Womens Health Policy: Coverage and Access to Care

1
Womens Health PolicyCoverage and Access to Care
Exhibit 1

• Alina Salganicoff, Ph.D.
• Vice President and Director, Womens Health
  Policy
• The Henry J. Kaiser Family Foundation
• February 2008

2
Exhibit 2
Why Focus on Women?
Health Status, by Gender, 2004
50
Women
Men
34
34
26
19
17
Regularly Uses a Prescription Drug
Fair/Poor Health
Chronic Condition Requiring Ongoing Care
Note Includes women and men ages 18 to 64.
Source Henry J. Kaiser Family Foundation (KFF),
Kaiser Womens Health Survey, 2004.
3
Exhibit 3
Wage Gap Persists Throughout Lifetime
Median Income, by Sex, 2006
42,210
32,649
Women
Men
Note Includes women and men ages 15 and older.
Source US Census Bureau, August 2006 American
Community Survey Reports.
4
Exhibit 4
Access to Health Services Is a Problem for Many
Barriers to Health Services, by Gender, 2004
27
Women
22
21
Men
15
14
11
Had health problem and needed to see doctor but
did not
Unable to see a specialist when needed
Could not afford to fill a prescription
Note Includes women and men ages 18 to 64.
Source Henry J. Kaiser Family Foundation,
Kaiser Womens Health Survey, 2004.
5
Womens Health Care Needs, by Age, 2004
Exhibit 5
Womens Health Care Needs Change With Age
18 to 44
59
45 to 64
50
65
26
23
23
22
18
16
9
Chronic Condition That Requires Ongoing Treatment
Disability or Limiting Illness
Diagnosis of Anxiety/Depression
Source Henry J. Kaiser Family Foundation, Kaiser
Womens Health Survey, 2004
6
Exhibit 6
Federal, State and Local Policies Influence
Womens Health Coverage and Access to Care

• Federal Government
• Oversees and finances many important services
  including Medicaid, Medicare, CDC, NIH and other
  agencies that provide benefits to women.

• States
• Authority to regulate, finance, legislate, and
  enact key policies that affect scope of private
  insurance and public programs as well as health
  care providers and services.

• City and County
• Programs help fill gaps with many vital safety
  net services.

7
Exhibit 7
Womens Coverage
8
Health Insurance Coverage of Adults Ages 18 to
64, by Sex, 2006
Exhibit 8
Insurance Coverage Patterns Differ Between Women
and Men
3
3
6
10
Other
6
6
13
Medicaid
25
Individual/Private
Job-Based Dependent
49
38
Job-Based Own Name
Uninsured
23
18
Women
Men
Note Other includes Medicare, TRICARE, and other
sources of coverage. Source KFF analysis of the
March 2007 Current Population Survey, Census
Bureau.
9
Exhibit 9
Differences in Health Coverage Rates of Women by
Race/Ethnicity Are Significant
Health Insurance Coverage of Women Ages 18 to 64,
by Race, 2006
7
7
14
17
21
Medicaid
47
74
47
80
Private/Other
60
Uninsured
39
33
23
19
13
Am. Indian/ Alaska Native
Asian/Pacific Islander
African-American
White
Hispanic
Note Includes women ages 18 to 64. Other
includes Medicare, CHAMPUS, and other sources of
coverage. Source Kaiser Family Foundation
analysis of the March 2006 Current Population
Survey, US Census Bureau.
10
Exhibit 10
Employer-Sponsored Insurance Affordability and
Scope of Coverage

• Affordability of care is still a problem for many
  women with private coverage

Other 3
Medicaid 10

• Premiums rose 80 and worker contributions
  doubled over 7-year period

Uninsured 18
Employer- Sponsored Insurance 63

• Co-payments and deductibles also increased

Individual/Private 6
Note Other includes Medicare, TRICARE, and
other sources of coverage. Source KFF analysis
of March 2007 Current Population Survey, US
Census Bureau.
11
Exhibit 11
There Is Wide Variation in State Policies
Regarding Benefit Mandates
Number of States that Mandate Following Benefits
50
Cancer Screening
Reconstructive Surgery After Mastectomy
37
37
Direct Access to Ob/Gyns
Contraceptive Coverage
33
Mental Health Parity Eating Disorders
32
21
Mental Health Parity Depression
Mastectomy Minimum Hosp. Stay
20
Ob/Gyns as Primary Providers
16
Osteoporosis Screening
14
Infertility Diagnosis Treatment
14
5
HPV Vaccine
Source Kaiser Family Foundation State Health
Facts Online.
12
Exhibit 12
Access to Individual Market Can Be Difficult and
Coverage Is Limited

• Pre-existing conditions and age may limit
  eligibility and affordability of coverage

