Medical Coverage for Women

Going to the doctor is rarely a fun trip. It can be stressful, confusing and uncomfortable. For more and more American women, it also can trigger a financial panic attack.
Recent studies have shown that women face unique barriers to becoming insured and they are more likely to be under and uninsured. Our current system is a patchwork of employer-sponsored insurance, state programs and individual commercial policies. Every insurance company or government program has its own requirements and bureaucratic qualifications that often leave women with nowhere to go.
While men and women face many of the same problems to getting insurance, women are more likely to report cost-related access problems. Ttend to work at lower paying jobs or at part-time jobs where insurance is simply not provided.
Many women are insured through a spouse’s insurance. If their husband loses his job, dies or the couple divorces these women are left with few options for coverage. Twenty-four percent of women get their insurance through their spouse, compared with only 11 percent of men. This “dependant coverage” is important, but is also less stable. Many companies are cutting dependant coverage all together because of the high costs associated with providing insurance coverage for entire families.
Horse trainer and riding instructor, Pam Wagenheim knows all too well what can happen when a spouse’s job no longer provides insurance. Wagenheim relied on her husband’s plan to cover her medication for asthma. After their divorce she was left with few options. She paid her own premiums for six months through the COBRA program.
“It was awful,” she said. “I was on it for the maximum amount of time but it was really expensive.”
COBRA, or the Consolidated Omnibus Budget Reconciliation Act, is a federal program that allows people to continue their employer-sponsored health coverage after they are no longer covered by the company. The United States Department of Labor list qualifying events such as: voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan.
Dependants can often take advantage of the program if they lose coverage too. The problem is that the individual is now paying the corporation’s share of the premium as well an there own plus an extra 2 percent.. This becomes prohibitively expensive very quickly.
Wagenheim applied for coverage with Blue Cross and Blue Shield.
“They both turned me down,” she said. “Blue Shield because of my occupation and Blue Cross because of my asthma.”
She finally found coverage through a company she found on the internet. Assurant Health offered reasonable rates at first but they didn’t cover the cost of medications for the 38 year old equine specialist. What’s more, the company stated that they would terminate coverage in the event of a pregnancy, but also refused to cover birth control pills.
Luckily, Medicare provides coverage for pregnant mother and newborns, providing vital services and prenatal care. The government also provides some insurance coverage for children and low income families through the SCHIP and Medicaid programs. While this coverage is vitally important for many people, it cannot begin to offer coverage for the 44.8 million Americans who need it.
Sarah Uribe spent her entire childhood in California and uninsured. The 22-year old Women’s Studies major lived in constant fear of getting sick or injured. From riding her bike to climbing a tree, any normal activity could potentially be a disaster to the struggling family.
“Mom always said as we were in the car - you know you have to die if you get in an accident because we can't afford to take you to the emergency room,” she said. “We knew she was joking, but not really.”
Uribe’s worst fears became reality when she fell off her bike at the age of seven. Her bike had hit a rock and the little girl broke her arm at the wrist, completely separating her hand from the growth bone.
“I thought my mom was going to kill me,” she said.
Eventually, Uribe’s mother was forced to admit that she could not treat her daughter alone and took her to the hospital. The local low-cost clinic the family frequented was not equipped for such an emergency. She had to borrow almost $3,000 from family and friends to pay for medical treatment including x-rays and a cast.
People who don’t qualify for government help and who do not have coverage through their employers are left to find insurance on their own. Many large insurance companies such as Aetna and Blue Cross offer individual policies. Because they are not part of a group policy, the premiums are high and coverage is subject to preapproval.
Aetna routinely denies coverage to women who have experienced irregular periods in their lifetime. They also screen for cesarean section deliveries and any past treatment for depression. Women are three times as likely as men to seek treatment for depression.
While California has a reputation of being a health-conscious, progressive state, women are no better off here than in the rest of the country. In fact, they may be worse off. Nearly one in five California women — or 20 percent — is uninsured, compared to the national average of 14 percent, according to "Nearly A Failing Grade: A Report Card on the Health Status of Women and Girls in California," a study released by the The Women's Foundation, the largest philanthropic fund for women in the western United States.
The study uses both national and regional health data and the foundation has issued grades in four areas: access to health insurance (F); health status of women and girls (C-); women's health and the environment (D); and California's health policy framework (C-) for an average grade of "D."
It turns out California has the highest state uninsured rate in the nation overall. Of the 7.3 million uninsured Californians, 2 million are women and 60 percent of them are employed. According to the study, women who are at the highest risk for being uninsured are the young (ages 19 to 24); widows over the age of 55, divorced women, or those who have retired; women of color; immigrant women; and lesbians.
Students in the California State University system have the option of applying for health care through the school. The Klotz student health center at California State University, Northridge carries information about their insurance program. Requirements vary for international students and the cost is not insignificant. For about $900 a semester, non-international students who are enrolled in at least 9 units can get some insurance coverage. Students must have also attended classes for at least 45 days.
As with an HMO, students are required to go to the health center before seeing an outside doctor. A referral is required for outside treatment unless it is an emergency. About 80% of treatment costs are covered.
“It’s expensive, but it’s really my only option,” said Sedara Jones, a 23 year old English major at CSUN. “I can’t get coverage with my parents, so this is kind of it.”
The CSUN plan is underwritten by Anthem Blue Cross and covers pregnancy and maternity care for the student, spouse and dependent daughter as well as normal delivery, cesarean section, complications of pregnancy and abortion. There is also coverage for the well-baby and well-child programs.
OF course, once students drop below 9 units or graduate from college, they are left to find health care coverage all over again.
Uribe and Wagenheim have both found good insurance coverage and are enjoying the security of knowing they can go to a doctor when needed. Uribe recently married and, like many other women, is insured through her husband’s plan at UPS.
“If I feel like I have the flu, I can actually go to the doctor,” she said. “There are more resources available to me.”
Uribe also suffers from a blocked nasal passage due to another injury suffered as a child – a broken nose. Lack of health care meant that her nose had to heal without the benefit of a trained doctor to oversee treatment.
“I'll probably be able to fix my nose and it will be covered 100% by my insurance,” she said. Before, I would just have to accept that this is how it’s going to be forever.”
Wagenheim has also found coverage through a company that will accommodate her asthma and has fixed rates. The Alliance for Affordable Health Care took her information and found her a policy with Met Life. They cover her asthma medication and the $200 monthly fee is guaranteed not to go up for five years.
“My plan was $600 a month before and they didn’t cover medication,” she said. “The medications run $500 a month without coverage.”
Wagenheim is relieved to have found good coverage. She banged up her hand while riding last week and will now be able to go to a doctor and get it x-rayed.