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The End of Gender Rating: Women’s Insurance Under the ACA

August 04, 2015

The ACA has had other benefits besides increased insurance coverage. It has improved healthcare for women. One of the improvements has resulted from a ban on gender rating. What is gender rating and why is it so unethical? 

By Samantha Kahn, C’16                                         

Ever since the passage of the Patient Protection and Affordable Care Act (PPACA or ACA for short), its opponents have virulently campaigned against it. Supporters of the ACA usually counter these diatribes with the argument that the ACA has provided millions of previously uninsured Americans with health insurance. Often unmentioned in these arguments are the other benefits the ACA delivers. One is increasing women’s health insurance benefits. These improvements include the end of exclusion of some pre-existing conditions (which for women include C-sections and domestic violence); mandating the inclusion of maternal services on insurance plans; and the end of gender rating.

Gender rating is the practice of charging men and women different rates for identical health services.[1] These “different rates” usually translate to higher health insurance premiums for women than for men. Research conducted before the implementation of the ACA showed that women on the individual market could pay up to 1.5 times more than men for health insurance.[2] It also showed that gender rating costs U.S. women approximately $1 billion dollars annually.[3]

Gender rating has been banned for nearly forty years on the employer-sponsored market.[4] However, before the passage of the ACA, it was legal on the individual insurance market.

How much more do women pay for health insurance? 

Some proponents of gender ratings say that the different rates for men and women are justified because women and men use different amounts of healthcare.[5] They also often point to childbirth and maternal care as reasons why men and women’s healthcare may differ in cost.

The first part of this argument, that men and women use different amounts of healthcare and women are thus more expensive to insure, is false. The fact is, if you remove maternity services, women are not more expensive to insure than men are—they simply use healthcare differently.[6]  Women cost the healthcare system more when they are younger, since they use preventative healthcare more than men do.[7] Men cost the healthcare system more when they are older, since they are more likely to have heart attacks, lung cancer, and liver cancer.[8] Also, men are more likely to smoke, drink, and get in accidents.[9] It is unjust to penalize women when in fact both men and women cost the health system relatively equal amounts, just at different points in their life. Additionally, we should not punish women for their cautiousness while rewarding men for their recklessness. The argument that women are charged more because they use healthcare more is also incorrect because the parts of healthcare that women and men use at the same rate, such as specialty clinics and the emergency room, charge women more. [10]

The second tenet of this argument is also untrue; women cannot be “more costly to insure” due to coverage of the maternal and child health services, since very few of the plans that gender rate cover maternity services. According to a 2012 report from the National Women’s Law Center, before the implementation of the gender rating ban and inclusion of maternity services on insurance, 92% of best-selling insurance plans engaged in gender rating.[11] Of those plans, only 3% covered maternity services.[12] Regardless of the verity of this argument, however, this should never be a reason that women have to pay more for healthcare. Men and women play equal roles in the conception of a child—they should both have to pay for childbirth.

Aside from financial facts behind gender rating, it is clear that unequal rates are unethical. The $1 billion that gender rating costs women is especially impactful because women tend to have a lower income, often due to the wage gap. Before the passage of the ACA, 52% of women reported delaying medical care because of cost, and 32% of women reported giving up basic necessities in order to pay for healthcare expenses.[13] Although gender rating is not the only reason for these difficulties in affording health care costs, it is a large factor.

The ACA rectifies this problem by banning gender rating. Starting in 2014, “gender rating [became] illegal in all new individual and small group plans.”[14] There has been no significant pushback to this part of the legislation, it has bipartisan support, and as of 2015 it is still law.[15]

The elimination of gender ratings has gained some recognition as an improvement to America’s healthcare system. On June 25th, President Obama outlined gender rating as a benefit of the ACA when delivering a speech about the King v Burwell outcome. He triumphantly announced, “If you’re a woman, you can’t be charged more than anybody else…just because you’re a woman.”[16]

With all of the talk about repealing the ACA, it is important to remember how significantly it has improved health coverage for women. King v Burwell was a victory not just for the uninsured population, but for all women who obtain insurance on the individual market.

  [1] Cauchi, Robert. “Gender rating in health insurance.” Colorado Healthcare Task Force. Published August 10, 2009. Accessed July 2, 2015. http://www.ncsl.org/portals/1/documents/health/COGeninsur809.pdf

  [2] Ibid.

  [3] “Obamacare and women: Obamacare’s women’s health services.” Obamacare Facts. Accessed July 8, 2015. http://obamacarefacts.com/obamacare-womens-health-services/

  [4] Carney, Robert J., and Donald W. Hardigree. “The Economic Impact of Gender-Neutral Insurance Rating on Women.” The Journal of Insurance Issues and Practices (1990): 1.

  [5] Andrews, Michelle. “Health insurance prices for women set to drop.” NPR. Published July 17, 2012. Accessed July 2, 2015. http://www.npr.org/sections/health-shots/2012/07/17/156895577/leveling-the-playing-field-for-women-s-premiums

  [6] Graves, Lucia. “Why making women pay more than men for health insurance doesn’t make sense.” National Journal. Published December 12, 2013. Accessed July 7, 2015. http://www.nationaljournal.com/politics/why-making-women-pay-more-than-men-for-health-insurance-doesn-t-make-sense-20131212

  [7] Robertson, R., and S. R. Collins. “Realizing health reform’s potential: women at risk: why increasing numbers of women are failing to get the health care they need and how the Affordable Care Act will help. Findings from the Commonwealth Fund Biennial Health Insurance Survey of 2010.” Issue Brief (Commonwealth Fund) 3 (2011): 1.

  [8] Graves, Lucia. “Why making women pay more than men for health insurance doesn’t make sense.” National Journal. Published December 12, 2013. Accessed July 7, 2015. http://www.nationaljournal.com/politics/why-making-women-pay-more-than-men-for-health-insurance-doesn-t-make-sense-20131212

  [9] Ibid.

  [10] Robertson

  [11] Garrett, D. “Turning to fairness: insurance discrimination against women today and the Affordable Care Act.” National Women’s Law Center, March 2012.


   [13]“Obamacare and women: Obamacare’s women’s health services.” Obamacare Facts. Accessed July 8, 2015. http://obamacarefacts.com/obamacare-womens-health-services/

  [14] Ibid.

  [15]Andrews, Michelle. “Health insurance prices for women set to drop.” NPR. Published July 17, 2012. Accessed July 2, 2015. http://www.npr.org/sections/health-shots/2012/07/17/156895577/leveling-the-playing-field-for-women-s-premiums

   [16]“Obama’s Full Remarks on Supreme Court Ruling.” US News. Published June, 25 2015. Accessed June 25, 2015.  http://www.usnews.com/news/articles/2015/06/25/president-barack-obamas-full-statement-on-supreme-court-affordable-care-act-ruling

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