Everyone's preparing for health reform. Financier and publisher Steve Forbes warned this morning that President Obama's nationalized health insurance plans to be unveiled next month will cause a "summer flu of unprecedented severity." And healthcare lobbyists have been trudging up to Capitol Hill daily to offer up their solutions for our healthcare crisis.
Karen Greenrose, president and CEO of the American Association of Preferred Provider Organizations, who treks in from Louisville, Ky., every week, tells me health reform is desperately needed, though she'd rather it be left largely in the hands of industry than those of government. Her organization—which represents PPO health insurance plans, through which nearly 70 percent of Americans receive their healthcare—has a detailed health reform proposal. But when I met with her last week, I asked specifically for her take on women and their health needs.
Brandishing a new report issued by the Department of Health and Human Services, I asked to know how health reform will address gender disparities cited in the report. It found that only 48 percent of working women are able to get health coverage at work compared with 57 percent of men. (That's mainly because women are more likely to work part time, which leaves them ineligible for insurance.) Single women are twice as likely to be uninsured as married women, since the former can't rely on a spouse for insurance. Making matters worse, many of the 14 million women who purchase individual insurance on their own are charged higher premiums than men who buy the same coverage. That's justified, managed-care companies say, by the fact that women visit doctors more often, have higher healthcare costs, and face the possibility of future pregnancies and hospitalizations to give birth.
When I asked Greenrose about these problems, she said she doesn't have specific statistics on gender differences with PPO plans—whether women pay more than men for individual or family policies. I don't see any mention of addressing disparities in her healthcare reform proposal beyond a call for "medical care for all Americans." She told me that she certainly favors "fixing these problems" as part of health reform but says she's even more worried about a lack of access to state-of-the-art care.
Greenrose was speaking from personal experience. After being diagnosed with breast cancer two years ago, she wanted to have a new test, called Oncotype Dx, that would determine her risk of having a recurrence. If the risk came out low, she probably wouldn't need chemotherapy for her small tumor, which hadn't spread beyond the breast tissue. "My insurance company refused to pay for the $3,500 test even after I appealed to them over and over again," Greenrose says. She decided to pay the cost out of pocket and found she had a low risk of a cancer relapse. That meant she probably wouldn't benefit from the chemotherapy, so she decided not to receive it. What irks her is that her insurance company would have wound up shelling out three times as much for chemotherapy, if she'd gotten it, than for the test that dissuaded her from seeking that expensive treatment.
"It makes me angry to think that women who can't afford this test may be forced to go through unnecessary chemotherapy," she says, with all the side effects it can cause. What struck me, though, was how even a woman who's a leader in the healthcare field couldn't successfully navigate the insurance system to get it to agree to cover a justifiable test. If Greenrose has these types of troubles, where does that leave the rest of us? And just how much will be fixed by health reform?