On Wednesday, a packed room of women (and a few brave men) gathered to hear a panel of leaders in Massachusetts health care reform speak about how state and national reform impacts women’s health coordinated by the Massachusetts Health Policy Forum (read the studies and presentations).
Not surprisingly, women use the health care system more often then men. By design, we give birth, and we typically live longer. It was disconcerting, however, to learn that even with health care reform laws working to eliminate disparity in insurance coverage because of gender, women still struggle to get coverage and medical attention we need. As one panelist aptly stated, recently adopted health care reform laws merely provide an outline, and implementation is an evolving process that must be continually addressed at the state or local level. Nancy Pelosi’s powerful statement resonated throughout the forum, “Being a woman is no longer a preexisting condition.” Despite initial efforts to ensure everyone has access to coverage, however, access for women get needed care with that coverage is another more challenging issue.
On average, women make a disproportionately lower income than men and are far more likely to use a publically subsidized insurance plan. There are currently 17 million uninsured women in the United States, and half of those women are expected to become eligible for Medicaid when eligibility is extended to those with incomes at or below 133% of the federal poverty level. Of insured women in Massachusetts, 75% of them are enrolled in publicly subsidized care. This may be attributed to the fact that many women who work part-time, or even multiple part-time jobs, to support a family often do not have access to employer sponsored insurance. Women are also more likely than men to become unpaid part- or full-time caregivers of family members. Of women who do have access to employer sponsored insurance, they are generally included as a “dependent” on a spouse or partner’s plan and are therefore more vulnerable lapses in coverage after a change in marital status or termination or retirement of a spouse or partner. One panelist pointed out that it is absolutely essential that public and private insurance programs be tied at the hip to ensure that women do not fall through gaps in coverage.
The panelists also discussed the need for outreach and education for newly insured individuals. A report on reproductive health in Massachusetts revealed that many women are thrilled to have coverage for family planning and prescriptions, but they often get lost in the small print of their actual insurance plans. Learning the terms of an insurance plan is like learning another language; users of the health care system cannot make real choices if they cannot understand their options. It is difficult to distinguish between in-network and out-of-network providers and different tiers of prescription coverage, particularly if using a subsidized plan that can change on a dime with a sudden change in income eligibility. Call centers and websites, such as the Massachusetts Health Connector interface, are essential for helping individuals access covered services they need.
Looking at the big picture, it does not matter how many women are insured but whether women are healthy. One panelist commented that during her course of research, she asked women from multiple states which services they would seek out first if they had unlimited free access to the health care system. She was surprised to discover that rather than better cancer treatments or other anticipated responses, most women would make their first stop at the dentist. Next stop, a mental health care provider. It’s easy to justify making a mortgage payment rather than crowning a painful rotting tooth and to take a pill to treat the stress of life’s problems than go to costly counseling. These instant fixes do not resolve underlying problems that manifest themselves in costly long term conditions. To really reduce costs within the system, it’s important that issues are addressed as they come up with high quality care.
Gaining moral support for an issue is not nearly as tedious as creating a program since money for one program must come out of another. Complex legislative changes are challenging because the legislative system is designed address issues in pieces rather than as a big picture. The panelists all agreed that they need more data to provide a basis for addressing and eliminating disparities in health care, particularly during this time of change. One panelist pointed out that the Massachusetts health care reform model was based on what existed and that there has not been one intervention in the last thirty years to address disparities within the system. To help ensure that women get the care they need it is important to not get discouraged in addressing issues one at a time to keep pushing for change.