The Department of Health and Human Services recently released a report called “The Affordable Care Act: Advancing the Health of Women and Children.” In summary, the report touted that the majority (56 percent) of enrollees in exchange plans are women, that women are enjoying new coverage for no-copay preventive care, and that the uninsured rate among women has declined since 2013.
The spin is enough to make you dizzy. A closer look reveals that while some women may find new benefits under the Affordable Care Act (or Obamacare), the downsides for women are far greater than the upsides. The law’s impact on women’s health will be great, but overall, it will not be an improvement.
First of all, it’s nothing new that women are the primary consumers and decision-makers in health care. By nature, women’s bodies require more health care services, and even before Obamacare, women controlled approximately two out of every three private health care dollars. Women are also the primary beneficiaries of other government safety net programs, like Medicaid (70 percent) and Medicare (56 percent). Women are also more likely than men to work in low-wage or part-time jobs that don’t provide on-the-job health benefits, making them likely consumers of exchange plans.
One interpretation of this is that the exchange plans, and the subsidies that come with them, are a benefit to women. Another interpretation — obviously not mentioned in the government report — is that these women consumers are the biggest victims of a substandard system, and are disproportionately being hit with narrower provider networks, rising premiums, and the decreasing amount of choice in plans.
But wait! Women famously get preventative care for “free” now! The HHS report says a whopping 48.5 million women are the beneficiaries of this policy change, which requires that insurance plans cover preventive visits, screenings, and contraceptive care with no copay.
In reality, this figure actually represents a great cost: Imagine that in years past, these 48.5 million women paid copays of $20 each year for a wellness visit to their doctors. That’s nearly $1 billion in costs that have been shifted away from individual consumers and back into the broader insurance pool where it is passed on as higher premiums. That’s not good news.
While women may be tempted to shrug at this different payment pipeline, we should actually be concerned about its inefficiency and the perverse incentives it creates.
It’s a problem when consumers have no “skin-in-the-game” when it comes to health care consumption. Women and men ought to be encouraged to use resources wisely, and insurance ought to be focused on covering unexpected costs, not prepaying expected expenses. That’s the real route to controlling costs and “advancing the health of women” and men.
This latest report from HHS also celebrates decreasing rates of uninsurance. There are likely many factors (an improving economy or increased public awareness of health coverage) driving insurance rates up. But let’s give credit where credit is due: It’s no surprise that Obamacare’s mandate — that Americans must have health insurance or pay a penalty — would mean more people would get the required coverage.
But sadly even increased rates of coverage don’t necessarily translate to good news. The goal of our health reform should have been better health care, not better health coverage. While it’s easy to confuse the two, Obamacare’s path for the future — if not altered — will make it easier. Because the number of health providers is limited, and because holding an insurance card increases one’s demand for health care services, the result will undoubtedly be shortages, which will manifest in longer wait times, fewer choices, and a lower quality of health care . . . even for those who are “covered.”
Although Obamacare may be expanding women’s government insurance coverage, the real-world results are just the opposite of “advancing the health of women.”
Hadley Heath Manning is the health policy director at Independent Women’s Forum