May 14, 2018 | Rosemarie Day

CommonWealth Magazine: With junk insurance, you get what you pay for

Read Rosemarie Day’s the article on CommonWealth’s site or below.

INSPIRED BY MARCHES, movements (#MeToo, #TimesUp), and momentum (the unprecedented surge of females running for office), women are standing up for the issues that matter most to them. Let’s make sure that healthcare continues to be on that list.

Under the Affordable Care Act (ACA), American women have made dramatic gains. The number of uninsured working-age women has fallen by 8 million. More than 55 million women have access to preventative care at no cost. And women saved $1.4 billion on birth control in just one year.

Now, the Trump Administration is poised to erase some of that progress. How? By proposing new regulations that will allow the sale of “short-term” health insurance plans for much longer periods in the individual marketplace.  (The individual marketplace is where people shop for health insurance if they don’t have coverage through their employer.)  Valid for a proposed 364 days, rather than their current 3 months, these “short-term” plans don’t have to adhere to the consumer protections afforded by the ACA.

These changes are being billed as ways to give consumers health insurance that costs less. But you get what you pay for, and once these “bare-bones” plans start percolating through the marketplace, I’m anticipating a cascade of negative consequences—especially for women.

Under these proposed regulations:

  • Women’s reproductive health may not be covered. Imagine 28-year-old Jennifer who is between jobs and low on cash. She opts for one of the Trump administration’s proposed short-term insurance plans. If Jennifer gets pregnant, it’s likely she’ll find out that maternity coverage is not included in her plan. What’s more, if there are any complications in Jennifer’s pregnancy and she goes to the emergency room or must be hospitalized, many of those services may not be covered either. What if Jennifer isn’t pregnant and wants to use birth control? She had better check carefully, because her short-term health insurance policy may not cover it.
  • Women’s wellness care and pre-existing conditions won’t have to be covered. Meet Sue, who decides not to have her mammogram because preventative services are not covered under her new short-term insurance plan. Sue then detects a lump in her breast, pays out-of-pocket for a mammogram, and finds out that she has breast cancer. Only now the cancer is at a later stage where treatment is much more intense and expensive. Surely Sue’s insurance would kick in at this point? Not necessarily. It’s likely that Sue’s hospital visits and prescription drugs wouldn’t be fully covered, and she’d be subject to an annual limit of benefits. Could the situation get any worse? Yes. Under the Trump administration’s new proposed regulations, when Sue goes to look for different insurance, she could be denied her less expensive coverage because her cancer is now considered a pre-existing condition, and depending on the timing and circumstances, she could be locked out of purchasing ACA-compliant coverage for close to a year (due to being outside of the open enrollment period). 
  • Women may have to pay more for insurance just because they’re women. The Trump administration also wants to expand the use of Association Health Plans for businesses. While the Labor Department plans to prevent associations from rating, or pricing, groups based on health status of previous claims, they will still be free to use factors to set premiums prices based on age, gender, or industry. In other words, a business with more women of childbearing age could be quoted a higher rate than a company comprised of employees who are mostly men.
  • Changing jobs will be more difficult. Given their caregiver roles, women tend to need more workplace flexibility throughout their careers. But if you can only get “good” insurance, affordably, through your employer, you’re apt to stay in your current job, even if it’s not the best fit for you and your family.

If you’re opposed to health insurance changes like these, stay informed and speak up. Understand that states can push back on these federal rules by establishing their own rules. Support the organizations that are advocating for your coverage.  Connect to reputable sources so you’re aware of any proposed changes and ask questions to know where your elected officials stand. Lastly, vote — and make support of healthcare a priority in how you cast your ballot. 

Rosemarie Day is the President of Day Health Strategies, a Somerville-based consulting firm that focuses on transforming the health care system to make it more patient-centered, affordable, and high performing.  She served as the founding Deputy Director of the Massachusetts Health Connector and has been actively involved in health reform since 2006.  Follow her on Twitter:  @Rosemarie_Day1.