WASHINGTON -- Women of child-bearing age routinely pay more for health care because they're women. If they're pregnant, they can be legally denied coverage.
Women face other problems in today's insurance market: They tend to need more preventive care and therefore are subject to more co-pays and deductibles, and single heads of households are often women, meaning they're responsible for the family's health care bills.
Legislation now being considered by Congress to overhaul America's health care system would dramatically change the rules, and there's general agreement that this is a problem that needs fixing.
"This is very significant, particularly for women buying policies on their own," said Linda Blumberg, senior fellow and economist at the Urban Institute, a policy research group.
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Bills moving through Congress would end the longstanding practice of basing rates on gender, which is allowed in most states. Legislation also would eliminate co-pays and deductibles for preventive care, require maternity coverage to be offered at reasonable rates and provide financial help for those who couldn't afford coverage.
The changes have widespread support, not only from women's groups but notably from Karen Ignagni, president and chief executive officer of America's Health Insurance Plans, which represents insurers.
But there is some disagreement.
"The Democrats are choosing to ignore a basic fact: Their health care bill will raise taxes, increase costs and raise insurance premiums on men, women and families alike ... a trillion-dollar government takeover of health care will actually make things worse," said Antonia Ferrier, spokeswoman for House Republican Leader John Boehner of Ohio.
Nancy Pfotenhauer, spokeswoman for Patients First, a conservative group, argued that creating a government-run program to compete with the public sector, as legislation in the House of Representatives and one major Senate measure would do, "will devastate American women and undermine our access to affordable quality health care."
In that argument, private insurers eventually would stop covering people, meaning Americans would have to resort to government for their care.
"Women will have less autonomy and control," Pfotenhauer said.
Three House committees and the Senate Health Committee have written bills that include a public option, or a government-run alternative to private insurance, while the Senate Finance Committee rejected the idea. Instead, it would create co-ops, or nonprofit member-run plans.
That committee is expected to take a final vote on its bill later this week. If approved, it will be combined with the Health Committee version and be debated by the full Senate, probably later this month.
House leaders are also trying to combine their committees' three bills into one, and also hope for a full floor debate in late October.
Women's issues are likely to be considered in three general categories -- gender-based pricing, preventive care and helping lower-income parents. In each case, they tend to affect the uninsured who get no coverage through their employers.
Younger women are usually charged more for coverage because they tend to use more health services than men. The National Women's Law Center found that women ages 15 to 44 spent 68 percent more on health care than men during those years.
In addition, the center found in a survey last year that in 47 states and the District of Columbia, insurers that used gender ratings charged 40-year-old women between 4 percent and 48 percent more than men of the same age.
Often, said Blumberg, "premiums are based on expectation of pregnancy."
The health insurance industry supports legislation that would end such gender ratings, but Robert Zirkelbach, America's Health Insurance Plans spokesman, was asked why companies don't simply end the practice now.
"Right now, premiums in the individual health insurance market are based on the expected cost of providing care just as it is with auto and life insurance," he said. If virtually everyone is required to buy health insurance, the risk pool grows, and coverage becomes more affordable."
Preventive care is particularly important to women because they tend to need it more, particularly at a younger age. It can involve mammograms, more regular checkups, Pap smears and other tests.
More women are in lower income brackets, making it hard for them to get coverage. In 2007, 45 percent of women ages 18 to 64 were uninsured or underinsured, compared with 39 percent of men, according to a study this year by the Commonwealth Fund, an independent New York City-based health care research group.
"Women are in double jeopardy," said Rep. Jan Schakowsky, D-Ill. "They earn less than men, so even if we were charged the same premiums they would pay a bigger percentage of their income, and women are usually charged more."
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