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