The Hidden Gender Issues in Health Care Reform

21 October 2009

The Centre for American Progress released The Shriver Report on Monday, a lengthy collection of reports and essays on the way gender roles have changed in the United States in the recent past, and the evolving way families operate. Based on what I’ve read so far, it’s well worth checking out, and the whole book is available to download from the CAP website, either by individual chapter or in its complete 454-page form.

One of the really interesting points the report raises is the role of gender in health care and the health care reform debate. While much attention has been paid to some of the fact many health insurance plans don’t cover things that disproportionately effect women (for example, it’s legal to consider domestic violence a pre-existing condition in nine states), not so much focus has been given to the institutional ways health insurance discriminates against women and against many modern families.

In their chapter from The Shriver Report, “Sick and Tired: Working Women and Their Health”, Jessica Arons and Dorothy Roberts highlight some of the problems modern families face with health care. One of the significant obstacles is that, because of the limited flexibility of most full-time jobs, mothers who are both primary care givers and breadwinners are more likely to have jobs that do not offer health insurance. In fact, women in general are far more likely to be outside the employer-provided health care system - being more likely to work in low-wage or part-time jobs, or for small businesses. This is only compounded in the case of single mothers, who often require flexibility in order to fulfill both their professional and personal obligations. For many, such flexibility is only found in a part-time job, which usually doesn’t include health insurance.

Thus, women are often forced into the private market, which charges higher fees for premiums for women, yet frequently doesn’t cover maternity care- in spite of the higher premiums. Newsweek recently quoted a National Women's Law Center report demonstrating that a 25-year-old woman could pay anything between 6 and 45 percent more for her coverage than a man the same age with an identical health plan. And because American women, on average, are still paid less than America men, health care costs eat up a greater proportion of their income.

The problem is largely an inherited one: the employer-provided health care system evolved when the majority of families were supported by a male breadwinner working full time, under whose insurance the other members of the household could be covered. As fewer families conformed to traditional models, an increasing number were left outside the protection of the existing health insurance system. Some lost their access to their former-spouse’s coverage after divorce. Some were unable to take a single, full-time job that would guarantee health care coverage due to care-giving duties. Some were denied access to their partner’s health care because the system still discriminates against gay couples. The current arrangement is woeful in its attempts to accommodate and adapt to the modern family.

The Shriver Report is largely focused on the way families have changed in the last decade. Among other things, it seeks to raise awareness to the fact that an increasing number of Americans aren’t covered by a system that was designed before the tremendous cultural shifts of the last 40 years. It will be well worth looking closely at the final health reform bill to see whether it creates a system that is more flexible and makes it more difficult for health insurers to discriminate against women.