Women pay higher price out of pocket than men for health insurance

1/7/09 5:00 PMWomen Buying Health Policies Pay a Penalty - NYTimes.com
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October 30, 2008
Women Buying Health Policies Pay a Penalty
By ROBERT PEAR
WASHINGTON — Striking new evidence has emerged of a widespread gap in the cost of
health insurance, as women pay much more than men of the same age for individual
insurance policies providing identical coverage, according to new data from insurance
companies and online brokers.
Some insurance executives expressed surprise at the size and prevalence of the
disparities, which can make a woman’s insurance cost hundreds of dollars a year more
than a man’s. Women’s advocacy groups have raised concerns about the differences,
and members of Congress have begun to question the justification for them.
The new findings, which are not easily explained away, come amid anxiety about the
declining economy. More and more people are shopping for individual health insurance
policies because they have lost jobs that provided coverage. Politicians of both parties
have offered proposals that would expand the role of the individual market, giving
people tax credits or other assistance to buy coverage on their own.
“Women often fare worse than men in the individual insurance market,” said Senator
Max Baucus, Democrat of Montana and chairman of the Finance Committee.
Insurers say they have a sound reason for charging different premiums: Women ages 19
to 55 tend to cost more than men because they typically use more health care, especially
in the childbearing years.
But women still pay more than men for insurance that does not cover maternity care. In
the individual market, maternity coverage may be offered as an optional benefit, or
rider, for a hefty additional premium.
Crystal D. Kilpatrick, a healthy 33-year-old real estate agent in Austin, Tex., said: “I’ve
delayed having a baby because my insurance policy does not cover maternity care. If I
have a baby, I’ll have to pay at least $8,000 out of pocket.”
In general, insurers say, they charge women more than men of the same age because
claims experience shows that women use more health care services. They are more
1/7/09 5:00 PMWomen Buying Health Policies Pay a Penalty - NYTimes.com
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claims experience shows that women use more health care services. They are more
likely to visit doctors, to get regular checkups, to take prescription medications and to
have certain chronic illnesses.
Marcia D. Greenberger, co-president of the National Women’s Law Center, an advocacy
group that has examined hundreds of individual policies, said: “The wide variation in
premiums could not possibly be justified by actuarial principles. We should not tolerate
women having to pay more for health insurance, just as we do not tolerate the practice
of using race as a factor in setting rates.”
Without substantial changes in the individual market, Ms. Greenberger said, tax credits
for the purchase of insurance will be worth less to women because they face higher
premiums.
The disparities are evident in premiums charged by major insurers like Humana,
UnitedHealth, Aetna and Anthem, a unit of WellPoint; in prices quoted by eHealth, a
leading online source of health insurance; and in rate tables published by state high-
risk pools, which offer coverage to people who cannot obtain private insurance.
Humana, for example, says its Portrait plan offers “ideal coverage for people who want
benefits like those provided by big employers.” For a Portrait plan with a $2,500
deductible, a 30-year-old woman pays 31 percent more than a man of the same age in
Denver or Chicago and 32 percent more in Tallahassee, Fla.
In Columbus, Ohio, a 30-year-old woman pays 49 percent more than a man of the same
age for Anthem’s Blue Access Economy plan. The woman’s monthly premium is $92.87,
while a man pays $62.30. At age 40, the gap is somewhat smaller, with Anthem
charging women 38 percent more than men for that policy.
Todd A. Siesky, a spokesman for WellPoint, declined to comment on the Anthem rates.
Thomas T. Noland Jr., a senior vice president of Humana, said: “Premiums for our
individual health insurance plans reflect claims experience — the use of medical
services — which varies by gender and age. Females use more medical services than
males, and this difference is most pronounced in young adults.”
In addition, Mr. Noland said, “Bearing children increases other health risks later in life,
such as urinary incontinence, which may require treatment with medication or surgery.”
Most state insurance pools, for high-risk individuals, also use sex as a factor in setting
rates.
1/7/09 5:00 PMWomen Buying Health Policies Pay a Penalty - NYTimes.com
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rates.
Thus, for example, in Dallas or Houston, women ages 25 to 29 pay 39 percent more
than men of the same age when they buy coverage from the Texas Health Insurance
Risk Pool.
In Nebraska, a 35-year-old woman pays 32 percent more than a man of the same age
for coverage from the state insurance pool.
Representative Xavier Becerra, Democrat of California, said that “if men could have
kids,” such disparities would probably not exist.
Elizabeth J. Leif, a health insurance actuary in Denver who helps calculate rates for
Nebraska and other states, said: “Under the age of 55, women tend to be higher utilizers
of health care than men. I am more conscious of my health than my husband, who will
avoid going to the doctor at all costs.”
“Many state insurance laws require insurance policies to cover complications of
pregnancy, even if they do not cover maternity care,” Ms. Leif said. Insurers say those
complications generate significant costs.
Representative Lloyd Doggett, Democrat of Texas, asked, “How can insurers in the
individual market claim to meet the needs of women if maternity coverage is so difficult
to get, so inadequate and expensive?”
Cecil D. Bykerk, president of the Society of Actuaries, a professional organization, said
that if male and female premiums were equalized, women would pay less but “rates for
men would go up.”
Mr. Bykerk, a former executive vice president of Mutual of Omaha, said, “If maternity
care is included as a benefit, it drives up rates for everybody, making the whole policy
less affordable.”
The individual insurance market is notoriously unstable. Adults often find it difficult or
impossible to get affordable coverage in this market. In most states, insurers can charge
higher premiums or deny coverage to people with health problems.
In job-based coverage, civil rights laws prohibit sex discrimination. The Equal
Employment Opportunity Commission says employers cannot charge higher premiums
to women than to men for the same benefits, even if women as a class are more
expensive. Some states, including Maine, Montana and New York, have also prohibited
sex-based rates in the individual insurance market.
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sex-based rates in the individual insurance market.
Mila Kofman, the insurance superintendent in Maine, said: “There’s a strong public
policy reason to prohibit gender-based rates. Only women can bear children. There’s an
expense to that. But having babies benefits communities and society as a whole. Women
should not have to bear the entire expense.”
And that expense can be substantial.
In Iowa, a 30-year-old woman pays $49 a month more than a man of the same age for
one of Wellmark’s Select Enhanced plans. Her premium, at $151, is 48 percent higher
than the man’s.
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My Thoughts:
-While health disparities are often discussed in terms of racial or ethnic differences, I think this article highlights the fact that health insurance and quality healthcare are very gendered issues.
-Although there are many women's health programs and hospitals, few work to counteract the economic differences that women face due to health costs. In discussing gender differences in health coverage, I think it is also important to think about single mothers who have the burden of providing health insurance for their children as well.
-The reason I found this article to be relevant to my site (Planned Parenthood) and our readings in general is because this issue crosses class, race and sexuality lines. Women of any group or category can be affected by higher health costs due to biologic differences.

