Health Care Reform —A Woman’s Issue
By Catherine DeLorey, Dr.PH.
Dissatisfaction with the cost and quality of the health care available in the United States is increasing. With the Democratic take-over of Congress in the November elections, there is new interest in changing the health care system, but little agreement on the best alternative for improving access to health care. Complicating this issue for women’s health activists is the fact that — while women are often disproportionately affected by our health care system’s problems — only fledgling efforts have been made to ensure that health care reform initiatives address women’s concerns. It is important that current proposals consider women's health care needs, and for activists and advocates to support efforts that prioritize and recognize women’s issues.
Access to Health Care is a Women’s Issue
The failures of our current health care system greatly affect women, especially women of color. Women constitute more than 52 percent of the U.S. population, and are the major consumers of health services, as well as the traditional caretakers of their families’ health. Women have greater annual health care expenses than men ($2,453 vs. $2,316) and pay a greater proportion of their health care expenses out-of-pocket (19% compared to 16%).1 Women make 58% more visits each year to primary care physicians, and are more likely than men to take at least one prescription drug on a daily basis.1
Because women are disproportionately represented among low-wage workers and/or work in industries that do not offer benefits, they are more likely to be uninsured or under-insured than men. In fact, women work in jobs that are 15 percent less likely to offer health care and, because of their low incomes and high health care costs, women are 20% more likely than uninsured men to have trouble obtaining health care.1 Women are also more likely to be dependent on their spouses for coverage: they are more than twice as likely as men to receive employer-based health coverage as “dependents” through their spouses’ insurance (26% vs. 11%). This dependent status makes women vulnerable to losing their coverage as a result of being divorced or widowed.2 The predominance of employer-based insurance also hampers lesbians from accessing health coverage through their partners, since many companies do not recognize domestic partners and, of course, with limited exceptions, gay and lesbians cannot get married.
Although American women tend to live longer than men, this is not the case for uninsured women, compared to uninsured men. Women who are uninsured tend to forgo getting health care, especially preventive services, and they are more likely not to fill prescriptions than are women with insurance coverage. Of the 17 million uninsured women in America, more than 67 percent did not seek health care because they could not afford it.3,4,5 The direct result of the way our health care system is structured is that women are more likely than men to be sick and to find health services unattainable.
Biological and physiological issues are not the only factors that influence women’s concerns in health and health care. Other influences include women’s social/cultural roles, and how we both use and are treated by the health care system. These other influences include inequities in health care that result in women traditionally not being included in clinical research studies on drugs and medical procedures; and not receiving the same rigorous care and treatment for cardiac problems as men do. In addition, important aspects of women’s lives (such as pregnancy or menopause) are treated as medical conditions or diseases, rather than life experiences.
These problems — particularly access to health care — are magnified for women of color. Thirty-eight percent of Latinas and 23 percent of African American women are uninsured, compared to just 13 percent of White women.6 Difficulties accessing health care are compounded for immigrant women who face both linguistic and cultural barriers to their receipt of health care. For undocumented women, the problems in accessing health care are compounded by State and Federal restrictions on their ability to use public health services.
Because women are more likely to be employed in industries that do not provide health insurance, and because they spend more time out of the workforce as caregivers and mothers, women are less likely to have adequate health insurance and more likely to face barriers in accessing care and other services. For these reasons, the fight for universal health care is a fight for equality and justice for all women. Only a system that guarantees access to affordable, comprehensive health cares for everyone will resolve the health care disparities that women experience.
What Should Be Included in Women’s Health Care?
There can be no health security for women without protection of the full range of women’s reproductive needs that include, but are not limited to, abortion services. Comprehensive reproductive health care supports a woman’s right to information and services that both prevent pregnancy and help her to become pregnant when she wants to; that support her during a healthy pregnancy; and promote healthy outcomes for pregnancy.
In addition to comprehensive reproductive rights, the following principles are central to health system change that meets women’s needs:
- Universal access to quality health care,
- Comprehensive health benefits for all women, employed or not,
- Access to health services from a variety of providers,
- Access to health services provided in a variety of settings,
- Systems accountable to women and other consumers,
- Complete information for women to use to make own health care decisions.
Making Women’s Needs a Central Priority
The only way to achieve an adequate health system for women is for women to work together to have our voices heard. It is critical that women’s health advocates come together to support initiatives that prioritize women’s health care needs. The following organizations are among the many that are working on health care reform:
- The Avery Institute for Social Change, MergerWatch,and the National Women’s Health Network are working together on an effort called "Women Lead on Health Care Reform". This effort mobilizes and unites advocates who are committed to achieving universal health care that meets women’s comprehensive reproductive health care needs and works to ensure that any new system will meet women’s comprehensive reproductive health care needs. More information is available on the organizational web sites.
- Women’s Universal Health Initiative is a national organization dedicated to building diverse communities of women and work for health care reform. In addition, the organization publishes a quarterly electronic newsletter on women and health care reform.
These initiatives are a start, but we must ensure that our voices are heard by those who are making decisions about the future of health care in the U.S. Those of us who are working in health reform organizations must raise awareness of women’s needs, and keep advocates focused on the issue of comprehensive reproductive rights. Those of us in professional organizations need to speak out and make sure health reform and women’s needs are included in all of our efforts. And, in our own communities, we all need to communicate about the importance of health care reform, and inform others about efforts to enhance women’s health.
Catherine DeLorey, Dr.PH., is the Director of the Women's Health Institute, which provides health information “to empower women to make their own wise health decisions." She is also the Coordinator of Women's Universal Health Initiative in Boston, Massachusetts. She can be reached at Catherine@wuhi.org.
1. Lambrew, J, Diagnosing Disparities in Health Insurance for Women: A Prescription for Change. NY: Commonwealth Fund, August 2001. Available online at: http://www.cmwf.org/publications/publications_show.htm?doc_id=221296
2. Sered, S. “Seven Reasons Why Health Care Coverage is a Women’s Issue.”
3. Salganicoff A, "Diagnosing Women's Health Care," National Council of Jewish Women Journal 2006; 29(1):1-4.
4. Kaiser Family Foundation, "women's Health Policy Facts: Women's Heatlh Insurance Coverage Fact Sheet," Menlo Park, CA. November 2004.
5. Kaiser Family Foundation, "Women's Health Policy Facts: Women's Health Insurance Coverage Fact Sheet," Menlo Park, CA, March, 2006.
6. Salganicoff, A, Ranji, U, Wyn, R. Report: Women and Health Care: A National Profile. Kaiser Family Foundation: Menlo Park, CA, Summer, 2005. Available online at http://www.kff.org/womenshealth/upload/Women-and-Health-Care-A-National-Profile-Key-Findings-from-the-Kaiser-Women-s-Health-Survey.pdf.