New Health Law Brings Better Coverage For Women
Maria Villa, who cannot afford insurance, has her pregnant belly examined in 2009. - New insurance plans that start up five months from now will allow women to go directly to obstetricians and gynecologists, without a referral from a primary care doctor. (Joe Raedle / Getty Images)
Among the many goals of the new health law is one that hasn't received much attention: to improve women's experiences in the health insurance world. For some women, insurance policies cost far more than those for men their age; some women simply can't find an insurer to cover them. And, even for women who have insurance, sometimes it just doesn't cover certain scenarios, like pregnancy.
Take the case of Jody Miller, an exercise physiologist who wanted to have a baby. She had insurance, but it didn't cover most of her infertility costs. So, she paid about $22,000 out of pocket.
After her triplets were born, she and her husband went looking for a less expensive insurance policy. Miller says one company told them, "Fine, we're happy to insure your children, but because of your infertility, we won't insure you or your husband." That was even without infertility coverage. Other insurers denied her as well.
"I'm as healthy as they come," Miller says. She wound up in a special Maryland state pool for people who can't get insurance.
Or consider Jenifer Wilson of Vancouver, B.C., who used to live in Indiana. She had an unexpected pregnancy seven years ago. She and her husband then discovered their insurance didn't cover her pregnancy. It only would have covered the pregnancy if they paid an additional $350 a month, starting before conception.
That means they had to pay for an emergency cesarean section out-of-pocket. And when they subsequently looked for a different insurance policy, they couldn't get one.
"That's when I realized I wasn't eligible," says Wilson. Her C-section counted as a pre-existing condition.
High Hopes For The New Health Law
Wilson had a work visa and a job with a Canadian company at the Vancouver Olympics, which got her into the Canadian health insurance plan. She has another baby due in August, but her work visa runs out at the end of July, so her Canadian health insurance does, too.
Even if she can't find a way to extend it, she's going to stay in Canada. The out-of-pocket costs for a C-section are about a third of what they are in the U.S., she says. But she might come back to the U.S. eventually because she has "really high hopes" for the new health law.
In fact, she would be helped, but not until 2014, when the new health insurance exchanges kick in. Those exchanges will offer health insurance policies that include pregnancy coverage. And under the new law, Wilson's rates would be the same as everyone else's her age; they won't be based on her personal health history or her sex.
A Lot To Gain
Wilson's and Miller's problems are due in part to the fact that they were getting individual insurance policies -- not group policies through a mid- or large-sized company. Even without the new law, those group policies don't cost more for women, and pre-existing conditions don't come into play.
But it's different for individual and small-group policies. In 2009, the National Women's Law Center, an advocacy group that worked hard to get the new law passed, found that insurance companies charged women up to 84 percent more than men for the exact same health insurance policy, even without coverage for maternity care.
"Women have an enormous amount to gain from this bill," says Marcia Greenberger of the National Women's Law Center. Other provisions of the new law will help women who get their insurance through mid- and large-sized employers, she says.
"The health care bill requires employers with 50 or more employees to provide a place and time for nursing mothers to lactate," she says. And new insurance plans that start up five months from now and later will have to allow women to go directly to obstetrician/gynecologists without a referral from a primary care doctor. Insurers also won't be allowed to charge co-payments and other upfront costs for preventive services like mammograms and pap smears.
Gail Wilensky, an economist who headed Medicare during George H. W. Bush's presidency, says these provisions will help women who've previously been shut out of the insurance market, though, "in the short term at least, they're going to bump up the cost of health care."
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STEVE INSKEEP, host:
When it comes to health insurance in the United States, being a woman can mean paying more. The new health law is designed to end the disparity and it has other special provisions in it for women. NPR's Joanne Silberner reports on how women's dealings with health insurers will change under the new law.
JOANNE SILBERNER: Marcia Greenberger has bothered by the disparities for years. She's co-president of the national women's law center, a nonprofit advocacy group that worked hard to influence what was in the final legislation.
Ms. MARCIA GREENBERGER (Co-president, National Woman's Law Center): The truth is those women have really gotten the short end of the stick in health care, in many, many ways. And as a result, have an enormous amount to gain from this health care bill.
SILBERNER: One of those women who could gain is Jenifer Wilson, who helps organize and produce events like the Olympics. Seven years ago, when Wilson was 31 years old, she had an unplanned pregnancy. She and her husband had an insurance policy, but it turned out it didn't include maternity benefits. They realized they had to do something about coverage.
Ms. JENIFER WILSON: And we quickly found out that the only way that you could even get maternity is if you self-pay into the plan.
SILBERNER: Self-pay where they pay their insurer an extra $350 a month, starting before conception. Wilson was essentially uninsured. She ended up having to pay out-of-pocket for what turned out to be an emergency caesarean section. Then she and her husband went looking for another insurance policy.
Ms. WILSON: And that's when we realized that since I had the c-section, previously, I wasn't even eligible for the pay in plan anymore, because they saw it as a pre-existing condition.
SILBERNER: As free lancers, she and her husband were looking into plans just for their family. That means without the protections and discounts you get in a group plan from a mid- to large-sized employer, the kind most people have. So Wilson took a job at Lowes. It meant a 50 percent cut in income, but it came with health insurance.
Women have faced other problems, as well, says Marcia Greenberger of the National Women's Law Center. Her group has found insurance policies in some states that cost a woman 50 percent more than it would cost a man, even 85 percent more, and these policies don't cover pregnancies. That, she says, will go away with the new health insurance shopping marts, the so-called exchanges scheduled to start up in 2014.
Ms. GREENBERGER: Any individual woman or a person who's trying to buy insurance through a small employer or a small-group plan, through the exchange, will be able to buy that insurance without having to pay the extra premium for being a woman. And maternity is also required to be included.
SILBERNER: There are more benefits for women in the new law, including women insured by medium and large employers. For example, starting next year no co-payments for preventive services like mammograms and pap smears. And businesses that employ 50 or more people will have to provide a place and time for nursing mothers to be able to lactate.
The new law does include many provisions that will help women, says Gail Wilensky. She's an economist who headed Medicare during the first President Bush's administration. But there's one thing, she says, people shouldn't forget.
Ms. GAIL WILENSKY (Economist): In the short term, at least, they're going to bump up the cost of health care. All of these will increase the cost of insurance, along with various other provisions.
SILBERNER: Including another provision women might like. The requirement, that starting five months from now, new health insurance plans must permit women to see obstetrician/gynecologists without first getting authorization from a primary care doctor.
Joanne Silberner, NPR News.
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INSKEEP: This is NPR News. Transcript provided by NPR, Copyright National Public Radio.
