The Inherent Inequality of Health Care for Women

The political debate that has been occupying much of our time over the past several weeks -- that of Obama's health care plan granting free access to birth control for women -- fails to take into account an inherent gender inequality with regard to health care.

The political debate that has been occupying much of our time over the past several weeks -- that of Obama's health care plan granting free access to birth control for women -- fails to take into account a deeper problem at stake, which is an inherent gender inequality with regard to health care. When Rush Limbaugh, for instance, talks so charmingly about how he shouldn't have to pay for someone to have sex (and that if he does, he wants a sex tape in return), a statement then echoed by other more seemingly functional members of society, he fails in two ways. Along with a failure to understand how birth control works in the first place, he's also failing to acknowledge that a gender gap already exists with regard to health care.

Robert Pear, writing in The New York Times, explains, "Women still pay more than men for the same health insurance coverage, according to new research and data from online brokers." Though Obama's Affordable Care Act, signed on March 23, 2010, will ban gender rating starting in 2014, the gender gap currently exists "in most states," leading to inequalities, often highly variable, like the following:

For a popular Blue Cross Blue Shield plan in Chicago, a 30-year-old woman pays $375 a month, which is 31 percent more than what a man of the same age pays for the same coverage, according to eHealthInsurance.com, a leading online source of health insurance.

In Louisville, Ky., according to eHealthInsurance.com, a 40-year-old nonsmoking woman pays $196 a month for a HumanaOne policy. That is 53 percent more than the $128 premium paid for the same coverage by a nonsmoking man of the same age. In addition, the nonsmoking woman pays 14 percent more than the $172 premium charged to a man of the same age who has used tobacco in the past year.

Disconcertingly, "more than 90 percent of the best-selling health plans charge women more than men" in states that haven't banned gender rating (14 states, including California, New Jersey, and New York, have moved to limit or get rid of gender rating in the individual insurance market), writes Pear. Civil rights laws have prevented employers offering group benefit plans from charging higher premiums to women than men for the same benefits. But in the individual insurance market, that has not happened.

Why has gender rating been considered acceptable in the first place? According to insurers, women use health care more and "are more likely to visit doctors, to get regular checkups, to take prescription drugs and to have certain chronic illnesses."

Women also, on average, live longer, possibly because they tend to take better care of themselves and go to doctors. And they have routine checkups as women that men don't have -- routine checkups that can prevent big insurance costs down the road. (These rate differences do not include maternity care, which is not part of the standard package, generally, and bumps costs up even higher; the Affordable Care Act would require plans to cover it as an essential health benefit.) But the category of prescription drugs does seem to include birth control. Thus, in some places, women are not only paying for their birth control itself, but also paying a higher insurance premium that says that, because they're women, they might buy it -- or have children. 

The Affordable Care Act also prohibits sex discrimination in health programs receiving federal assistance and mandates that insurers can't charge higher rates to the sick and that rate variance for smokers and older people must be limited. The act is being challenged by 26 states who oppose the requirement that Americans must buy insurance or pay a penalty, as well as the expansion of Medicaid; the Supreme Court case, which will begin next week, is being touted as "an exceptionally important case in every dimension."

One thing is clear: Given the inequalities that continue to exist with regard to health care, contraception access -- which, while provided to women, is indisputably applicable to both genders -- is just one part of the overall story.