1. 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. 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

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

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

5. Insurance Coverage Patterns: Uninsured Women by State Source: NWLC analysis of 2006 &2007 7 CPS Data

6. 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%

7. 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

8. 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. 9 Where Do Women Get Their Health Coverage? Source: U.S. Census Bureau, Current Population Surveys 2008 Annual and Social Economic Supplement

10. 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. 11 Nowhere to Turn: How the Individual Health Insurance Market Fails Women

12. 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. 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. 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

15. 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

16. 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. 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$2,000 20 % 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

18. 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

19. 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. 20 For More on Women and Health Reform… Visit our website www.nwlc.org/reformmatters to:www.nwlc.org/reformmatters –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 reformmatters@nwlc.orgreformmatters@nwlc.org Lisa Codispoti lcodispoti@nwlc.org 202/588-5180lcodispoti@nwlc.org