Health Reform and Women:
Shaping
p g a Women’s Agenda
g
Alina Salganicoff, Ph.D.
Vice President and Director, Women’s Health Policy
y
The Henry J. Kaiser Family Foundation
Academy Health:
Gender Based Research Interest Group Meeting
Gender-Based
Chicago,
g , IL
June 27, 2009
Slide 1
Why Focus on Women?
56%
42%
38%
Women
Men
30%
19%
21%
Fair/Poor Health
Chronic Condition
q
g Ongoing
g
g
Requring
Care
Note: Includes women and men ages 18 and older.
Source: Kaiser Family Foundation, Kaiser Women’s Health Survey, 2004.
Regularly Uses a
p
Drug
g
Prescription
Slide 2
Many Women Have Problems Accessing
Health Care Due to Cost
Percent of men and women who say they or a family member
have done each of the following in the past year because of COST:
35%*
P off
Put
ff or postponed
d getting
i
needed health care
27%
29%
Skipped
Ski
d a recommended
d d
medical test or treatment
24%
29%*
29%
Didn’t fill a prescription
Cut pills or skipped
doses of medicine
Skipped dental care or
checkups
Source: Kaiser Health Tracking Poll: (June 2009).
*Indicates statistical significance at the 95% level
Women
Men
23%
22%*
17%
39%*
32%
Problems Even Greater for Women of Color and
Huge Range Across the States
Percent Reporting No Doctor Visit in Past Year Due to Cost, by State and Race/Ethnicity, 2004-2006
White
Asian/Native
Hawaiian/Pacific
Islander
15%
U.S. Average
12%
American
Indian/Alaska
Native
Black
Hispanic
26%
22%
27%
Source: Kaiser Family Foundation, Putting Women’s Health Care Disparities on the Map, 2009
Problems Even Greater for Women of Color and
Huge Range Across the States
Percent Reporting No Doctor Visit in Past Year Due to Cost, by State and Race/Ethnicity, 2004-2006
DC: 8%
White
L
Lowest
t State
St t
15%
U.S. Average
Asian/Native
Hawaiian/Pacific
Islander
American
Indian/Alaska
Native
DC:7%
12%
AK:15%
26%
MA:13%
Black
22%
DE:10%
Hispanic
27%
Source: Kaiser Family Foundation, Putting Women’s Health Care Disparities on the Map, 2009
Problems Even Greater for Women of Color and
Huge Range Across the States
Percent Reporting No Doctor Visit in Past Year Due to Cost, by State and Race/Ethnicity, 2004-2006
DC: 8%
White
Lowest State
15%
U.S. Average
WV: 24%
Highest State
Asian/Native
Hawaiian/Pacific
Islander
American
Indian/Alaska
Native
DC:7%
12%
FL:23%
AK:15%
26%
OR:35%
MA:13%
Black
22%
TX:33%
DE:10%
Hispanic
27%
AR:39%
Source: Kaiser Family Foundation, Putting Women’s Health Care Disparities on the Map, 2009
Women’s Coverage
Exhibit 2
Insurance Coverage Patterns Differ
Between Women and Men
Health Insurance Coverage of Adults Ages 18 to 64, by Gender, 2007
100%
1
80%
3%
7%
6%
10%
6%
13%
25%
60%
Other
Medicaid
Individual/Private
Job-Based, Dependent
Job Based
49%
40%
3%
Job-Based, Own Name
Uninsured
39%
20%
18%
22%
Women
Men
0%
Note: Other includes Medicare, TRICARE, and other sources of coverage.
Source: Kaiser Family Foundation analysis of the March 2008 Current Population Survey, US Census Bureau.
Exhibit 3
Challenges for Insured Women
Other
3%
Employer
sponsored
coverage
64%
Medicaid
10%
•
Employer sponsored coverage
– Affordability
y – Premiums,
copays & deductibles
– Scope of coverage
– Variation in benefits
Uninsured
18%
•
Individual market
– Pre-existing exclusions
– Scope of benefits often limited –
maternity, mental health
– Gender rating
•
Medicaid
– Narrow eligibility – income and
categorical test
– Instability of coverage
– Low provider participation
Individual
6%
Women’s Health Insurance Coverage, 2007
Note: Other includes Medicare, TRICARE, and other sources of coverage.
Source: Kaiser Family Foundation analysis of March 2008 Current Population Survey, US Census Bureau.
