Universal Health Care and Women

Now, three years later, things are, in many ways, worse, says Alina Salganicoff, KFF vice president and director of Women’s Health Policy. The number of uninsured women has grown to 17 million.  Tens of millions more women have inadequate coverage for their needs.  Nationwide, annual individual insurance premiums averaged $4,242 in 2006.  Family premiums averaged $11,480.  Only the poorest of the poor qualify for Medicaid.  Those who do not qualify, who do not have access to employer-sponsored health plans, or who do not earn enough to afford a good individual policy may be struggling the most.

“Women who are uninsured or underinsured don’t receive adequate preventive care,” says Salganicoff.  “When they’re sick they tend to postpone care or often go without any care at all.  They don’t fill prescriptions because they can’t afford them.  Women, and for that matter, men, are more likely to die at an earlier age when they’re uninsured.”

Toward Universal Care

To address this downward trend, some elected officials are wrestling with the question of how to get to that magical place of “universal coverage,” where every person has access to high-quality health care.

To use the word “magical,” actually, is unfair.  Several states are just steps away from making their own versions of universal coverage a reality.  Gov. Arnold Schwarzenegger (R-CA) announced his health care reform plan in January.  In Maine and Vermont, laws intended to ensure catastrophic health care coverage for all have already been passed by the legislature, if not yet fully realized.  New York and Pennsylvania are considering revamping their health care programs so that more residents are insured.  Massachusetts, in its push toward universal coverage by July 2007, intends to implement a sliding-scale payment system combined with a variety of subsidies and individual and employer mandates — the first program in the nation to make health insurance a legal requirement.

Salganicoff says elements of the Massachusetts program may be useful when it comes to designing a national model for universal health care, but certain issues must be ironed out first. With an individual mandate, she says, “You really have to have adequate subsidies for people who are low income.”  Another challenge is ensuring that all employees have access to quality health insurance, even those who work for small employers who can’t afford to provide coverage for their workers. 

Still, Salganicoff says she’s optimistic such issues will be resolved.  “I think that there’s agreement on the federal level that we have a really big problem.  But there’s also a lot of energy around looking for solutions to address the uninsured.”

Angus McQuilken, vice president for public relations and government affairs at Planned Parenthood League of Massachusetts (PPLM), also sees light at the end of the tunnel. “One aspect of the Massachusetts plan is expansion of eligibility for MassHealth, which is our state Medicaid program,” he says. “We have always sought to provide services to low-income women through a combination of providing services to MassHealth patients and providing a sliding scale for patients who are paying out of pocket.”

McQuilken points out that the more patients who have insurance, the more access they have to PPLM services and other health care services, particularly on the prevention end.  “Our experience has been that people who don’t have insurance tend to skip prevention-oriented health care visits.  And that results not only in negative health outcomes for individual patients, but also increased costs for the health care system.  By providing insurance for everyone, we will go a long way toward encouraging people to include prevention as a part of their approach to keeping themselves healthy.”