1 No Where to TurnNo Where to Turn: Women and the Individual Insurance Market: Women and the Individual Insurance Market: Lisa Codispoti, Senior Counsel.

Slides:



Advertisements
Similar presentations
Health Insurance Coverage Among North Dakotans May 10, 2004 Alana Knudson, PhD Kyle Muus, PhD Mike Cogan, MA.
Advertisements

MEASURING LABOUR FORCE PARTICIPATION OF WOMEN
Insure Montana Small Business Health Insurance Program The Small Business Health Care Affordability Act, was requested by State Auditor John Morrison and.
The Role of Health Coverage in Eliminating Disparities in Care Marsha Lillie-Blanton, DrPH Associate Research Professor GWU School of Public Health and.
1 Private Insurance: What State Advocates Need to Know Cheryl Fish-Parcham Families USA January 25, 2007.
CHART 1 Federal Health Reform: Whats in it for Me? Cara V. James, Ph.D. Director of Race, Ethnicity and Health Care Kaiser Family Foundation January 28,
Health Insurance for the Sick Holly Whelan, MPA Health Action 2006 Conference Washington, D.C. January 27, 2006.
K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 0 Medicaid: The Essentials Diane Rowland, Sc.D. Executive Vice President, Henry J.
K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 0 Health Reform Primer: Who are the Uninsured? Diane Rowland, Sc.D. Executive Vice.
THE COMMONWEALTH FUND Adults Ages and the Affordable Care Act Sara R. Collins, Ph.D. Vice President, Affordable Health Insurance AARP and Alliance.
Jocelyn Guyer Co-Executive Director Center for Children and Families Georgetown University, Health Policy Institute April 4, 2011 Caucus Room, Cannon House.
Protecting Consumers Through Insurance Regulation Commissioner Sandy Praeger State of Kansas October 3, 2008.
Medicare: The Essentials Juliette Cubanski, Ph.D. Principal Policy Analyst Kaiser Family Foundation for Alliance for Health Reform Washington, D.C. March.
Health Insurance Regulation: Pricing Presentation for the Alliance for Health Care Reform By Thomas F. Wildsmith, FSA, MAAA, CLU, ChFC Hay Group, Inc.
Private Health Insurance: Challenges for Reform Karen Pollitz Research Professor Georgetown University Health Policy Institute Alliance for Health Reform.
K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 0 Childrens Coverage: The Role of Medicaid & SCHIP Diane Rowland, Sc.D. Executive.
Figure 0 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Medicaid: A Primer Robin Rudowitz Associate Director Kaiser Commission on Medicaid.
John M. Colmers Secretary Department of Health and Mental Hygiene How States Are Trying To Expand Employer Sponsored Health Coverage.
TABLE OF CONTENTS CHAPTER 1.0: Trends in the Overall Health Care Market Chart 1.1: Total National Health Expenditures, 1980 – 2007 Chart 1.2: Percent.
TABLE OF CONTENTS CHAPTER 1.0: Trends in the Overall Health Care Market Chart 1.1: Total National Health Expenditures, 1980 – 2010 Chart 1.2: Percent.
Figure 1. There Are 13.3 Million Uninsured Young Adults Ages 19–29, 30 Percent of the Nonelderly Uninsured, 2005 Source: Analysis of the March 2006 Current.
Majorities of Americans Across Income Groups Say that Candidates Views on Health Care Reform Will Be Important Factor in Election Decisions Percent Source:
Figure 1. Majority of U.S. Workers Get Health Insurance Through Employers, 2007 Own employer coverage 56% Other employer coverage 16% Public programs 5%
Figure ES-1. How Well Do Different Strategies Meet Principles for Health Insurance Reform? Principles for Reform Tax Incentives and Individual Insurance.
Minnesota Health Care Market Trends and Strategies for Cost Containment Health Care Transformation Task Force July 30, 2007 Julie Sonier Director, Health.
Presented by the Illinois Department of Insurance Andrew Boron, Director November 2012.
1 Office of Consumer Information and Insurance Oversight (OCIIO) OCIIO Office of Oversight Office of Insurance Programs Office of Consumer Support Office.
The Affordable Care Act and Ryan White 2013 United Conference on AIDS (USCA) New Orleans September 10, 2013 Jen Kates, Kaiser Family Foundation.
What You Need to Know about The New Health Reform Law Lisa Codispoti IDF Board Member and Patient Senior Counsel, National Womens Law Center June 25, 2011.
A Presentation of the Colorado Health Institute 1576 Sherman Street, Suite 300 Denver, Colorado Hot Issues in.
THE COMMONWEALTH FUND 1 Benefit Design for Public Health Insurance Plan Offered in Insurance Exchange Current Medicare benefits* New Public Health Insurance.
A Majority of Adults Who Are Potentially Eligible for the Law’s New Insurance Options Are Aware of the Marketplaces and the Availability of Financial Assistance.
Exhibit 1. The Affordable Care Act’s Key Coverage Accomplishments, November 2013 HEALTH INSURANCE COVERAGE PROVISION, START DATEIMPACT Young adults up.
