By Molly M. Ginty
Sunday, March 21, 2004
The first of a series on health insurance and women: Women's eNews looks at research by the Kaiser Family Foundation that shows that a significant number of U.S. women under 64 lack health insurance and that others face barriers to adequate care.
WOMENSENEWS--Asa Reyes took her health insurance for granted--until losing it nearly cost her health.
"In 2001, when the economy started failing, I lost my job as a graphic designer and the insurance that came along with it," says Reyes, a 36-year-old artist in New York City. "Several months later, while I was still unemployed and uninsured, a routine Pap smear indicated I had cancerous cells in my cervix. Panicked, Iborrowed $2,300 from my family and had surgeryto remove the malignant cells. But even though the treatment was successful and my Pap smears have since come back normal, nearly developing cervical cancer when I didn't have insurance was one of the most terrifying experiences of my life."
Like a growing number of women in the United States, Reyes has learned that problems with insurance coverage can be hazardous to a woman's health. Nearly 18 percent of American women ages 18 to 64 are uninsured, according to a February report by The Henry J. Kaiser Family Foundation, a health care policy organization based in Menlo Park, Calif. Other research by the foundation indicates that women who do have coverage are not getting adequate care. As the economy worsens and medical costs skyrocket, experts predict that more women will continue losing coverage that is already spotty, unreliable and highly priced.
The Kaiser Family Foundation report said that 16 million women across the U.S. have no insurance coverage, and coverage rates vary widely from place to place. States with the lowest percentage of uninsured women were Minnesota (7.9 percent), Wisconsin (8.9 percent) and Delaware (8.9 percent). Those with the highest were Texas (28.3 percent), New Mexico (28.1 percent) and Louisiana (25.8 percent).
From 2001 onward, Kaiser has published a series of reports showing that health coverage is a growing problem for women under 65, the age at which they can qualify for government-sponsored Medicare.
"Women use the health system differently than men and have a greater overall need for health services," says Alina Salganicoff, the director of Women's Health Policy for the Kaiser Family Foundation. "They make more doctors' visits and have higher health costs, particularly during their reproductive years. Women are more likely to have chronic conditions. But since they are disproportionately low income, they have fewer financial resources with which to purchase coverage."
Kaiser surveys show that 32 percent of women ages 18 to 64 have a health condition that requires ongoing treatment, compared to 24 percent of men. Yet 24 percent of women have delayed treatment or gone without it in the past year because they couldn't afford it, compared to 16 percent of men. Twenty-one percent of women didn't fill a prescription because of costs, versus 13 percent of men.
Kaiser researchers found that without insurance, women are more likely to skip necessary screenings like Pap smears for cervical cancer and mammograms for breast cancer. They are also more likely to be diagnosed with diseases that have already progressed to the advanced stages.
Researchers found that even women who do have insurance face health risks because their plans may not pay for needed services, may have high cost-sharing provisions and may have benefit caps that prevent women from getting emergency care.
"Recent medical advances have made coverage much more expensive," says Salganicoff. "We can identify problems and save lives much more quickly, but these changes have come at a high price."
Kaiser surveys indicate that 82 percent of U.S. women ages 18 to 64 have some type of health insurance. Sixty-two percent have coverage through employers, 6 percent have private insurance, and 9 percent are covered by Medicaid, the national health insurance program for low-income Americans. Researchers found that in all three cases, barriers to adequate health care persist.
When it comes to employer-sponsored coverage, women are twice as likely as men to get insurance through their spouses, making them more vulnerable to losing their coverage if they are divorced or widowed. In addition, many companies are cutting back on the coverage they offer employees. And due to the increasing costs of medical care, worker contributions to health benefits are rising, now averaging $508 per year for individual coverage and $2,412 per year for family coverage.
In a 2003 survey, most companies reported that they planned to increase the amount workers pay for health insurance in 2004 to combat rising medical costs and the increase in the amounts employers must pay to provide insurance to their staff.
When it comes to privately purchased insurance, costs can range from $200 to $600 per month for individual coverage and $800 to $1,200 per month for family coverage. Strict eligibility requirements are also a pressing problem.
Take Chelsea Cain, an author in Portland, Ore. In 1999, when Cain started working as a freelance writer and tried to purchase private insurance, she was stunned to discover that she couldn't buy it any price.
"Because I had been treated for an eating disorder and the insurance companies considered covering me a risk, it took me six months to find a provider that would take me," says Cain. "Even though I was a 28-year-old, healthy woman, I was turned down by three insurance companies and was only able to find one after submitting a letter from my psychiatrist saying that I had recovered. I was flummoxed and terrified of having an accident when I didn't have any coverage."
Researchers found that eligibility is also a problem for the 9 percent of women who rely on Medicaid. If a woman is under 65 and has no children or disabilities, for instance, she can not qualify for this government-paid health insurance regardless of how low her income may be. Moreover, rules that govern who among the parents and disabled are eligible are far from consistent. Most states offer state children's health insurance programs to meet the medical needs of children from low-income families, however, while many of these program do cover pre-natal care, they most often do not cover any of a mother's other medical expenses.
"Medicaid eligibility is jointly determined by the state and federal government," says Judy Waxman, the vice president for the National Women's Law Center, a Washington-based advocacy group. "But coverage varies widely from state to state and only 15 states cover everyone who's poor."
Regardless of whether they are insured or not, a significant number of women say they are dissatisfied with their health care. Researchers at Kaiser found that 23 percent of women think their costs are too high, 22 percent are concerned about the quality of their care and 18 percent changed providers in the past five years due to dissatisfaction with services. Health experts say this dissatisfaction is only bound to grow as the total number of uninsured Americans--which now stands at a 10-year high of 43.6 million--continues to rise.
"We need to figure out how to finance care for those who are uninsured and improve care for those who are insured," says Salganicoff. "Making this change is the only way that we can protect women's health."
Next month: Molly M. Ginty examines how Congress, President George W. Bush and Candidate John Kerry propose to address health insurance shortage in America.
Molly M. Ginty is a freelance writer based in New York City.
Kaiser Family Foundation--
"Health Insurance Coverage of Women Ages 18 to 64, by State, 2001-2002":
Kaiser Family Foundation--
2001 "Women's Health in the U.S.: Health Coverage and Access to Care":
Kaiser Family Foundation--
"Employer Health Benefits 2003 Annual Survey":