Why do we need health care reform with a public option? Because one of the last bastions of legal discrimination against women is the individual health care market.
In a Colorado legislative health care task force hearing Monday morning, Colorado State Sen. Joyce Foster (D-Denver) asked insurance broker/insurance underwriters representative Jamie Scholl why women pay more than men for health insurance in the individual insurance market. His answer: "You'll have to ask God, because he put our parts on the outside and yours on the inside." Crude and laughable, but the rest of the insurance industry's reasoning basically follows the same appalling logic (and just for emphasis, he repeated his response in the afternoon session). Women are complicated and more health conscious, therefore more expensive. Men are simpler and less likely to see a doctor, therefore cheaper. Another health insurance lobbyist backed him up in the Denver Post, telling a reporter that women's health care is more expensive because their reproductive systems are more complex and require more complicated, costly and risky procedures.
Bottom line: the insurance industry uses gender ratings in the individual market to penalize women for taking better care of their health.
The individual market (as opposed to employer-based group insurance) is already the insurance of last resort for many people, and anyone needing to buy insurance that way pays more than in just about any other case. Fewer than a dozen states ban gender in individual market rate setting, although the use of gender in GROUP market rate setting has been prohibited since the Civil Rights Act. In the individual insurance market, discrimination against women is standard operating procedure. In a report last fall, the National Women's Law Center analyzed 3,500 individual health insurance plans and found that insurers charged 40-year-old women anywhere from 4 percent to 48 percent more than they charged men of the same age. It may take two to tango (insert Gov. Sanford joke here), but thanks to gender ratings, only one partner pays higher insurance rates. Quite simply, women of reproductive age are penalized for potentially being sexually active - whether they get pregnant or not. Go to a doctor, get birth control, and your 'health status' changes. Never mind that you're saving the insurance company money by preventing an unwanted pregnancy.
And conversely, as this woman belatedly and regrettably found out, good luck getting maternity care. In most cases, maternity care is an optional rider on an individual insurance policy, not picked up by the insurer. Policies will cover complications from a pregnancy, but not the pregnancy itself. Or, they may have caps so low ($3000 in this case) as to be basically useless. Know what else changes your 'health status' and your rates? Domestic violence -- in 9 states and the District of Columbia, it's legal to use domestic violence as a factor in gender ratings for health insurance.
Gender ratings discourage exactly the kind of behavior we actually want to encourage -- taking responsibility for health care, seeing a doctor regularly, and preventing unwanted pregnancies. It's incident-based, rather than outcome-based, health care. As CO Sen. Gail Scwartz (D-Aspen/Snowmass) pointed out in an AP article, why should only one-half of the responsible party pay the price? Sen. Foster added that women are being forced to subsidize health care for young men, and that it's unfair for one group of people to pay one rate and another group a higher rate for medical care.
But the insurance industry isn't in the fairness business, they're in the profit business - and as they told the legislators, if health care is left up to them, policymakers will just have to choose between fairness and economics.
Here's a newsflash for the insurance industry: the health issues of the majority of the population aren't a more-expensive aberration, they should be an accounted-for norm. This is why we need a public option -- so that women can speak with their checkbooks and choose health care that treats them as equals. Regardless of plumbing.