April 11, 2022
By Marysol Encarnación, Drexel University College of Medicine

This blog will use the term “women” to generally indicate those assigned female at birth; transgender men must also be considered when discussing the topics below, as there are risk factors that exist for both populations.

When discussing health care access, one of the key features of the system that is often overlooked is the coverage of care for those assigned female at birth. First and foremost, women normally should have a separate physician from a primary care provider that addresses complex conditions such as polycystic ovarian syndrome, dyspareunia, breast health and more. These conditions are often chronic, underdiagnosed and therefore undermanaged (Nature, 2021). Then there are the added obstetrical costs that need to be covered for those who choose to have a child. The U.S. health care system has historically not been forgiving to women. A few examples of this are the outdated and painful tools that have been used during gynecological exams (which has only recently changed) and the health care system failing to address pain, especially in conditions that predominantly affect women (Blei, 2018). All these factors are exacerbated in a national health insurance system that has been designed without equity or justice in mind. This perspective will focus on health care costs for women and why a system like single payer would be extremely beneficial for women in particular.

Women are more likely on average to go to a doctor than men (Sondik, 2001). The costs that women accrue because of these visits should still be explored. Especially as health care costs continue to rise, we may see that women could reduce their health care usage and opt out from seeing physicians for preventive medicine. This is further accentuated by the fact that women often make less than their male counterparts. For centuries, women have fought for their right to equitable pay, and while we have made strides in this country, inequities generally still exist, especially for women of color. Too many recent news stories describe how Black women are not believed when it comes to their symptoms, leading to poor health outcomes and even death (Chin, 2021).

The incoming generation of childbearing women is now more and more likely to delay having a child (Livingston, 2019). The cost of living in most major cities has increased considerably while wages have remained stagnant. If women choose to have children, maternal leave is often limited to a paltry few weeks (in comparison to European countries that provide paid leave for months at a time) (Bryant, 2020). With the added cost of health care for routine health maintenance, it’s no wonder that women choose to delay having children. Some women do not have access to proper birth control, a growing concern in this country. These women are often saddled with the responsibility of motherhood in a country that treats it as a punishment.

When a family unit decides to have a baby, it only takes a quick online search to see how costs are extremely prohibitive. Different websites advise parents to call their insurance company immediately upon giving birth. One website outlined steps to take during and after pregnancy to reduce cost, including tips like “question authority” when a health care professional suggests an expensive procedure, and “go home early” (Sinrich, 2020). While well-meaning, advice like this leads to distrust in health care providers. Regardless, these steps are only able to be taken by people who have the medical literacy, health care access, and time to advocate for themselves. The rest of U.S. women must endure terrible health outcomes, which is one explanation as to why those who are underinsured have an increased risk of maternal and fetal mortality (Romano, 2021).

In the state of Maryland, for example, if a family makes less than $35,000 a year, they can opt-in for Medicaid, which reduces the cost of family planning to nearly nothing. However, if a family makes anything more than that, it’s a completely different story. For those who are insured with employer-based insurance, the average out-of-pocket costs for vaginal birth in 2015 was $4,314 and for C-sections was $5,161. And while the Affordable Care Act required most insurance companies to cover maternal care, these costs continue to increase as insurance companies use the existing demand for life-saving and necessary procedures to make a profit (Sinrich, 2020).

So how does Medicare for All fit into this? The latest bill, introduced by Congresswoman Jayapal, covers all preventive health care costs, including maternal and reproductive health. Another key feature of the bill is that it covers abortions. What’s most important about this bill is that it eliminates all co-pays and deductibles for all Americans, but this is especially important for maternal health care by reducing the out-of-pocket expenses to practically zero for pregnancy.

One of the most common arguments that opponents voice is the cost of single payer. While commodifying and assigning monetary value to human life should be generally frowned up, our economy still exists on principles that do exactly that. Thankfully, many economists, epidemiologists and even members of the Congressional Budget Office have provided various analyses that a single-payer system would in fact reduce national health care expenditure (Gaffney, 2021). The question naturally would be, how do costs decrease if we see an increase in health care usage? A single-payer system reduces much of the bloat we see in our system, namely the overhead costs that hospitals and insurance companies claim to maintain their companies and profits.

There’s no doubt that we need to completely revamp our health care system. Women, especially women of color, are facing daily barriers to care. If we can implement a national program such as Medicare for All, it would be a large step toward lifting financial barriers from life-saving interventions and medications. Policymakers need to start thinking about the legacy they want to leave on their nation and realize that they are consistently hurting women with policies that prevent something like single-payer to become a reality.

Sources/Resources:

• Blei, D. (2018, March 8). Women Are Reinventing the Long-Despised Speculum. The Atlantic.
• Bryant, M. (2020). Maternity leave: US policy is worst on list of the world’s richest countries. The Guardian.
• Chinn, J. J., Martin, I. K., & Redmond, N. (2021). Health Equity among Black Women in the United States. Journal of Women’s Health, 30(2). https://doi.org/10.1089/jwh.2020.8868
• Gaffney, A., Himmelstein, D., & Woolhandler, S. (2021). Congressional Budget Office Scores Medicare-For-All: Universal Coverage For Less Spending. Health Affairs.
• It’s time to expand the definition of ‘women’s health.’ (2021). In Nature (Vol. 596, Issue 7870). https://doi.org/10.1038/d41586-021-02085-6
• Livingston, G. (2019). They’re Waiting Longer, but U.S. Women Today More Likely to Have Children Than a Decade Ago. Pew Research Centre.
• Romano, A., & Kleine, J. D. (2021). Medicare For All? Start At The Beginning: Cover All Births And Modernize Maternity Care. Health Affairs.
• Sinrich, J. (2020, December 28). How Much Does Pregnancy Cost? What To Expect.
• Sondik, E. J., Anderson, J. R., Madans, J. H., Cox, L. H., Douglas Williams, P., Hunter, E. L., Zinn, D. L., Rothwell, C. J., Demlo, L. K., Arispe, I. E., Burt, C. W., Hodgson, T., & Director Thomas Hodgson, A. (2001). Utilization of Ambulatory Medical Care by Women: United States. https://www.cdc.gov/nchs/data/series/sr_13/sr13_149.pdf