Why Making Women Pay More Than Men for Health Insurance Doesn’t Make Sense

Take maternity off the table and men aren’t any cheaper to insure than women. But Republicans wanted men to pay less anyway.

National Journal
Lucia Graves
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Lucia Graves
Dec. 12, 2013, 11:16 a.m.

Aman­da Car­penter, a speech­writer and seni­or com­mu­nic­a­tions ad­viser to Sen. Ted Cruz, has been loudly lament­ing baby-de­liv­ery costs on Twit­ter.

“Was just for­war­ded a let­ter from a preg­nant wo­man fa­cing a big un­af­ford­able de­duct­ible if she does not de­liv­er by Janu­ary 1 be­cause of Obama­care,” she tweeted. “Did you tell her mar­ket­place plans carry cost-shar­ing pro­tec­tions for ma­ter­nity care ser­vices?” replied Salon‘s Bri­an Beut­ler. “Or is that not the idea”¦”

Last week, Car­penter soun­ded off about how, un­der Obama’s “gold plan,” it costs $1,590 out-of-pock­et to have a baby. Ac­tu­ally, as MS­N­BC’s Ben­jy Sarlin noted, that’s about half as much as it costs the av­er­age in­sured wo­man, who’s been pay­ing something closer to $3,400.

It’s a funny gripe for a num­ber of reas­ons. First, as The Wash­ing­ton Post‘s Ezra Klein poin­ted out, high-de­duct­ible health care plans, or “health sav­ings ac­counts,” were a cent­ral ten­et of Re­pub­lic­an health care think­ing in the days be­fore Obama­care. The high-de­duct­ible com­plaint is even more hy­po­crit­ic­al with re­gard to preg­nant wo­men, giv­en that pren­at­al care is one of the key is­sues at hand in the whole Obama­care de­bate — and one some Re­pub­lic­ans have con­sist­ently knocked as a stu­pid be­ne­fit

Rep. Ren­ee Ellmers, R-N.C., made the point at an Oct. 30 House hear­ing when she poin­tedly asked Health and Hu­man Ser­vices Sec­ret­ary Kath­leen Se­beli­us: “To the best of your know­ledge has a man ever de­livered a baby?” She’s hardly the only con­ser­vat­ive to make the case that men are be­ing un­fairly burdened by things like ma­ter­nity care.

For all the hype over can­cel­la­tions, very little at­ten­tion has been paid to the spe­cif­ic reas­ons vari­ous plans didn’t make the grade. Very of­ten it’s be­cause the new law doesn’t al­low for health plans to carve out cer­tain things that might have al­lowed a health plan to price a product lower in the past — like al­low­ing men to not pay for ma­ter­nity care. That’s a policy known as gender rat­ing.

“The only reas­on con­sumers are get­ting no­tices about their cur­rent cov­er­age chan­ging is be­cause the ACA re­quires all policies to cov­er a broad range of be­ne­fits that go bey­ond what many people choose to pur­chase today,” Kar­en Ig­nagni, pres­id­ent and chief ex­ec­ut­ive of the health in­dustry lobby Amer­ica’s Health In­sur­ance Plans, ex­plained re­cently.

Gender rat­ing is pro­hib­ited un­der the Af­ford­able Care Act. The New Re­pub­lic‘s Jonath­an Cohn notes there are a lot of good reas­ons for that, and Amer­ic­ans on the whole largely agree. Over­all, 61 per­cent have a fa­vor­able view of the pro­vi­sion, ac­cord­ing to data from Kais­er Health from 2012. That num­ber rises to 69 per­cent among wo­men as a group, and about three-quar­ters of wo­men un­der age 50 (73 per­cent of whom back it). Men as a whole are some­what less sup­port­ive with roughly half (52 per­cent) sup­port­ing it — a num­ber that rises to 57 per­cent among young­er men.

The ar­gu­ment for gender rat­ing, in the days be­fore the Af­ford­able Care Act, had al­ways been that wo­men cost more to in­sure. But if we ig­nore all costs dir­ectly as­so­ci­ated with preg­nancy and child­bear­ing (the lo­gic here be­ing that it takes two parties to cre­ate a child and both parties should be will­ing to pay equally to sup­port that en­deavor), men aren’t ac­tu­ally any cheap­er to in­sure than wo­men.

“When you get older, men cost more to in­sure than wo­men,” ex­plained Jonath­an Gruber, a health eco­nom­ist at Mas­sachu­setts In­sti­tute of Tech­no­logy. Later in life, men are more likely to have a vari­ety of con­di­tions in­clud­ing heart at­tacks, lung can­cer, and liv­er can­cer. They’re also more likely to smoke, drink, and get in ac­ci­dents, ac­cord­ing to ex­perts.

Larry Levitt, a seni­or vice pres­id­ent of the Kais­er Fam­ily Found­a­tion, said that while Kais­er doesn’t have any in­de­pend­ent ana­lys­is of this, in­surers have his­tor­ic­ally charged young­er wo­men more than men in the in­di­vidu­al mar­ket, even though those plans rarely covered ma­ter­nity ser­vices. “That tends to re­verse at older ages, when men have gen­er­ally been charged more than wo­men,” he said. “It’s reas­on­able to as­sume that in­surers set those premi­ums based on the pat­terns of health care use that they saw.”

In 2008 the av­er­age ex­pendit­ure per per­son with an ex­pense, in­clud­ing ex­penses covered by in­sur­ance and those paid out-of-pock­et, was slightly high­er for wo­men ($5,635) than for men ($4,952), ac­cord­ing to data from the Agency for Health­care Re­search and Qual­ity. But the dif­fer­ence in ex­pendit­ures is largely at­trib­ut­able to child­birth.

As shown in the chart, men’s av­er­age ex­pendit­ures sig­ni­fic­antly ex­ceeded wo­men’s for hos­pit­al in­pa­tient ser­vices ($18,984 versus $12,997, re­spect­ively). The over­all mean health care ex­pense was great­er for wo­men be­cause of the great­er per­cent­age of wo­men in­cur­ring more ex­pens­ive ser­vices. For ex­ample, 10.8 per­cent of wo­men had hos­pit­al in­pa­tient ser­vices — that in­cludes child­birth de­liv­ery — com­pared with 6.4 per­cent of men, con­trib­ut­ing to a high­er mean ex­pendit­ure over­all.

“The bot­tom line,” says Gruber, “is that the pre­dom­in­ant dif­fer­ence is ac­tu­ally ma­ter­nity.” The next time a Re­pub­lic­an flack be­moans the cost of hav­ing a baby un­der Obama­care, it’s worth re­mem­ber­ing that that’s a cost Re­pub­lic­ans would have wo­men pay.

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