Call it The Perry Effect.
The Commonwealth Fund, a New York-based health-policy think tank, recently estimated the impact of health reform on the rate of uninsured women in Texas. The authors estimated that the percent would decrease from the current rate of more than 30 percent to less than 12 percent.
That decrease did not take into account Gov. Rick Perry’s decision that Texas would not expand the Medicaid program in 2014 as part of the Affordable Care Act (ACA). D Healthcare Daily asked the authors to recalculate their estimate in light of Perry’s announcement.
The result: 20 percent of Texas women will remain uninsured, rather than the original 11.6 percent. In raw numbers, that means about 500,000 fewer women would gain insurance coverage because of the decision not to expand Medicaid.
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In addition to reducing the rate of uninsured women, the ACA also will ban what essentially makes being female a pre-existing condition worthy of higher insurance rates. The practice is known as gender rating. Because of it, women spend $1 billion more a year on health insurance premiums.
Insurers currently charge women more because they consume more healthcare than men do.
According to a study by the National Women’s Law Center (NWLC), more than 90 percent of individual health-insurance plans charge women higher premiums than for men for the same coverage. Remarkably, the study found that more than half of individual plans charge a 40-year-old, non-smoking woman more than a 40-year-old man who smokes.
Sara Collins, one of the Commonwealth Fund study authors, said women are hit particularly hard by out-of-pocket costs. Younger women are charged more in their childbearing years, and generally earn less than men do. That exposes them to greater financial burden.
About four out of 10 women spent $1,000 or more out-of-pocket for medical costs in 2009-2010, compared with about 1 out of 4 in Switzerland, 1 percent in Sweden, and zero in Great Britain, according to the Commonwealth Fund. One out of four U.S. women said they had problems paying for medical costs—twice as many as any other nation.
Gender rating also affects the group insurance market. Businesses with a predominantly female workforce often pay more for coverage. The healthcare industry is hit especially hard. More than three out of four hospital and physician office employees are women. The implication is that some healthcare companies may see a moderation in health insurance premiums.
According to a Kaiser Family Foundation poll, only about one out of three people were aware that the ACA banned gender rating. Surprisingly, six out of 10 respondents were in favor of that ban—including about 50 percent of Republicans.
The health law allows insurers to vary premiums based on whether it is an individual vs. family policy, age, tobacco use, and geography.
According to the NWLC report, maternity coverage is largely absent from the individual health-insurance market. In states where it is not required, only 6 percent of health plans provide maternity coverage.
Some states have attempted to provide some insurance-market protection for women. Fourteen states ban or limit gender rating in the individual market. Seventeen states ban or limit gender rating for group health plans. Nine states require all insurers in the individual market to cover maternity care. Texas is not among any of those groups.
Other notable Texas percentages from the NWLC report:
100: Best-selling plans that practice gender rating.
80: The proportion of plans that charge non-smoking women more than male smokers.
22-56: The range of excess women are charged for premiums by plans that practice gender rating.
0: Plans that offer maternity coverage, out of 118.