Women's Health Insurance Coverage Fact Sheets

By
Kaiser Family Foundation
February 5, 2007

As the cost of health insurance continues to rise, women in particular may face difficult challenges affording coverage because they are disproportionately low-income and can have more limited access to employer-based insurance. To document the health coverage status of women, the Kaiser Family Foundation is releasing new fact sheets providing state and national data on women's health insurance.

Highlights include:

• Nationally, one in five (19%) non-elderly women ages 18 to 64 are uninsured. Among the states, Minnesota has the smallest share of uninsured women (9%) and Texas, the highest (29%).
• One third (34%) of women 18 to 64 in the U.S. have incomes less than 200% of poverty ($31,154 for a family of three) and 37% of low-income women are uninsured.
• Approximately two-thirds of women and men have job-based coverage, however, women are less likely than men to be insured through their own job (38% vs. 50%, respectively) and more likely to have dependent coverage (24% vs. 13%).
• Medicaid, the health program for the poor, covers 10% of non-elderly women in the U.S. In Maine, 20% of women are covered by Medicaid, compared to just 3% in neighboring New Hampshire.  

WOMEN’S HEALTH INSURANCE COVERAGE - February 2007

Health insurance coverage is a critical factor in making health care accessible to women. Women with health coverage are more likely to obtain needed preventive, primary, and specialty care services, and have better access to many of the new advances in women’s health. The patchwork of different private sector and publicly funded programs in the U.S. leaves nearly one in every five non-elderly women uninsured.

Women’s Health Insurance Coverage, 2005

Total = 93 Million Women Ages 18 to 64

Note: Other includes Medicare, Champus, and other sources of coverage.
Source: Kaiser Family Foundation/Urban Institute analysis of March 2006 Current Population. Survey, Bureau of the Census.

Employer-Sponsored Insurance

Over 57 million non-elderly women in the U.S. get their health coverage from their own or their spouse’s employer. Historically, fulltime employment has provided the greatest opportunity for securing job-based coverage. However, even full-time work does not guarantee coverage.

• Women in families who have at least one individual working fulltime are the most likely to have job-based coverage (74%) and much less likely to be uninsured (15%) than women in families that work part-time (32%) or that don’t have workers (31%).1
• In 2006, annual insurance premiums averaged $4,242 for individuals and $11,480 for families. Workers typically picked up 16% of the premium costs for individual coverage and 27% for family coverage.2
• Among workers, women are less likely than men to be eligible for and to participate in their employer’s health plan. The overall take-up rate for employer-sponsored coverage is 80% for women workers compared to 89% for men.3 This is in part because women are more likely to work part-time, have lower incomes, and rely more on spousal coverage.
• Women are more vulnerable to losing their insurance should they become divorced or widowed, because they are more likely than men to be covered as dependents. Women are also at greater risk of losing coverage if their spouse loses his job or his employer drops family coverage or increases premium and out-of-pocket costs to unaffordable levels.
• Cost pressures are increasingly acting as a barrier to health care-even for women with private insurance. In 2004, one in six privately insured women reported she postponed or went without needed care because she couldn't afford it, up from 2001.4

Sources of Health Insurance Coverage

Employer-sponsored insurance provides coverage to almost twothirds of women between the ages of 18 and 64 (Figure 1). Although women and men have similar rates of job-based coverage overall, women are less likely to be insured through their own job (38% vs. 50%, respectively) and more likely to have dependent coverage (24% vs. 13%).

Medicaid, the health program for the poor, covers 10% of non-elderly women. Typically, only very low-income mothers, pregnant women, and certain women with disabilities qualify.

Individually purchased insurance is used by just 6% of women. This type of insurance can be costly and often provides more limited benefits than job-based coverage, and can leave women more exposed to health care costs.

Other government health insurance covers a small fraction (3%) of women under age 65 because coverage is limited to women who either have a disability (Medicare) or are the spouses or dependents of those in the military (CHAMPUS, TRICARE). Medicare is the primary form of coverage for those 65 and older and many women with longterm disabilities.

Uninsured women account for 19% of the non-elderly population of women. Most of these women either do not qualify for Medicaid, do not have access to employer-sponsored plans, or cannot afford individual policies. 