Slide 5
Improving Reach of Coverage:
Covering the Uninsured
Percentage of women 18 -64 who
are uninsured, 2007:
Poor
41%
•
Over 17 million uninsured women
•
Younger, low-income, and women
of color are particularly at risk
•
Two-thirds are in households with
at least one full-time worker
Below 100% FPL
Near-Poor
100% - 199% FPL
Single Mother
31%
26%
< High School
19 to 24 years
Latina
American Indian/
Alaska Native
37%
– Many working women either don
don’tt
qualify for ESI due to part-time
work or low wages
28%
37%
•
Access to care ((both preventive
p
and treatment) compromised
•
Health outcomes poorer
31%
US average for women = 18%
Note: The federal poverty level (FPL) was $17,170 in 2007 for a family of three.
Source: Kaiser Family Foundation analysis of the March 2008 Current Population Survey, US Census Bureau.
Women and the
Health Care Delivery System
Exhibit 5
Chronic Health Conditions
Are A Concern for Many Women
9%
Disability/condition
limiting activity
18 to 44 years
45 to 64 years
65 and older
18%
22%
Chronic condtion
requiring
q
g ongoing
g
g
treatment
23%
50%
9%
Arthritis
32%
5%
Diabetes
13%
20%
2%
Heart disease
8%
18%
Note: Chronic conditions diagnosed by physician in past 5 years.
Source: Kaiser Family Foundation, 2004 Kaiser Women’s Health Survey.
59%
61%
Exhibit 6
Health Professional Shortages are
Increasingly Affecting Provider Availability
•
Many women live in
counties with primary care
shortages
•
Nearly 50% of U.S.
counties had no Ob/Gyn
providing direct patient
care
•
87% of counties
(representing 35% of U.S.
women) had no abortion
provider.
•
In some places, waiting
times for first-time
mammograms exceed 40
y
days
U.S. Average= 43%
IL
< 40% (13 states)
40- 49% ((22 states))
≥ 50% (15 states and DC)
Source: Area Resource File, 2004.
Reproductive Health Policy
Exhibit 7
Challenges in Reproductive Health
• Half of pregnancies in U.S. unintended; (half of these
end up in abortion)
– Major disparities by income and race
– Slight uptick in teen birth rate
• Rising rates of STIs/HIV
– Young people at high risk
– Heavy toll of AIDS epidemic on women of color
• One-third of births are C-Sections
– Implications for costs, maternal and infant health
• Abortion debate - Nation divided on this issue
– Increased limitations on abortion access through federal and
state laws
Exhibit 8
Availability of Contraception for Women
•
Employer sponsored coverage
– No federal mandate requiring insurers to cover contraceptives
– 27 state mandates
mandates, but self
self-funded
funded plans exempt
•
Individual market
– Limited coverage
g
– Few state mandates on benefits in individual insurance
•
Public sources:
– Title
Titl X
• Federal block grant-providing funding for confidential services to
about 5 million low income women and teens
• Funding levels have not kept up with inflation
– Medicaid
• Serves millions women of reproductive age through basic program and
family planning waivers
• Accounts for over 2/3 of public funding for family planning
• Services matched at 90%,
90% Copays prohibited
Long Term Care
Long-Term
Exhibit 9
Multiple Factors Predispose Women
to Needing Long-term
Long term Care
Women
Limitations in 2+
ADLs
Men
49%
Income less
than
$20,000/yr
17%
28%
11%
39%
Living alone
Limitations in 2+
IADLs
9%
Widowed
Cognitive/mental
i
impairment
i
t
19%
15%
23%
46%
14%
17%
Age 85+
17%
9%
Note: ADLs refer to Activities of Daily Living (bathing, dressing, eating, walking, using the toilet, getting in and out of chairs).
IADLs refer to Instrumental Activities of Daily Living (doing housework, making meals, managing money, shopping, using the
telephone). Analysis excludes institutional population.
Source: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey Access to Care file, 2006.
Slide 12
Women Comprise the Majority of the
Long term Care Population
Long-term
Nursing Home Residents
Home Health Users
Men
M
24%
Women
76%
Total = 1.5 million
Men
32%
Women
68%
Total = 2.5 million
Source: Kaiser Family Foundation analysis of Medicare Current Beneficiary Survey Access to Care file, 2006.
Slide 13
Costs, Coverage, and Access
as Women’s Health Issues
•
Across the lifespan women’s health concerns are at core of
many policy debates– health reform, reproductive health, chronic
illness and long
illness,
long-term
term care
•
Covering the uninsured is a women’s health priority
General agreement on need,
need multiple approaches under debate
•
Addressing rising health costs a major challenge — rise in
premiums, copays and deductibles are a challenge to many women.
C t l iissue iin reform
Central
f
•
Scope of coverage matters—reproductive care, chronic illness
management mental health are all important – details of coverage
management,
not yet fleshed out
•
The health care delivery system is falling short of many
women’s
’ needs
d and
d will
ill need
d to
t be
b shored
h
d up - Availability
A il bilit off
health care services important to women limited in many states and
counties