Health Reform Law Prohibits Gender Rating, Offers Other Benefits For Women's Health

Under the recently signed health reform law (HR 3590), health insurance companies will no longer be able to charge women more than men for the same insurance policies, ending a practice known as "gender rating," the New York Times reports. In the past, insurance companies "took full advantage" of the lack of restrictions on gender rating in the individual insurance market, arguing that women should pay more for health coverage because they tend to use the health system more than men, the Times reports.

According to a 2008 report from the National Women's Law Center, some companies charged women 4% to 48% in higher premiums than men in the individual market, even for insurance policies that did not include maternity coverage. Now, gender rating is "essentially outlawed" and maternity coverage is considered an "essential health benefit," the Times reports.

According to the Times, although gender rating "has been perfectly legal" in the individual insurance market, some insurers also have applied the practice to small-group coverage, but laws against sex discrimination in the workplace prohibit employers from passing on higher costs to their employees. As a result, some midsize and small businesses -- which tend to have more female employees -- have been forced to offer plans with very high deductibles or drop health benefits altogether, the Times reports.

Marcia Greenberger, founder and co-president of NWLC, said the health care and insurance industries "in general [have] been riddled with the most discriminatory and unfair practices to women." She added that the health reform law "is a giant leap forward to dismantling the unfairness that has been a part of the system."

Greenberger said that although some of the law's provisions will be delayed until 2014, the ban on gender rating will take effect immediately. She added that no organization that receives federal funding will be able to discriminate on the basis of sex, including insurers, making gender rating "a problem whose days are numbered."

The new law also prohibits denying coverage based on pre-existing conditions, including for women who have had caesarean sections or experienced domestic violence. In a statement issued Thursday, Sen. Barbara Mikulski (D-Md.) drew attention to a woman who testified before Congress that she was denied coverage after a medically necessary c-section. Mikulski said, "That will never, ever happen again because of what we did here with health care reform" (Grady, New York Times, 3/29).














According to HealthLeaders Media, the new law will expand private insurance and Medicaid coverage to millions of uninsured, low-income women. About 45% of women are uninsured or underinsured, compared with 39% of men, according to NWLC. Kirsten Sloan, vice president of the National Partnership for Women & Families, said that a significant portion of the 31 million U.S. residents who gain health insurance under the law will be women. She added, "That is top of the list for everybody, but looking down from there, you've got benefit issues ... that are of particular interest to women now being covered." For example, private health plans and Medicare will be required to cover the cost of preventive services, such as mammograms, Pap tests and immunizations (Simmons, HealthLeaders Media, 3/29).

According to the Times, the new law also will allocate $1.5 billion over five years for nurse home-visit programs for pregnant teenagers. Such programs have been shown to help teen mothers learn parenting and coping skills that help reduce child abuse and neglect by nearly 50%, according to research published in the Journal of the American Medical Association. The law also mandates that employers allow women who are breastfeeding periodic breaks to pump breastmilk and that they provide a private place that is not a bathroom to do so.

The law also allocates $50 million per year over five years in matching federal funds for states to use for abstinence-only sex education programs. President Obama cut $115 million in funding for such programs in his fiscal year 2010 budget, instead appropriating funds for comprehensive approaches to reducing teen pregnancy. In June 2009, Congress allowed an additional $50 million in abstinence-only funding to expire. However, states are required to match any federal funding they receive. Heather Boonstra, senior public policy associate at the Guttmacher Institute, said this provision "may be significant" because "many states had already stopped participating" in abstinence-only programs (Andrews, New York Times, 3/30).


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