Medicaid

According to Medicaid program statistics, in 2003 nearly 19 million low-income women (19 to 64 years) were enrolled in Medicaid, the state-federal program for low-income individuals.5 Medicaid is only available, however, to low-income women who are parents, pregnant, disabled, or over 65 and who also meet the program’s very restrictive income eligibility criteria.

• Over half of (57%) non-elderly women (18 to 64 years) on Medicaid are considered “poor” under federal guidelines (less than 100% Federal Poverty Level (FPL) and one-quarter (27%) are near-poor (100-199% FPL).
• Medicaid disproportionately carries the weight of covering the sickest groups. One-third (34%) of non-elderly women on Medicaid rate their health as fair or poor, compared to only 11% of low-income women covered by employer-sponsored coverage.1

Uninsured Women

Over 17 million women are uninsured. When women are uninsured, they are more likely to postpone care and to forgo filling prescriptions than their insured counterparts and often delay or go without important preventive care such as mammograms and Pap tests (Figure 2). These individuals lack adequate access to care, get a lower standard of care when they are in the health system, and have poorer health outcomes. An Institute of Medicine report estimates that 18,000 people die unnecessarily each year because they are uninsured.10

Barriers to Care, by Insurance Coverage, 2004

• Women who are younger and low-income are particularly at risk for being uninsured, as are women of color, especially Latinas (Figure 3).
• Nearly eight out of ten (79%) uninsured women are in families with at least one part-time or full-time worker. Almost two-thirds of uninsured women (64%) are in families with at least one adult working full-time. Just 21% of uninsured women are in families without workers.

Women at Greater Risk for Being Uninsured, 2005

Percent of women 18 to 64 years who are uninsured:

U.S. Average = 19%

Note: The federal poverty level (FPL) was $15,577 in 2005 for a family of three. Poor indicates family income <100% FPL. Near-poor indicates family income of 100 to 199% FPL.
Source: Kaiser Family Foundation/Urban Institute analysis of the March 2006 Current Population. Survey, Bureau of the Census.

Outlook for the Future

Addressing Affordability: The steady growth in health costs has had a disproportionate effect on women because of their lower incomes and greater need for health care services throughout their lives. While growth in health care spending has slowed, it still doubles the rate of growth for wages. Some policymakers and employers have looked to so-called “consumer-driven” health care models to control spending. These plans encourage consumers to make more economical choices by paying directly for some health services; however, these plans are not widespread and it is not clear what impact they will have on spending and affordability. In the public sector, policymakers have allowed for greater cost-sharing in Medicaid in order to control costs, but this could also expose low-income women to higher out-ofpocket spending and potentially limit their access to care.

Covering the Uninsured: In recent years, there has been bipartisan interest in broadening access to health coverage to the nearly 47 million uninsured Americans, but without consensus on how to achieve this goal. While there has been relatively little activity at the federal level, a handful of states have recently adopted or are considering proposals to expand coverage. States are using a combination of strategies, such as expanding public programs to cover most children in a state, mandating employers to cover all workers or contribute to a public financing pool, and requiring all individuals to carry health insurance, with subsidies for those with lower incomes. Given the importance of health insurance in improving women’s access to care and health status, federal, state, and private sector efforts will be needed to expand coverage to the over 17 million uninsured women.

Endnotes

1 Kaiser Family Foundation and Urban Institute analysis of March 2006 Current Population Survey, Bureau of the Census.
2 Kaiser/HRET, 2006 Employer Health Benefits Survey, 2006.
3 B. Garrett. Employer-Sponsored Health Insurance Coverage. Kaiser Commission on Medicaid and the Uninsured (KCMU), 2004.
4 Kaiser Family Foundation, Women and Health Care: A National Profile, 2005.
5 KCMU analysis of 2003 MSIS data from CMS, 2006.
6 National Governors’ Association, MCH Update 2005: States Make Modest Expansions to Health Care Coverage, Draft, June 2006.
7 Centers for Medicare and Medicaid Services, National Health Accounts, 2006.
8 Kaiser Family Foundation and Alan Guttmacher Institute, Medicaid: A Critical Source of Support for Family Planning Services, 2005.
9 Alan Guttmacher Institute, State Policies in Brief, December 2006.
10 Institute of Medicine, Care Without Coverage: Too Little, Too Late, 2002.