Individual 6

• Many services important to women are not
  typically covered

Job-Based, Own Name 38
Uninsured 18

• Prescription Drugs

Medicaid 10

• Contraception

• Maternity Care

Job-Based, Dependent 25

• Preventive Services

Other 3
Note Other includes Medicare, TRICARE, and other
sources of coverage. Source KFF analysis of
March 2007 Current Population Survey, Census
Bureau.
13
Exhibit 13
Making Medicaid Work for Low-Income Women

• Women comprise 69 of adult Medicaid enrollment
• Women more likely than men to qualify

Individual 6

• Covers important benefits
• Screening
• Contraception
• Maternity care
• Prescription drugs
• Physician and hospital care
• Long-term care

Uninsured 18
Job-Based, Own Name 38
Medicaid 10
Job-Based, Dependent 25

• Eligibility for narrower set of benefits
• Family planning programs
• Breast and cervical cancer

Other 3
Note Other includes Medicare, TRICARE, and
other sources of coverage. Source KFF analysis
of March 2007 Current Population Survey, US
Census Bureau.
14
Exhibit 14
Minimum Medicaid Eligibility Levels, 2006
Income Eligibility Levels as a Percentage of the
Federal Poverty Level
133
74
42
0
Nondisabled Childless Adults
Elderly and Individuals with Disabilities
Parents of Dependent Children
Pregnant Women
Note The federal poverty level was 16,600 for a
family of three in 2006. Source Cohen Ross,
Cox, and Marks, 2007 and KCMU, Medicaid Resource
Book, 2002.
15
Exhibit 15
Uninsured Women
16
Exhibit 16
Improving Reach of CoverageCovering the
Uninsured

• Over 17 million uninsured women

Individual 6

• Two-thirds are in households with at least one
  full-time worker

Job-Based, Own Name 38
Uninsured 18

• Access to care (both preventive and treatment)
  compromised

Job-Based, Dependent 25
Medicaid 10

• Health outcomes poorer

Other 3
Note Other includes Medicare, CHAMPUS, and
other sources of coverage. Source Kaiser Family
Foundation analysis of the March 2007 Current
Population Survey, US Census Bureau.
17
Exhibit 17
Uninsured Women Who is at Risk?
Percentage of Women Who Are Uninsured, 2006
Distribution of Uninsured, 2006
Children 18
Poor
41
(
Near Poor
32
(100-199 FPL)
37

Women 37
27
19-24 Years Old
Men 45
39
Latina
36
Nat. Amer./Aleut. Eskimo
33
Foreign-Born
27
Single Parent
Total 46.5 Million
18 Average for Women 18-64
Source Kaiser Commission on Medicaid and the
Uninsured and Urban Institute tabulations of 2007
ASEC Supplement to the Current Population Survey.
The Federal Poverty Threshold for a family of
three in 2006 was 16,227.
18
Exhibit 18
Uninsured Rates Vary Widely Between the States
Uninsured Rates Among Non-Elderly Women by
State, 2005-2006
9-14 (21 states)
15-18 (10 states)
U.S. Average 18 Range 9 (MN) to 28 (TX)
19-22 (13 states)

23-28 (7 states)
Source KFF analysis of the March 2006 and 2007
Current Population Survey, US Census Bureau.
19
Exhibit 19
Uninsured Women Face Many Access Barriers
Access Barriers, by Insurance Status
Percentage of women reporting
Insured
10
No visit to provider in past year
Uninsured
33
17
Delayed care because of cost
67
Not able to see specialist when needed
12
33
Did not fill prescription because of cost
17
42
Note Includes women ages 18 to 64.


Source KFF, Kaiser Womens
Health Survey, 2004.
20
And Coverage is Only Part of the Challenge
Exhibit 20
Percent Reporting They Delayed or Went Without
Care They Thought Was Needed in the Past 12
Months Due to
33
Low-income Non-poor 200 FPL
All Women
27

21
20

19
19
19
18
17

15
13
12
8
7
3
Transportation Problems
Couldnt find time
Couldnt take time off work
Child care Problems
No Insurance
Note Includes women ages 18 and older. 200 of
the FPL was 29,552 for a family of three in
2004. Significantly different from 200 of
poverty and higher, pemployed. Among women with children younger
than 18 years living in household. Source Kaiser
Family Foundation, 2004 Kaiser Womens Health
Survey.
21
Exhibit 21
Costs and Coverage as Womens Health Issues

• Covering the uninsured is a priority womens
  health issue private vs. public approaches under
  debate.

• Scope of coverage matters services important to
  women should be includedreproductive care,
  chronic illness management, mental health, dental
  care all important.

• Addressing rising health care costs is a major
  challenge, particularly since women have lower
  incomes.

22
Resources
Exhibit 22

• Womens Health Policy Resources on kff.org
• Womens Health Policy Reference Library on
  kaiserEDU.org
• Womens Health on statehealthfacts.org
• Institute for Womens Policy Research (IWPR)
• Jacobs Institute of Womens Health
• National Partnership for Women and Families
• National Womens Law Center