Barack Obama and John McCain

(WOMENSENEWS)–As Wall Street’s freefall tops political concerns, women’s health advocates say some fundamental questions about the presidential candidates’ proposals for health insurance reform aren’t getting answered.

“The top issue for both candidates now is the economy,” says Alina Salganicoff, vice president for women’s health policy at the Kaiser Family Foundation, a research group in Menlo Park, Calif., that plans to release an election brief on women’s health in mid-October. “But while Obama and McCain turn their attention there, the health care details that would affect women have not been specifically articulated.”

Ahead of the Nov. 4 election, the Kaiser Family Foundation joins a cluster of prominent health-care groups–the Women’s Law Center, the Center for Policy Analysis, the Women’s Universal Health Initiative, the National Women’s Health Network, MergerWatch and the Avery Institute for Social Change–which are still wondering how the candidates’ plans could affect women.

Both Sen. Barack Obama, the Democratic presidential nominee, and Sen. John McCain, the Republican hopeful, say they want to make health insurance available to more Americans.

Obama wants to create government-sponsored universal care by 2012, with a federal insurance system filling gaps left by the private system, which would make insurance more affordable to lower-income people.

McCain advocates for allowing market forces to make insurance more flexible, more affordable and more available to Americans.

But the details of those proposals aren’t in the political limelight.

Women Quiz the Candidates

In October, the Women’s Universal Health Initiative, a Boston-based consortium of 500 health advocates who joined forces in 2001, plans to publish the candidates’ answers to an in-depth questionnaire about women’s health issues.

“We hope we’ll get straight answers,” says Catherine DeLorey, the group’s director. “A year ago, health care was a top concern among voters. But it’s taken a back seat to the economy, and the candidates may not get more specific about their plans.”

“Women have an enormous stake in what happens to our health care system because we use it more than men do but have a much harder time affording it,” agrees Amy Allina, program director of the Washington-based National Women’s Health Network. “We need to weigh our choices carefully and elect a leader who will address our health care crisis.”

Eighteen percent of women under 65 have no health coverage, reports the Kaiser Family Foundation. And medical prices are rising at three times the inflation rate, putting health care out of reach for a growing number of women, reports the Dallas-based National Center for Policy Analysis.

Women have greater annual medical expenses than men ($2,453 versus $2,316) and pay 19 percent versus 16 percent of expenses out of pocket, reports the Commonwealth Fund, in New York. One in five women has not filled a prescription because of costs, compared to one in eight men, reports the Women’s Universal Health Initiative.

Analysts at the Washington-based Tax Policy Center say Obama’s plan would cover more women but would be more expensive. Their Sept. 12 report estimates Obama would spend $1.6 trillion over 10 years and insure 34 million more people, while McCain would spend $1.3 trillion and insure 5 million more.

“Whether either plan could be fully funded is uncertain in this economy,” says Judy Waxman, a spokesperson for the National Women’s Law Center.

Obama’s Public-Private Approach

Obama has espoused a public-private reform approach, in which the most basic health services are publicly guaranteed.

A government-run program modeled on federal employees’ insurance policy would expand coverage to all children and to uninsured low-income people. It would pay for all essential services, including preventative, maternity and mental health care, though nonessential services may not be covered.

“Because women have lower incomes and a harder time affording insurance than men–and because paying for children’s health insurance is such a burden for single women–the changes Obama proposes so far could benefit women greatly,” says Waxman.

Obama would also create a National Health Insurance Exchange in which private insurers compete for business with the government. “Women could compare employer-provided benefits and prices with those on the exchange, and choose a plan that was most affordable and best for them,” says Allina.

The exchange would help lower-income people with federal subsidies afford private coverage.

The Obama plan would require insurers to charge consistent fees to all policyholders, and require companies to cover employees or else risk fines. Insurers could not turn away applicants with pre-existing conditions, a designation now sometimes assigned to pregnancy or to women who have had C-sections.

Obama would expand eligibility for Medicaid and State Children’s Health Insurance programs, known as SCHIPs, on which women rely more than men.

One potential drawback for low-income women is a catch with the pricing structure. People with no health problems would have little incentive to buy insurance until they need it, and those with health problems could buy more generous coverage at no personal cost.

“This could potentially drive up policy prices, making them far more expensive for the poor than Obama is predicting,” says Devon Herrick, a spokesperson for the National Center for Policy Analysis.

McCain’s Private-Insurance Approach

McCain’s plan restructures the health care system so there would be fewer employment-based group plans, which now cover 60 percent of families. Instead, he promotes private insurance policies such as health savings accounts, which allow people to contribute to a tax-exempt account and spend it on medical services as they choose.

McCain’s proposal would allow people to buy private coverage outside their states, and carry this private coverage more readily from one job to another.

“The flexibility of McCain’s plan is a plus for women, who are more likely than men to be self-employed, work part time, and move in and out of the labor market; all of which makes them more likely to purchase private insurance that can cost twice as much as employer-sponsored coverage,” says Herrick.

To offset the cost of private insurance–and to help low-income people who currently lack coverage–McCain’s plan includes a tax break ($2,500 for individuals and $5,000 for families) that Americans could use to purchase policies.

Nationwide, annual premiums average about $2,613 for individuals and $5,799 for families, reports the Washington-based America’s Health Insurance Plans. But policies in some states, particularly the Northeast, can be double that, making the McCain plan less attractive.

Even where premiums are around the average price, the difference between McCain’s tax break and the average price of insurance can be too high for women on tight budgets. Women would get a $2,500 individual and a $5,000 family tax break, but because average insurance costs are still higher, they could pay up to $800 out of their own pockets each year. It’s unclear how the proposal would impact low-income women’s ability to take the earned-income tax credit.

“Impoverished women may not be able to pay this difference,” says Waxman. “And insurance could be out of their reach if McCain doesn’t offer the tax break in advance.”

Molly M. Ginty is a freelance writer based in New York City.

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