THE COMMONWEALTH FUND Figure 1. Three of Five Health Care Opinion Leaders Feel that Mixed Private-Public Group Insurance Is an Effective Approach to Achieving.
HEALTH INSURANCE COVERAGE OF WORKING-AGE ADULTS. One-Third of Working-Age Adults Were Currently Uninsured or Had a Recent Gap* 164 million adults age.
Policy, Politics and Power: Building – And Passing – Our Health Access Law Ellen R. Shaffer PhD MPH Center for Policy Analysis
Minimum Creditable Coverage Policy Committee Meeting January 19, 2007.
STATE STRATEGIES TO EXPAND OR MAINTAIN HEALTH CARE COVERAGE Presentation to the Citizens’ Health Care Working Group May 12, 2005 Linda T. Bilheimer, Ph.D.
Trans Select 5, 10, 20 SM Group Voluntary Term Life Insurance.
HIV in the Southern United States: Regional Challenges & Opportunities Jen Kates, PhD June 18, 2014 Vice President; Director, Global Health & HIV Policy.
The Affordable Care Act: An Early Progress Report David Grande, MD, MPA Senior Fellow, Leonard Davis Institute of Health Economics Assistant Professor.
“CLEAN/Good Government”
California AB 2244 Applicants Under Age 19 Final Starting March 2, 2011.
The Affordable Care Act (ACA) and Health Care for People with Disabilities Presented by Lisa D. Ekman Director of Federal Policy, Health & Disability Advocates.
State Reforms of Small-Group Health Insurance Vivian Ho, Ph.D. Baker Institute Chair in Health Economics, Rice University Associate Professor, Baylor College.
RIte Share Premium Assistance Program Then and Now Kate Brewster, Manager Employer Contact Unit Center for Child and Family Health RI Department of Human.
THE COMMONWEALTH FUND Rising Numbers of Uninsured Young Adults: Causes, Consequences, and New Policies Jennifer L. Nicholson Associate Program Officer.
THE URBAN INSTITUTE Genevieve Kenney 2009 ACAP Medicaid Managed Care Policy Summit Hotel Monaco – Washington, DC July 15, 2009 Health Reform for Children:
Massachusetts HC Reform November 29, The Context The problem of the “uninsured” and “underinsured” is perennial issue Clinton Health Security Act.
Overview of Health Care Coverage and Cost Trends in Minnesota Presentation to the State Budget Trends Study Commission April 22, 2008 Julie Sonier Director,
1 WHAT IT MEANS FOR YOU? April Health Access is the leading voice for health care consumers in California. Founded in 1987, Health Access is the.
Presented by the Illinois Department of Insurance Andrew Boron, Director SEPTEMBER 2012.
Health Care Reform in California Steven P. Wallace, Ph.D. UCLA Center for Health Policy Research & UCLA School of Public Health UCLA Center for Health.
Presented by the Illinois Department of Insurance Andrew Boron, Director December 2014.
What Does Health Care Reform Mean for You? Presented by Alliance 360° Insurance Solutions © 2013 Zywave, Inc. All rights reserved.
Section 5: Public Health Insurance Programs Medicare Medical Assistance (Medicaid) MinnesotaCare General Assistance Medical Care (GAMC) Minnesota Comprehensive.
Health Insurance Coverage of the Nonelderly, 2010 * Medicaid also includes other public programs: CHIP, other state programs, Medicare and military-related.
Impact of Healthcare Reform (PPACA)March The Impact of Healthcare Reform (PPACA) on City Employees Presented by: Lisa Ghotbi - Deputy Director,
Health Care Reform: Understanding your new healthcare options What do I need to know? Presented by: Michigan Consumers for Healthcare
Women’s Health: Key Issues for the Election and Beyond Alina Salganicoff, Ph.D. Vice President and Director, Women’s Health Policy The Henry J. Kaiser.
The Affordable Care Act’s Patients’ Bill of Rights Presented by Cobbs Allen © 2013 Zywave, Inc. All rights reserved.
+ The Affordable Care Act. + Outcomes Participants will: Gain knowledge of the history of the Affordable Care Act; Understand the benefits for children.
Health Insurance Exchanges
THE COMMONWEALTH FUND Achieving and Maintaining Near Universal Coverage Under the Affordable Care Act: Key Issues For Federal and State Policy Makers Sara.
Legal/Regulatory Issues in Life and Health Insurance RMI 4115.
American Public Health Association Annual Meeting November 2010 Judy Waxman National Women’s Law Center.
1 WOMEN AND HEALTH REFORM: LESSONS FROM MASSACHUSETTS November 9, 2010 American Public Health Association Annual Meeting Tracey Hyams, JD, MPH, Director.
National Conference of State Legislatures National Medicaid Congress June 5, 2006 State Pharmaceutical Assistance Programs, Medicaid & Part D: 2006 State.
Health Reform: An Overview Unit 4 Seminar. The Decision The opinions spanned 193 pages, upholding the individual insurance mandate while reflecting a.
State Coverage Initiatives Chiquita Brooks-LaSure June 15, 2007
Presentation transcript:

