Back in my twenties, when I was wandering through a string of temporary and contract job positions and I had no such thing as benefits (although I worked forty hours per week with each of these jobs), I remember the alarm expressed by one of my friends when she found out I didn’t have health insurance, a 401k, or disability insurance. “What if you get in a car wreck? Do you want to burden your parents with taking care of you?” I had never considered the possibility. I was young, healthy, and earning a living – but now I had to worry about burdening my parents!
You’ll be glad to know that I took her concern to heart and I made an appointment with someone who sold health insurance. One day on my lunch break I went to her office, where she presented me with my options. The plans were laid out on a table, side-by-side, so that I could compare. After seeing the monthly costs, my main concern was catastrophic coverage. It would be a stretch for me to buy this insurance, but I had been fearfully convinced of it’s need, and I could afford only the basic plan, which the insurance lady assured me was all I probably needed.
As we discussed benefits, deductibles, and other new terminology, I asked her about the considerably lower price printed beside the rate she quoted me. “That price is for men your age,” she explained.
I was puzzled. “Why do they pay so much less?” I asked.
“Because they don’t need pregnancy care,” she answered.
“But I’m not married or even in a relationship,” I objected.
“It doesn’t matter. You’re of childbearing age. The coverage is going to be higher for you because you can get pregnant.”
Not only did I probably make less money at my job as my male peers, but now I could see in black and white that I was paying significantly more for my health coverage, and only because I’m female. I burned inside with fury at the injustice. Must women bear every burden of reproduction? If I was being responsible for myself, why did I have to pay more? I couldn’t even afford a plan that included maternity, but I still had to pay more! And if I was paying more because I could get pregnant, why didn’t men pay more because they could get me pregnant?
I mention this now because in the years since that encounter, healthcare has made great strides in addressing women’s needs. As recently as 2012, a 25 year-old woman might pay 81% more in health insurance than a man the same age – even for plans that didn’t include maternity care. But now it is illegal for insurance companies to charge women more than men, and even better, insurance companies are required to include these essential services for everyone:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
Additionally, many employers are now required to accommodate the needs of nursing mothers by giving them a reasonable break time in order for them to pump milk for their babies, and to provide a private space in which to obtain that milk. (And that space cannot be a bathroom – ick!). Not only do breastfed babies benefit from from the antibodies in breastmilk, their decreased risk of developing asthma, allergies, ear infections, respiratory illness, and bouts of diarrhea results in lower healthcare costs for those children and fewer missed work days for their mothers. Over time, what we pay out in preventive care results in lower sick-care costs.
I could say that the gender discrepancy in the insurance rates has been corrected. Indeed, men now pay more for their health coverage. But this leveling of the playing field has an even broader, and more just effect, in that (in theory) all of the adults in our society (who have health care insurance) are now sharing the financial cost of reproduction, which by pregnancy occurs through the body of a woman, with the cooperation of a man, but benefits the wider community as a whole, men, and non-childbearing women alike. Reproduction is a part of life, and societies need healthy babies to be born, educated, and raised to be productive members.
When I was single and looking over those insurance plans, I would not have thought twice about paying that high rate, as long as everyone else had to pay it, too, and it covered necessary services should I have found myself pregnant (whether through my actions or through rape).
Unfortunately, these services that women and their babies have been receiving for the price of their insurance are at risk of being lost. Women may again have to pay more than men for their insurance, and that insurance might not even include maternity care. For as our new president-elect and congress take office, their first order of business is to dismantle the law that brought such important improvements to our healthcare system: the Affordable Care Act. And what’s worse is that they don’t even have a proposal for what will replace the law.
If you want to know more about what you stand to lose, take a look at your protections enacted by the law:
The Affordable Care Act and Maternity: https://www.hhs.gov/healthcare/facts-and-features/fact-sheets/aca-and-maternity-care/index.html
The Patient’s Bill of Rights and other key features of the law: https://www.hhs.gov/healthcare/facts-and-features/key-features-of-aca-by-year/index.html