Health Insurance Restructuring: Women’s Status Declines, The Battle Continues

By Ethel Long-Scott

From Oakland, CA to the slums of Cairo, Egypt, to the earthquake torn shores of Haiti, Women are not just more likely to be poor than men, they also tend to need more health care than men. A recent New York Times article attributed that to the demands of pregnancy and family planning, as well as the tendency of insurance companies in most states to charge young women more for health insurance than they charge young men. These are just some of the inequities that make the recent health insurance restructuring passed by Democrats in Congress a mixed blessing. You could say it’s like easing a housing shortage by adding more floors to the tops of apartment buildings whose foundations were already crumbling.

Most people call it health care reform, but it’s really only health insurance restructuring. Some celebrate as a major accomplishment the delivery of 32 million more people into our broken market-driven insurance system, even though about 24 million will remain uninsured, and more will be under-insured. They say it’s wonderful to end denials of coverage due to pre-existing conditions, although the insurance companies’ appeal process is internal to the industry and lacks enforcement. They celebrate the allocation of billions of dollars more to community clinics to provide minimum care to the new mandated market. But because it doesn’t raise the Medicaid reimbursement rates sufficiently, the safety-net hospitals could be in worse shape if Medicaid rolls rise as expected.

The reason the Democrats decided to put some good measures on top of a fundamentally broken system is that this restructuring represents a transition from employer-based health care delivery to an individual mandate health system. In an era of the jobless recovery and growing, permanent, structural unemployment, this was a prudent thing to do. You may lose your job, but you still have to buy health insurance. The health industry is nearly 17% of the nation’s Gross Domestic Product. Mandating 32 million individuals to pay the health insurance industry for care subsidizes these industries at the expense of workers and the poor who still need health care. The new law contains NO restrictions to keep insurance companies from skyrocketing premiums.

Gender inequities will continue under the new system. The New York Times said a recent report by the Joint Economic Committee of Congress estimates that about 1.7 million women have lost health insurance benefits as a result of job losses since December 2007 — 71 percent of these as a result of their spouses’ job loss. The new health insurance restructuring will not help with women’s reproductive rights — a new executive order from the President enshrines oppression against women by expanding segregation of funds, which in practice will likely mean few insurers will cover abortion and perhaps other reproductive medical services.

We know that women seem to be more affected than men by insurance-related problems, including inadequate coverage. A Commonwealth Fund study released last May found that about 52 percent of working-age women, compared to 39 percent of working-age men, reported in 2007 that they had to forgo filling a prescription, seeing a specialist, obtaining a recommended medical test or seeing a doctor at all as a result of medical costs. Beyond that, “more than one-half of all bankruptcies related to medical costs in the United States in 2007 were filed by female-headed households.”

It gets even worse when you consider that women are disproportionately represented in the ranks of the poor. More than half of the 37 million Americans living in poverty today are women. And the gap in poverty rates between men and women is wider in America than anywhere else in the Western world. In 2007, 13.8 percent of females were poor compared to 11.1 percent of men.

According to the Center for American Progress, women are poorer than men in all racial and ethnic groups. Recent data shows that 26.5 percent of African American women are poor compared to 22.3 percent of African American men; 23.6 percent of Hispanic women are poor compared to 19.6 percent of Hispanic men; 10.7 percent of Asian women are poor compared to 9.7 percent of Asian men; and 11.6 percent of white women are poor compared to 9.4 percent of white men (Source). It is well established that in the United States, the poorer you are, the worse your health care is. The new law does almost nothing to address that problem, even though the economic realities of globalization mean poverty is likely to grow. New methods of production are replacing workers with everything from automated supermarket checkouts to computer-controlled factories. Every industry is being automated, and that destroys the social contract that developed under industrial capitalism.

But in the current era of Global capitalism, many other countries are suffering job loss from a decline in manufacturing. In the past decade, U.S. manufacturing jobs declined by more than 11 percent. During the same period, Japan’s manufacturing employment base dropped by 16 percent. Manufacturing jobs in Brazil declined 20 percent — and one of the biggest losers in manufacturing jobs was China!

So now that health insurance is being restructured, what do we need to do to get real health care reform? First we need a clear vision of what would be in everyone’s best interest in a rich nation like ours, facing the unpleasant economic reality that most of the good jobs we were used to will never come back. That vision starts with something the United Nations said more than 60 years ago, back in 1948. Health care is an economic human right. Health care as a human right is not simply the absence of disease: People have the right to reach their highest attainable state of complete physical, mental and social well being. Adequate medical care is only one of the things that people need to be as healthy as possible. A few of the others are healthy food, adequate housing, the right to water and a clean environment, having control over your own life, and being able to fully participate in decisions about your community. That is why, in going forward, we must link all these things together. Replacing the just-passed individual mandate plan with an improved and expanded Medicare for All program is an essential step in this process. Congress knows how to do this. The details were worked out years ago in earlier single payer proposals such as Just Health Care, H.R. 676 and others that were ruled off the table early in the Obama presidency, even though analyses showed it would cover everybody and more than pay for itself by eliminating the price-gouging private insurance companies from the system. We need to build a people’s movement to demand this human right to universal health care.

As we fight forward building this broad transformative movement, we need to consider working differently. We need a campaign that puts head, heart, and feet together to secure the health care we need. Going forward we need mass education campaigns, teach-ins, and direct actions that take U.S. health care horror stories and explain how the real life outcomes would have been better if we had secured health care as a human right by simply improving and expanding Medicare.

Going forward we get to redouble our efforts by asking people, “Now that we’ve had what’s called health insurance reform, is your health care what you need?” We know what the answers will be.

For nearly 40 years, Ethel Long-Scott has been on a mission to increase social and economic justice in jobs as varied as non-profit executive director, grassroots community organizer and political campaign strategist. Often that has meant working with labor and community groups to create opportunities for constructive social change where none seemed to exist. Always that has meant community organizing at a grassroots level to help ordinary people amplify their voices by teaming up with each other.