Health Insurance

September 13, 2011

Health insurance is a key factor facilitating access to health care services. Individuals without health insurance are often denied care, especially if the condition for which a patient is seeking care does not require any immediate attention and/or intervention. Uninsured and underinsured individuals tend to delay care and forego maintenance and/or routine health services to the extent that they can manage their symptoms. In addition, a large proportion of uninsured women do not see a medical specialist when needed and fail to fill prescriptions because of cost concerns.

Many studies have compared health care outcomes between insured and uninsured populations and invariably these studies have shown vast disparities by insurance status. Such disparities have been documented in the access, utilization, and outcomes pertaining to child care, prenatal care, cancer care, and a number of other clinical conditions. In comparing cancer-related outcomes, for example, studies have shown a greater likelihood of being diagnosed at later stages of disease among the uninsured, as compared to the insured. For cancers that are amenable to screening and prevention, such as breast and cervical cancer, such a finding reflects lack of access to cancer screening services.

To increase access to care among the near poor, state Medicaid programs have expanded their eligibility rules to provide coverage to pregnant women and children with household incomes exceeding the Federal Poverty Level (FPL). Similarly, there have been many programs in place to make it possible for elderly individuals with incomes higher than the FPL to enroll in Medicaid. Nevertheless, it has been estimated that approximately 14% of pregnant women (equating to over 450,000 women) remained without health care coverage when a substantial proportion may have qualified for Medicaid, and only half of the elderly potentially eligible for Medicaid actually enrolled in the program. Lack of knowledge of such programs, the stigma attached to welfare programs, and the long administrative process to enroll in Medicaid have been cited as possible reasons for low rates of participation in the program, especially in the elderly population.

According to recent census data, approximately 1 in 5 women 18-64 years of age is uninsured. Most uninsured individuals live in poverty or near-poverty, and many reside in rural areas. Eight percent of women receive health coverage through Medicaid; 40% through their own employment; 28% through their spouse’s employment, as a dependent; 3% through other public sources such as the Veterans Health Administration System; and 4% purchase their own insurance policy. In the latter scenario, the insurance premium can be prohibitively costly, and individuals are closely scrutinized for preexisting health conditions, such as a chronic disease. They may be denied an insurance policy in the presence of such conditions. When the purchaser is the employer, however, the management is able to negotiate a more affordable rate with insurance companies because of large volume and employees are not screened for preexisting health conditions.

Health benefits constitute an increasingly significant proportion of the fringe benefits offered by employers. As part of cost containment efforts, many employers have limited the scope of services covered in their health benefits and/or increased the employees’ share of health care expenses. Employers have also resorted to a wider base of part-time employees with limited or no fringe (health) benefits. Receiving coverage through a spouse’s employer may also be problematic, as women’s insurance status becomes dependent on their marital status, the spouse’s employment, and the employer’s decision to continue, discontinue, or limit health care coverage to the employees’ dependents. It is of note that lesbian women represent a particularly vulnerable subgroup of the female population (estimated at 3-10%) with respect to barriers they face in receiving health care coverage through their partner’s employer, as very few employers actually offer health insurance benefits to domestic partners. Even when the benefit is available, many are reluctant to let their sexual orientation be known to their employer for fear of discrimination.

Although most health plans provide coverage for various reproductive health services, such as pregnancy and childbirth, fewer plans actually provide coverage for contraceptives. According to the Henry J. Kaiser Family Foundation, only 13 states had enacted legislation as of October 2000 requiring coverage for contraceptive medication and supplies similar to other prescription medication. Nine other states had more limited provision. Coverage for mental health services is often offered on a limited basis as well. It has been reported that 26% of insured workers have coverage for a restricted number of outpatient visits (20 or less), and only 11% have coverage for an unlimited number of outpatient visits. Similar restrictions apply to the use of inpatient mental health services.

In the absence of universal health care, insurance coverage remains a key element to timely and adequate access to and use of health services. Women must capitalize on political gains made in the last several decades to further advance their cause in providing coverage to the most vulnerable subgroups of the population and to expand coverage to services in reproductive care and mental health.

SEE ALSO: Access to health care, Disparities in Women’s Health and Health Care (pp. 13-20), Medicaid, Medicare, Socioeconomic status

Suggested Reading

  • Ayanian, J. Z., Kohler, B. A., Abe, T., & Epstein, A. M. (1993). The relation between health insurance coverage and clinical outcomes among women with breast cancer. New England Journal of Medicine, 329, 326-331.
  • Conway, M. M., Ahern, D. W., & Steuernagel, G. A. (Eds.). (1999). Women and public policy. Washington, DC: CQ Press.
  • The Henry J. Kaiser Family Foundation. (2003). The women’s health data book.

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