1 No Where to TurnNo Where to Turn: Women and the Individual Insurance Market: Women and the Individual Insurance Market: Lisa Codispoti, Senior Counsel National Womens Law Center Families USA Health Action January, 2009

2 Overview Women and the individual insurance market Brief background on women and health coverage Overview of challenges women face getting coverage in the individual market Practice of Gender rating Availability of Maternity coverage How health reform can help

Insurance Coverage Patterns: Adults 18-64, 2006 Source: 2007 CPS Data

Insurance Coverage Patterns: Uninsured by Age Source: 2007 CPS Data

Insurance Coverage Patterns: Uninsured Women by State Source: NWLC analysis of 2006 & CPS Data

Insurance Coverage Patterns: Uninsured & Employment Status Source: NWLC Analysis of March 2005 Current Population Survey Uninsured Men Uninsured Women Full-Time 69% Full-Time 43% Not working 35% Not working 18% Part-Time 22% Part-Time 13%

Women and the Affordability Gap On average, women use more health services than men Reproductive health needs Prescriptions drugs More likely to have a chronic condition (38% vs. 30%) Certain mental health problems affect twice as many women

Women and the Affordability Gap Regardless of insurance status, women are more likely than men to: Spend greater than 10% of their income on out-of-pocket costs Avoid necessary health care due to cost Face medical bill problems

9 Where Do Women Get Their Health Coverage? Source: U.S. Census Bureau, Current Population Surveys 2008 Annual and Social Economic Supplement

10 Why Understand the Individual Market? Only a modest number of women are currently covered that way, BUT 1.Many more try to find individual market coverage without success – nearly 9 out of 10 people who seek policies do not ultimately buy a plan 2.Some employers are replacing employer-sponsored coverage with fixed sums to buy insurance through the individual market 3.Some proposals would expand the individual market 4.There are critical differences between employer- sponsored coverage and individual market coverage

11 Nowhere to Turn: How the Individual Health Insurance Market Fails Women

Some Definitions Medical Underwriting = Insurance companies decide 1)Whether to offer coverage 2)What to cover and 2) What premium to charge Gender Rating = Insurers charge women and men different premiums for the same health insurance coverage Actuarially Justified = Based on actual differences in providing health insurance to women versus men (insurance industry defense for gender rating)

13 Challenges Women Face in the Individual Market Rejection based on health history –Insurers in 9 states and D.C. can reject applicants who are survivors of domestic violence –Insurers can reject women for coverage based on a previous Cesarean section Rating based on age Rating based on gender Rating based on health status Pre-existing condition exclusions

14 State Efforts to Protect Against Gender Rating Bans gender rating: ME, MA, NJ, NY, OR, WA, MN, MT, NH, ND Limits gender rating with rate band: NM, VT State does not have protections against gender rating

Key Findings – Gender Rating Gender rating is prevalent throughout the country among similar plans: –At age 25, women are charged between 6% and 45% more than men. –At age 40, women are charged between 4% and 48% more than men. –At age 55, women are charged between 22% less and 37% more than men. Wide variations across and within states undercuts insurance industry defense of gender rating as actuarially justified – and raise questions of arbitrariness Maternity coverage does not explain the difference

Key Findings – Maternity Coverage Most Individual Market Insurance Policies Do Not Cover Maternity Care *Comprehensive maternity coverage includes coverage for prenatal care, labor, delivery, and postnatal care, for both routine pregnancies and in case of complications. *

17 Maternity Riders: A Bad Deal for Women Example: A woman pays $106 per month for a maternity rider, in addition to her regular health insurance premium. Her rider requires 20 % coinsurance and covers just $2,000 of maternity charges for the first 2 years she is enrolled. Uncomplicated Vaginal Delivery (2006 Average = $7,488) Cesarean Section with Complications (2006 Average = $16,996) Rider Covers$2, % Coinsurance$1,498$3,399 Over Benefit Limit$3,990$11,597 Annual Rider Premium $1,272 Woman PaysAt least $6,760At least $16,268

State Efforts to Ensure Access to Maternity Care 5 states have passed laws requiring all health insurers in the individual market to include maternity coverage –MA, MT, NJ, OR, WA Other states have adopted laws that are more limited in scope: –Only certain insurers are subject to the law –Insurers are merely required to offer the coverage Some states have enacted public programs to fill in the gaps

Some recent developments Gender Rating: Several states with possible legislative proposals to ban gender rating MT legislation filed to repeal gender rating ban Litigation: CA (filed by city of San Francisco) Maternity Coverage: CA: Maternity coverage mandate legislation vetoed by Governor

20 For More on Women and Health Reform… Visit our website to: –Download a copy of our report No Where to Turn –Download or request a copy of our Reform Matters toolkit for advocates –Participate in our monthly conference calls –Request technical assistance on health reform Contact us at Lisa Codispoti