Activity Goal: I would like to get the students thinking about what "health disparities" actually means and why it has far-reaching affects for many people in our society.

1. Show clips from Michael Moore's film "Sicko" to demonstrate the broad range of people lack of healthcare affects and what it means.
2, Quick Write: Please spend five minutes writing about how what health disparities mean to you and how they impact your everyday life. If you cannot think of an example or personal story, simply write about what you have heard in the media or from friends/family about the issue.

Discussion Questions:
1. If anyone feels comfortable sharing. Why did this particular idea/story come to mind? What does health disparities mean to you?
2. There are so many discussions about how to fix the healthcare system - universal healthcare, employer based, individual mandates. Based on your own experiences and school work, what are some problems you see with the current political arguments? Are any populations left out? (One clear example for our seminar would be abortion in universal healthcare. Would it be opposed or included?)
3. Why do you think health disparities generally focus on racial differences? Is it possible for women to health equality in an area where there are inherent, biological differences?

This is a really interesting

This is a really interesting subject. I love your activity, and the movie Sicko is a GREAT way of demonstrating our nations shortcomings in giving all of its citizens equal opportunity. I'm not sure if I could add or recommend anything further for your discussion questions. I know that if I were in this discussion I would definitely have a few things to say because my parents don't have health insurance, so of course I don't, and many people don't understand how this can happen to people. I've been told by doctors that "I need to GET insurance" as if it's just that easy. This sounds like it would be a good eye opener, and definitely more so considering the gender aspect.

I think this looks really

I think this looks really interesting and gives students a chance to really give their own opinions and experiences. Just have a back up so if they do not feel comfortable getting really personal- how are you going to coax them to talk about something controversial? Maybe you could find an online example or make a hypothetical story to bring in and have students work in groups talking about it...that way they can share their ideas without having it feel personal.