Last month the Center for American Progress noted that nearly one in four unmarried women between the ages of 18 and 64 were uninsured, compared with 15 percent of married women. Unmarried women have a hard time obtaining health insurance with lower household incomes than married women, jobs that often do not provide insurance, and no access to insurance through a spouse’s plan. Only half of unmarried women currently have insurance through their employer and young women are especially vulnerable to being uninsured. There has been an increased focus in the health care debate on the difficulties many women face when trying to obtain coverage, including a speech given today by First Lady Michelle Obama that focused on older women.
The Affordable Health Care for America Act, H.R. 3962, passed on Saturday 220-215, contains many provisions that will address these issues and will serve to expand health insurance coverage and affordability for unmarried women:
- Insurance exchange. The bill creates a federal exchange that would allow individuals and small businesses to purchase health insurance when their employer does not offer a group plan.
- Employer mandate. Employers must offer coverage or make an insurance contribution, with penalties for firms that do not provide coverage, excepting firms with less than $500,000 payrolls. Part-time workers will be covered on a pro-rata basis, in proportion to hours worked.
- Premium subsidies. Subsidies—affordability credits on a sliding scale—will reduce premiums and out-of-pocket costs for low- and moderate-income families.
- Private insurance market regulation. The bill bars insurance companies from denying or reducing coverage based on pre-existing medical conditions and prohibits consideration of domestic violence as a pre-existing condition.
- Caps on out–of-pocket expenses. These expenses will be limited annually on a progressive scale, up to $5,000 for an individual and $10,000 for a family, which should help to reduce medical bankruptcies.
- Medicaid expansion. The bill allows enrollment for those making up to 150 percent of the federal poverty level and requires Medicaid coverage during a newborn’s first 60 days of life.
- Allowing young adults to stay on their parents’ plan. The bill allows young adult children up to age 27 to remain on their parents’ group plan.
- Equitable tax treatment. The bill treats insurance coverage of domestic partners as tax free, as it is for married couples.
Focus now turns to the Senate, which is expected to bring a bill to the floor for substantial debate in the next few weeks. The Senate should include all of the above provisions in its bill to ensure broad access to health care coverage, and the Senate can improve on the House bill in one crucial way.
Senate leadership must follow the House’s example and include an employer mandate rather than an employer “free rider” provision. The free rider provision would require employers that don’t offer insurance and whose employees are eligible for federal subsidies or Medicaid benefits to contribute an amount roughly equivalent to what it would cost the federal government. This is in contrast to an employer mandate, which would fine employers for every employee they did not cover, regardless of their income.
Thus, counterintuitively, a “free rider” provision would penalize—and thus disincentivize—employers from hiring workers eligible for premium subsidies: low- and moderate-income individuals. This is a great concern for single mothers in particular, who could be penalized as less attractive hires.
In addition, the Senate should address the controversial House-side “Stupak amendment,” which goes farther than previous restrictions on abortion and would effectively take reproductive rights backward by barring abortion coverage in the insurance exchange. The bill prohibits individuals who receive health insurance subsidies (affordability credits) from purchasing a plan that includes abortion coverage, even though no government money would be spent on abortion services. This provision discriminates directly against low- and moderate-income women and will likely eliminate abortion coverage in the exchange for all women. The Senate ought to ensure, at the very least, that women be able to use their own money to purchase comprehensive insurance that meets all their health needs, including abortion.
While not on the table in the current debate, some additional policy proposals that would address the discrimination in health insurance coverage based on marital status include:
- Plus-one and/or household plans. Encourage or require employers and exchanges to treat two adults the same regardless of relation or marital status, which would allow unmarried women to support their loved ones just as married partners do.
- Domestic partners are provided coverage at many firms, but these should be defined broadly as same-sex or opposite-sex partners. Similarly, the definition of “family” should not be limited to an individual plus his/her spouse and dependents, but should include unmarried interdependent adults, such as domestic partners.
- COBRA. Employers are currently not required to provide COBRA continuing coverage to domestic partners or other adult nonspouses when the primary insured loses his or her job. Rather, all persons who were previously eligible under an employer’s plan should continue to be eligible under COBRA.
- Divorce and separation. Changes in marital status should not result in automatic loss of insurance for anyone covered as a dependent, unless both primary and dependent parties agree.