented immigrants, would be covered.
Regardless of their income or whether they have children, Californian women would benefit from the plan's focus on prevention, a strategy key to reducing future costs.
"In the Medi-Cal program, women who undergo regular mammograms or breast cancer screenings would be eligible for incentives such as discounts on bike helmets and weight management programs," says Schultz.
But women who are currently uninsured and who are low-income but not poor enough to qualify for Medi-Cal could have trouble under the plan.
"California could require residents to buy comprehensive policies, which are more expensive than catastrophic ones and also more expensive than health savings accounts, in which consumers 'save' for medical expenses at a tax break," says Devon Herrick, a health economist at the Dallas-based National Center for Policy Analysis. "But comprehensive policies could be too expensive for many residents."
Even with subsidies to buy insurance they might still struggle to pay premiums, deductibles and co-payments when they visit a doctor.
Women with lower incomes could wind up like 25 percent of drivers in California who don't have auto insurance even though it's required in the state. Such women could break the law and face penalties instead of paying for coverage they can't afford.
Stress on Small Employers, Doctors
Also at risk: small employers and doctors in private practice. To fund his plan, Schwarzenegger would raise $1 billion from businesses and $3.7 billion from health care providers.
Companies with 10 or more employees would have to insure workers or contribute 4 percent of their payroll to a fund that supports universal insurance. Although they would have higher Medi-Cal reimbursements, and thus more money to treat the poorest patients, doctors would have to funnel 2 percent of their gross revenues to the fund while hospitals would give 4 percent.
"These fees affect women disproportionately," says Sally Pipes, president of the San Francisco-based Pacific Research Institute. "Women are more likely than men to own small companies with 15 to 20 employees and this will add tremendously to their costs of doing business. Women doctors who have families and are working part time would have to work more hours and could even be driven out of practice."
Linda J. Blumberg, principal research associate at the Washington-based Urban Institute, says Schwarzenegger's plan is "a much better deal for California women than what they have now."
"But will it actually work in practice?" she asks. "That still remains to be seen."
Molly M. Ginty is a freelance writer based in New York City.
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For more information:
"Women Flock to Thai Hospital for Affordable Care":
"U.S. Women Lack Health Insurance, Access to Care":
Kaiser Family Foundation, "The Uninsured: a Primer":
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