July 9, 2014

Obamacare Gives Women Less Control Over Their Health Care

By: Hadley Heath Manning

Affordable Care Act Word Cloud Concept On A Blackboard

In the wake of the Supreme Court’s decision in the Hobby Lobby case, the term “women’s health” has been used repeatedly in reference to one issue alone: reproduction. Sadly, the conversation surrounding women, health care, and “women’s rights” commonly gets reduced this way. Of course, women care deeply about reproductive health, but our interest in the health care system goes much further.  That’s why I joined Accuracy in Academia to teach a short video-class on women’s interests in health care policy.

Like men, women are tired of watching our hard-earned dollars disappear into an inefficient and bloated health care payment system. Over the second half of the twentieth century, women joined the work force in mass numbers, meaning more women accessed employer-sponsored health insurance plans of our own.

While many women may enjoy a health benefit at work, the recent decision in Burwell v. Hobby Lobby highlights one problem with employer-centric health care: Decisions that are better left to individuals must be made in office-based groups, often among people with significant differences in their health care needs and their moral values. Getting rid of the employer-centric nature of our health care system – and instead encouraging individuals to purchase health insurance like we do car insurance or homeowner’s insurance – would be a first step to correcting this flaw in our health care system, and would also encourage greater efficiency and provide more choice and control for women.

Sadly, Obamacare failed to address the longstanding tax disadvantage that individuals face when they try to buy insurance on their own. In fact, the employer mandates in the law only reinforce the employer-centric nature of our health system; this system affects more not just birth control decisions, but all of our health care decisions.

Americans instinctively know that this is wrong.  Overwhelmingly, the public agrees that women should be free to make their own health decisions, without interferences from employers or the state. In the private sector, two out of every three health care dollars are spent by women, often because we are making health care and health insurance decisions on behalf of dependent children or aging parents.  And across nearly every age group, women utilize the health care system more than men.  This is partly because of how our bodies work – we bear children and there are costs associated with that. And this is partly because of behaviors: Women are more likely than men to seek preventative care.

Therefore, women have a particular interest in a flexible health care marketplace, but Obamacare’s many new layers of regulations and mandates—many of which were sold as chiefly benefiting women—having sacrificed such dynamism and created significant new costs as a result.  For example, Obamacare promised to “equalize” the premiums of men and women by regulating that insurance companies charge men and women (of similar ages) the same premium. That may sound like a good deal for women, but in practice women generally haven’t seen premium decreases.

Women in my age group have seen premiums rise for the low-cost plans that young adults prefer. According to a study from the American Action Forum, the average 30-year-old woman has seen a 193 percent increase in her premium while the average 30-year-old man has seen an increase of 270 percent. What good is it to women if men’s premiums triple and ours “only” double?

Another Obamacare promise to women is that their preventative care (including birth control) would be covered from the first dollar. This means insurance companies aren’t allowed to require co-pays or cost-sharing for these services. While seemingly “free” health care services may be attractive, this provision deserves a second look. This approach doesn’t really reduce health costs, to women or to anyone else. Instead, it forces all consumers to pay for these services through their higher health insurance premiums.  We still pay for our doctor’s visit and our birth control; we just do so through higher premiums, instead of co-pays that reflect consumption.

Importantly, we pay for this mandate not just in higher costs, but in less choice and innovation. Drug companies may be the real beneficiaries of the contraception mandate, because if third-party payers cover the costs, there’s no incentive for drug companies to keep prices for birth control low or to develop new products that might not be covered by the mandate. That disincentive really hurts women who do have to pay directly, if they are still uninsured. (This “third-party-payer problem” is the same reason room service is so expensive at hotels that mainly serve a corporate clientele.)

Moving forward, the goal of health reform should be to make insurance products more diverse, more affordable, and more competitive.  This would mean removing coverage mandates and equalizing the tax treatment of employer and individual insurance plans.  Women, who have diverse needs and preferences at all levels of health care, would benefit from more consumer choice, which would only result from removing these government distortions.

Women care about so much more than “free” birth control or abortion.  We care about participating as powerful consumers in a robust health marketplace. So far, we haven’t seen the right reforms to get us there, but we can continue to work toward a health system that works better for us all.

Follow Hadley Heath Manning on Twitter. Image courtesy of Big Stock Photo.