A report issued by The Commonwealth Fund on Aug. 30 says the number of uninsured women between the ages of 18 and 64 grew three times faster than the number of uninsured men. Although the number of the uninsured increased for both groups between 1994 and 1998, the increase for women – 2.2 million vs. one million for men – was much greater.
If these trends continue, the fund says, the number of uninsured women will surpass the number of uninsured men by 2005, and the unique challenges women face in accessing both health care and health insurance will grow worse.
The report, titled “Health Care Access and Coverage for Women: Changing Times, Changing Issues?” says lack of insurance is a serious problem for women because their health needs are greater than men’s: women are more likely than men to have chronic illness and more likely to have mental health problems.
They are also more likely to use prescription drugs than men. According to the Commonwealth study, 80 percent of women aged 50 to 70 regularly use prescription drugs compared to 71 percent of men. They also have higher health care expenses than men and pay a greater proportion out of pocket.
According to the fund, the decline in health care coverage for women can be attributed to three factors, among them the increased cost. During the five-year period 1993-1998, the percentage of women with an income of less than $15,000 a year who were able to maintain private insurance coverage dropped from 44 percent to 37 percent.
At the same time, private insurance rates for those earning $15,000 to $35,000 dropped by one eighth, from 82 percent to 72 percent. Today, low-income mothers account for three of five uninsured parents and represent more than a quarter of uninsured women.
Cost is also a factor in the number of women – 20 percent compared to 15 percent for men – who turn down employer-based insurance and thus become uninsured. The report says that 60 percent of these women “probably” cannot afford the premium, notwithstanding the fact that women tend to need healthcare and health insurance more than men.
A second major reason for the disparity between the number of uninsured women and men is that women with older husbands are often left without health insurance when their husbands retire, because the wife is too young to be covered by Medicare. (Over one-fifth of women over age 50 with a retired, older husband are uninsured.)
Insurance companies have also contributed to the increase in the number of uninsured women, About 80 percent of uninsured women live in states that allow insurers of individual insurance policies to deny coverage to applicants.
In addition, about 75 percent of uninsured women live in states without constraints on the premiums that can be charged.
Moreover, women may not get the benefits that they need, since individual insurance policies typically exclude or increase premiums for services like maternity care, prescription drugs, and mental health coverage.
The Commonwealth study also looked at what it called “the impact of different approaches to expanding coverage to women” and offered two proposals, the first to build on Medicaid and the Children’s Health Insurance Program by providing additional federal financing to states to cover low-income parents.
“[This] would disproportionately benefit women and their children,” the fund said. “It also would be relatively easy to accomplish since these parents’ children are already eligible for or enrolled in these programs.”
A second proposal called for extending the eligibility of public programs like Medicare or the Federal Employees Health Benefits Program to people ages 55 to 65, or at least to spouses of Medicare beneficiaries. This, the study said, “could provide an affordable alternative that disproportionately benefits women, who are more likely than men to be uninsured at this age.”