Kaiser Health News Examines Issue Of Gender Rating In Health Reform Debate

Main Category: Women's Health / Gynecology
Also Included In: Health Insurance / Medical Insurance
Article Date: 29 Oct 2009 - 4:00 PDT

email to a friend   printer friendly   view / write opinions

Kaiser Health News recently examined how health care reform legislation may affect the insurance industry practice known as gender rating, in which insurers use gender as a factor in determining the cost of policies. The practice often results in women paying more than men for similar policies because they typically use more medical services, such as maternity and reproductive health care. Some advocacy groups argue that using gender as a basis to charge more for health insurance is discriminatory and are pushing for it to be made illegal under health reform, according to KHN.

If a health reform bill is signed into law, it is possible that it will carry a mandate requiring all U.S. residents to purchase health insurance, something that the insurance industry supports, KHN reports. Some insurance industry trade groups have said they would agree to end gender rating practices when they sell insurance policies to individuals and small groups. However, the leading trade group -- America's Health Insurance Plans -- has stopped short of agreeing to end rating practices in the group market where large employers purchase coverage. AHIP says it is concerned that businesses that currently benefit from discounted insurance rates will see a rise in premiums if gender rating is not allowed, which it claims will force them to pull out of the group market and provide their own insurance.

The Senate Finance Committee's bill (S 1796) allows insurers to use gender and other factors when setting premiums for businesses with more than 50 or 100 employees, depending on the state's definition of a large business. The bill allows a large group to be as small as 51 employees, Karen Pollitz, project director at Georgetown University's Health Policy Institute, said. She noted, "A large group is just one more than a small group. It's just 51."

House health reform legislation (HR 3200) and the Senate Health, Education, Labor and Pensions Committee bill (S 1679) would prohibit insurers from using gender and other ratings systems to set rates for both large and small groups. The National Association of Health Underwriters, an industry trade group that represents insurance agents, supports eliminating gender rating for all groups, as long as there is an individual insurance mandate included in the final health reform bill.

As Congress tries to merge the different versions of health reform legislation, policymakers are under pressure from all sides of the issue. Sen. Barbara Mikulski (D-Md.), a member of the Senate HELP Committee, and 24 colleagues recently signed a letter urging a ban on gender rating in all markets, as well as a ban on other practices that are seen as discriminatory. Mikulski said, "Discriminatory insurance practices, such as gender rating, should be abolished across all markets -- individual and group," adding, "A woman should not face discrimination based on something arbitrary like the size of the employer she works for" (Gold, Kaiser Health News, 10/25).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.