Women & health care reform

National Women's Health Report, March, 2009

When Joy Lindquist lost her job as a health educator in 2004, she lost more than just a paycheck. She also lost her health insurance. Although she could have continued her health benefits by paying the entire premium, the $300 a month cost was more than she could afford. Hoping to make it through without health insurance for a while, Joy returned to school to become an acupuncturist, working part-time to support herself. Even though she only earned about S8,000 a year, she didn't quality for Medicaid, the state/federal health insurance program for poor women and children. The only policies she could afford had extremely limited coverage, offering little or no preventive care, routine office visits or prescription coverage. Today, the 50-year-old is self-employed as an acupuncturist in Brooklyn, NY, but still does not earn enough to buy health insurance on the open market.

The repercussions have been significant. Before she lost her job Ms. Lindquist took a prescription medication to control her asthma. But at $200 a month, she simply can't afford it. Today she tries to manage her asthma with over-the-counter medication, herbal remedies and a "rescue inhaler" that costs just $40 a month. Her worst fear is something that for most people is nothing more than an annoyance--catching a cold. A cold often results in a severe asthma flare and an emergency room visit costing more than $1,000.

Ms. Lindquist is just one of more than 47 million uninsured Americans (nearly 16 percent of the population), most of them working full- or part-time, who arc still unable to afford health insurance. Another 25 million Americans arc underinsured, unable to pay their medical bills and skipping needed care because of the cost. (1), (2)

In fact, a recent survey from the Kaiser Family Foundation found that 53 percent of Americans had cut back on health care in the past year because of cost concerns, another one in five had been forced into serious financial debt because of medical bills and 45 percent say they are very worried about having to pay more for their health care or health insurance. (3) The 2008 Women Talk survey by the National Women's Health Resource Center also found that high health care costs were causing women to neglect their own or their family's health care needs. (4)

Health Care: Not a Luxury Item

Health care is not like a new sofa or pair of shoes; it's not something you can afford to skip. A 2004 Institute of Medicine (10M) report found that uninsured children and adults experience worse health and die sooner than those with health insurance. (5) Lack of health insurance also affects communities by reducing hospital services and capacity and leading to financial problems for health care providers, all of which can reduce the quality and availability of care for everyone, even those with health insurance.

Speaking of cost, it's a major issue in the health care debate. By 2020, an aging population and a steady stream of new technologies are expected to drive health care costs from 17 percent of the gross domestic product (GDP) to 21 percent. "That means that more than one out of every $5 of economic activity will be devoted to health care," says Stuart Guterman, assistant vice president of The Commonwealth Fund, a national health policy foundation based in New York City.

This spending might not be so bad if we got our money's worth. But although the United States spends twice per capita on health care than any other major industrialized nation, we have more preventable deaths than 19 other major countries. Overall, an estimated 101,000 people die prematurely each year because they lack access to health care or receive poor quality care. (6) Other studies find that low-cost care often results in higher quality of care. (7)

"There is something inherently concerning about the fact that we spend so much and are not getting the results we'd like to sec," said Usha R, Ranji, a principal policy analyst at the Kaiser Family Foundation, a health care policy foundation outside San Francisco.

Our system isn't very efficient, either, with the United States scoring 53 out of 100 on measures of inappropriate, wasteful or fragmented care; avoidable hospitalizations; variation in quality and costs; administrative costs; and use of information technology.

Then there's the issue of quality. A major review of studies evaluating health care quality published in 2006 concluded that "there are large gaps between the care people should receive and the care they do receive ... whether one goes for a checkup, sore throat, or diabetic care." (8) Only about half of patients receive recommended care. The issue is just as bad for children, with a study published in 2007 finding that children received 46.5 percent of recommended care. (9) Where you live matters, with national surveys finding wide variations in the quantity, cost and quality of care delivered throughout the nation. (10)

The bottom line? The American health care system is broken. And, since women purchase and consume the majority of health care, as well as manage the health of the rest of the family, that means women are on the front lines of this crisis.