Tài liệu NOWHERE TO TURN: HOW THE INDIVIDUAL HEALTH INSURANCE MARKET FAILS WOMEN docx

This report is part of the National Women’s Law Center’s project, “Reform Matters: Making

Real Progress for Women and Health Care.” More information and resources for advocates

regarding women and health reform are available at http://www.nwlc.org/reformmatters.

About the Center

The National Women’s Law Center is a Washington, D.C., nonprofit organization working to expand opportunities

and eliminate barriers for women and their families, with a major emphasis on women’s health and reproductive rights,

education and employment opportunities, and family economic security.

Authors

This Report was a collaborative endeavor that relied upon the work of many individuals. The primary authors—Lisa

Codispoti, Brigette Courtot and Jen Swedish—were greatly assisted by Marcia Greenberger, Judy Waxman, Julia Kaye, Ellen

Newcomb, Gretchen Borchelt, Golda Philip, Sarah McGinnis, Amanda Maldonado, Amanda Stone, and Lisa M. LeMair.

The authors would also like to acknowledge the helpful advice and guidance provided by Cheryl Fish-Parcham, Deputy

Director of Health Policy at Families USA, and Terry Fromson, Managing Attorney with the Women’s Law Project.

Disclaimer

While text, citations, and data are, to the best of the authors’ knowledge, current as this report was prepared, there may well

be subsequent developments, including recent legislative actions, that could alter the information provided herein. This

report does not constitute legal advice; individuals and organizations considering legal action should consult with their own

legal counsel before deciding on a course of action. In addition, this report does not constitute medical advice. Individuals

with health problems should consult an appropriate health care provider.

©2008 National Women’s Law Center

Contents

Introduction & Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

I. Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

A. Buying Health Insurance: Important Differences Between Obtaining Health Insurance from an Employer versus the Individual

Market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

B. Obtaining Coverage in the Individual Insurance Market. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

1. How Insurers Decide Whether to Sell Insurance to an Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

2. How Insurers Determine Premiums. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

II. Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

A. Women Face Many Obstacles Buying Health Insurance in the Individual Market. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

1. Rejection: Insurers Refusing to Sell Women Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

2. Gender Rating: Charging Women More than Men for Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

3. Maternity Coverage in the Individual Market: Expensive, Limited and Difficult to Obtain . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

4. Additional Challenges Women Face in the Individual Market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

B. Some States Have Taken Action to Address Challenges Women Face in the Individual Market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

1. State Efforts to Protect Against Gender Rating. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

2. State Efforts to Ensure Access to Maternity Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

3. State Efforts to Address Additional Challenges Women Face. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

III. Policy Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

IV. Conclusion.......................................................................................... 19

Report Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26