Online-only: Many women fail to get the care they need, report finds
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* Teddi Dineley Johnson

Rising health care costs and a sluggish economy have put the health of many Americans at risk, but women — especially those in low- and moderate-income households — have been hit harder than men, a new report finds.

Forced to make tough trade-offs between health and other major decisions, nearly one in three women ages 19 to 64 — or 27 million people — were without health insurance during some part of 2010, according to the report, which presented findings from the Commonwealth Fund’s 2010 Biennial Health Insurance Survey. Women in low- and moderate-income families were most likely to go without insurance, the report said.

“This report shows how rapidly rising health care costs and lagging incomes are leaving increasing numbers of women unable to afford health insurance and health care —and millions are struggling with medical bills and debt,” said study co-author and Commonwealth Fund Vice President Sara Collins.

Released in May by the Commonwealth Fund, the report found that women with health problems who do not have coverage through an employer face barriers to gaining coverage in the individual insurance market. In the survey, 85 percent of women with a health problem who tried to buy coverage said that they either found it very difficult to find a plan that fit their needs or that they could afford, or that they had been turned down, charged a higher price or been excluded from coverage because of a pre-existing condition.

Women who seek coverage on the individual insurance market face additional hurdles, the report said, as few plans offer maternity coverage, and in most states insurance carriers charge higher premium rates to young women than men of the same age. The report blamed a combination of situations, including increasing health care costs, stagnant incomes and the loss of jobs and accompanying health benefits — for creating barriers to care for increasing numbers of women.

In 2010, cost constraints forced 48 percent of working-age women — up from about 34 percent a decade earlier — to be unable to fill a needed prescription, make a necessary appointment with a doctor or specialist or receive a recommended test or treatment. Even women with insurance reported problems, said the report, which found that more than one-third — or 37 percent — of women who were insured all year reported cost-related problems getting needed care, up from 26 percent in 2001. But women without insurance fared far worse, with 76 percent reporting they skipped needed health care because they couldn’t afford it.

While women are far more likely than men to forgo needed care because of cost, one-third of men reported cost-related access problems, according to the report, “Realizing Health Reform’s Potential: Women At Risk, Why Increasing Numbers of Women Are Failing to Get the Health Care that they Need and How the Affordable Care Act Will Help.”

The problem of paying for health care underscores the need for health reform, the report said, noting that several provisions in the Affordable Care Act are already benefiting women, including requiring insurance companies to cover preventive care services such as mammograms and Pap smears free of cost, and allowing women to seek obstetrical and gynecological services without a referral from a primary care provider.

In 2014, when the Affordable Care Act is fully implemented, nearly all of the 27 million uninsured women are predicted to have access to affordable, comprehensive health insurance that will cover the care they need — including maternity care — and insurance companies will no longer be able to charge women and small businesses with female dominated workforces more because of gender.

“The Affordable Care Act couldn’t come at a better time for women whose health and financial security has been increasingly in jeopardy over the past 10 years,” said Commonwealth Fund President Karen Davis. “Moving forward it will be crucial for the health reform law to be implemented quickly and effectively so the millions of uninsured women and those with poor health insurance in the United States can finally afford the health insurance and health care they need.”

For more information or to download the report, visit [www.commonwealthfund.org](http://www.commonwealthfund.org).

*   Copyright The Nation’s Health, American Public Health Association