What Do Women Know About Obamacare That Men Don’t?

Susan DentzerFor the second year running, more women than men have signed up for coverage in health insurance marketplaces during open enrollment under the Affordable Care Act. According to the Department of Health and Human Services, enrollment ran 56 percent female, 44 percent male, during last year’s open enrollment season; preliminary data from this year shows enrollment at 55 percent female, 45 percent male – a 10 percentage point difference.

What gives? An HHS spokeswoman says the department can’t explain most of the differential. Females make up about 51 percent of the U.S. population, but there is no real evidence that, prior to ACA implementation, they were disproportionately more likely to be uninsured than men – and in fact, some evidence indicates that they were less likely to be uninsured than males .

What is clear that many women were highly motivated to obtain coverage under the health reform law – most likely because they want it, and need it.

It’s widely accepted that women tend to be highly concerned about health and health care; they use more of it than men, in part due to reproductive services, and make 80 percent of health care decisions for their families . The early evidence also suggests that women who obtained coverage during open enrollment season last year actively used it.  According to Inovalon, a company that tracks and analyzes data for health plans and providers, people who used the coverage they bought through the marketplaces last year tended to be older, sicker, and more female than the general commercially insured population. As of June 2014, 41 percent of females who purchased coverage through exchanges had face-to-face visits with health care professionals, versus 32 percent of males.

Those numbers are consistent with the notion that many women who signed up for coverage under the ACA had preexisting conditions or other health issues that led them to seek treatment.  In some cases, their pre-ACA insurance may have excluded those conditions, or the preexisting conditions may have prevented them from obtaining coverage at all.

What’s more, as HHS points out in a recent report, there are plenty of benefits in the ACA’s qualified health plans that are especially attractive to women. These include coverage at no out of pocket cost for many preventive measures, such as mammograms or screening for gestational diabetes.  An estimated 48.5 million are benefitting from that provision of the law alone.

Other data support the notion that many U.S. women are in disproportionately higher medical need, relative to men – even adjusting for the fact that they typically live longer.  According to an analysis of Medical Expenditure Panel Survey data from the Agency for Healthcare Research and Quality, women constitute nearly 60 percent of people in the top tenth of medical expenditures in 2011 and 2012.  Most of those in the top tenth of spending are either ages 45 to 64, or 65 and older.

One obvious conclusion is that many, and perhaps most, of those who’ve benefited from coverage under the Affordable Care Act are female – and especially women in middle age and beyond. Another is that, if the Supreme Court rules in King v. Burwell that subsidized coverage can’t be obtained through the federal marketplace, women will be disproportionately harmed.

A case in point: Rosemary Forrest, 63, who lives in Augusta, Georgia.  Laid off from her job at a university science lab at age 55, she spent five years unemployed and without health insurance.   She now works as a contractor to a small nonprofit agency; battling painful osteoporosis, she sometimes earns less than $400 a month.  Last year, when the federal health insurance marketplace went live, she signed up for coverage.  This year, she re-enrolled, and after federal tax credits, pays $86 per month in premiums.

Forrest says the subsidized coverage has been a godsend. “I am very nervous” about losing it, she adds.

Susan Dentzer is a former editor of Health Affairs and is a senior health policy adviser for the Robert Wood Johnson Foundation. 

27 replies »

  1. Thanks Ms. Dentzer,

    I’m still unclear as to how osteoporosis limits someone’s mobility, and how that equates with being painful. Chronic pain can be limiting, but not usually vice-versa. Regardless, I wish Ms Forrest well, and hopefully she can find a rheumatologist that takes her “obamacare” insurance, but I wouldn’t hold my breath on that.

    However, I have REAL arthritis, which I would likewise describe as painful, but I still work full-time at my job as an ER physician and pay massive amounts of taxes (including self-employment taxes) for that privilege.

    I also pay my own health insurance premiums for myself and my family, which I would be thrilled to find at $86 a month, or even ten times that amount. I noted my premiums skyrocketed also due to the ACA, despite our leader’s assurance that they would not.

    I’m sure I will be seeing Ms. Forrest in my ED soon, since she has “insurance” that no one will want to accept, and she will end up with an expensive ED visit (or visits) to the tune of thousands of $$$, which, BTW, likely doesn’t exceed her deductible.

  2. “Not to mention every male figure portrayed on a sitcom is a bumbling boob.”

    bird, can’t say about sitcoms but how many women were on Jackass TV? Can’t say for sure but the odd time I passed by it surfing I never saw a women.

    Women are jackasses though in the men they pick as partners.

  3. agree totally, the bigger question is does the lack of male involvement drive policy or does policy dictate minimal male involvement. I am not at all against pink ribbons etc. but every hospital systems has womens centers, breast centers, womens and childrens hospitals etc and all that men get devoted to them is no shave november. Not to mention every male figure portrayed on a sitcom is a bumbling boob.

  4. Men deal with their mortality privately and there health care choices are private and on their own terms

    Men are less subject to fear-mongering doom and gloom predictions if they do not get a certain screening procedure.

    They do it their way….

