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How Health Reform Will Help Women Get the Coverage and Care They Need

Women are at particular risk in the U.S. health system. Not only do women have greater health care needs than men, they have lower incomes on average, and they have historically played larger roles in the health care of family members. As a result, women are more exposed to health care costs. The rapid acceleration in U.S. health care costs over the past decade—as real family incomes have barely budged and many women and their partners have lost their jobs and health benefits—has magnified the issue, leaving millions of women at risk of medical debt or forgoing necessary health care.

When fully implemented in 2014, the Affordable Care Act is expected to provide near-universal health coverage and make health care far more affordable for women than it is today. In the meantime, the law is already yielding health benefits for women through free coverage of preventive care like mammograms, small-business tax credits to help women-owned businesses pay for their health insurance, and breaks from work for nursing women to express breast milk.

A new report by the Commonwealth Fund shows that women are in need of these reforms now more than ever. Based on data from the Commonwealth Fund Biennial Health Insurance Survey, 27 million working age women under age 65, nearly one of three, spent some time uninsured in 2010. Over the past decade, women have spent an increasing proportion of their paychecks on health care. In 2001, a quarter of women spent 10 percent or more of their income on health costs; by the end of the decade, that rate had increased to a third. Women, even more than men, have been burdened with medical debt. Forty-four percent of working-age women—an estimated 42 million—reported problems paying medical bills in 2010, up from 38 percent in 2005.

Most worryingly, an estimated 45 million women, or nearly half of working-age women, reported not getting needed care because of cost in 2010, an increase from one-third in 2001. Women’s greater health care needs meant that women were more likely to experience these problems than men, and problems were worst for women with low incomes. More than three of five women with incomes under 200 percent of poverty went without needed care because of cost in 2010, as did three-quarters of women without insurance. Among insured women, those enrolled in plans with high deductibles of $1,000 or more were more likely to go without needed care than those who had no deductible.

The individual and small-group insurance markets have been especially hostile zones to women seeking health insurance, with health plans worried above all about risk and thus in most states charging women and female-dominated businesses higher premiums on the basis of gender and excluding coverage of services, especially pregnancy, that are intrinsic to family life. More than 70 percent of women who tried to buy health insurance in the individual market in the last three years reported difficulties finding affordable plans that met their needs: one-third were turned down, charged a higher price, or had a health problem excluded from their coverage.

The Affordable Care Act is already bringing dramatic change for women and their families through required free coverage of preventive care services integral to women’s health, coverage of young adults on family plans, preexisting condition insurance plans in all 50 states, small business tax credits, and insurance market reforms, including bans on lifetime benefit limits. But the heart of the health reform law—universal health insurance coverage—is yet to come and will bring relief to the estimated 27 million women who went without insurance coverage in 2010. This report’s findings underscore why federal and state policymakers must continue to put in place the provisions of the Affordable Care Act over the next three years. Health reform’s successful implementation will be critical to the future health and financial well-being of millions of women and their families.

Publication Details

Publication Date: May 11, 2011
Citation: R. Robertson and S. R. Collins, How Health Reform Will Help Women Get the Coverage and Care They Need, The Commonwealth Fund Blog, May 2011.


Sara Collins
Vice President, Health Care Coverage and Access, The Commonwealth Fund
Fellow in Health Policy, The King's Fund