  5. Thanks for your comments, lawyerdoctor. Needless to say, a 700-word blog post could never be a comprehensive discussion of the entire ACA, and the article certainly wasn’t entitled “Everything Wonderful about the ACA.” Everybody knows there are problems with the law; that’s not the point.

    Also, Rosemary Forrest describes her osteoporosis as painful because it inhibits her mobility.

  6. Thanks for your comments, Bird. The point of the article is simply to highlight the disparity in sign-up rates between men and women, and to try to suggest some factors that could be driving that disparity. It’s curious that more men haven’t signed up, and regrettable if they’re not getting health coverage that they may need, and not taking advantage of subsidies to purchase that coverage that may be available to them.

  7. “Women have no use for Viagra.”

    Not true by the latest Viagra commercial. Seems they want it more than men.

  8. “Her husband has been to the doctor four times, twice because the company made him go for life insurance reasons.”

    Does that mean it’s women who are driving the overuse of our medical system?

  9. Eventually the public is going to have to pay the high price for the ACA (both in dollars and care), but they will invariably blame the people that objected to its passage. We want everything, but we don’t want to pay for it. We even want things provided in the ACA that are near useless.

    I agree with bird and can’t figure out what the author was trying to demonstrate.

  10. I misspoke, men who are married to women of child-bearing age will benefit from maternity care. Men my age, unless we’re married to much younger women, not so much.

  11. Or scotch.

    By the way, women benefit greatly from the ACA with maternity care and birth control. Men have no use for those.

  12. I’d march in DC for men’s rights, so long as you can promise me good beer afterwards.

  13. so the war on women continues, at least we are not at war with anyone else at this point

  14. The old medical sociology aphorism “men die and women get sick” comes to mind.

    The adoption, and advocacy, for screening for prostate versus breast cancer is, in some ways, a gender thing.

    Men can’t be bothered. I am not sure yet whether that’s a good thing.

  15. We notice that women are much more in tune with health care pricing than men.

    Often if I show my web site to a man, he will say “why did you build that on WordPress?” But women are likely to say “OMG, are you live? Can I send this to my sister, to my mom?”

    Women own reproductive health, and data show they also own pediatrician appointments, elder care and other health matters. Women pick up prescriptions and argue with the insurance company. They know about health costs because they have experience.

    By contrast, and of course this is anecdotal but still…One of my friends has been married for 21 years. Her husband has been to the doctor four times, twice because the company made him go for life insurance reasons. He’s available for a conversation about the usefulness of the ACA and health insurance in general, but it’s not a huge issue for him.

  16. According to a recent article in Health Affairs magazine, prior to the ACA, 37% of adult males under age 35 were uninsured compared to only 27% of females, a 10 percentage point gap. In that age group, maternity benefits are likely an important issue even if women don’t need them immediately while healthy men are more likely to think they don’t need insurance and are unwilling to pay for it.

    Beyond age 65, the ACA issue is irrelevant because people are eligible for Medicare and the poorest seniors are also eligible for Medicaid. In the 35-64 age range, diseases like breast cancer are more likely to strike at a younger age than prostate or lung or colon cancer. Beyond age 40, recommended preventive care, including mammograms, is more expensive for women than for men. That creates an added incentive for women to acquire health insurance in greater numbers than men.

    At the end of the day, I think the greater health insurance take-up rate among women is driven more by perceived need than knowledge about the ACA law and the availability of subsidies for those who qualify.

  17. Women voted for obama 56% vs. 43% for McCain in 2008.
    In 2012, women supported obama again by a margin of 55% to 44%.
    No surprises that they have EXACTLY the same margin of support for “obamacare.”

    And BTW, Ms. Dentzer, please refrain from sharing anecdotes in support of your position. I can give you myriad instances of people who lost their insurance, or had their premiums skyrocket, or tried to log on to “healthcare.gov” and were thwarted by the system, or simply abuse Medicaid – to every one of the so-called “success stories” of “obamacare.”

    Also, “osteoporosis” is not generally considered to be painful. Perhaps you meant osteoarthritis? or osteosarcoma? or osteochondritis dissecans?

  18. 1. Men are afraid to confront their health issues or believe they are immortal. This why men live, on average, shorter lifespans. Women are more pragmatic.

    2. Family decision making has traditionally been managed by women. This includes health care. My guess is that these numbers have shifted over the last twenty years. It would not surprise me if male involvement is actually at or near an all time high. But that’s not a guess – not an informed comment …

  19. “One obvious conclusion is that many, and perhaps most, of those who’ve benefited from coverage under the Affordable Care Act are female – and especially women in middle age and beyond. Another is that, if the Supreme Court rules in King v. Burwell that subsidized coverage can’t be obtained through the federal marketplace, women will be disproportionately harmed.”

    I think she saying women are an up and coming voting constituency, so the Republicans better watch out if they are going to challenge Obamacare.
    On the other hand, I’ve seen and talked to plenty of others, both men and women that aren’t so thrilled about it.

  20. Im not sure i understand the relevance of this article? is it that women are sicker then men? smarter then men? more engaged then men? Or is it just a general plug for the ACA? Question is then: So do we pump money into programs that spend more on women or do we try to develop programs that atract more men?