Why is Healthcare so Expensive for Women?

I'm sure that you - like me - have often wondered: just why is healthcare - particularly women's healthcare - so expensive?

In this episode, I'm shedding light on the additional costs women face in accessing healthcare, and the things that cause these issues. These include wage disparity, geographical location, and the "pink tax" - the higher prices charged for products marketed to women.

I also talk about the fact that, despite the role the Affordable Care Act (ACA) has played in protecting women from discrimination, there are still challenges in ensuring affordable healthcare for all women.

But it's not all doom and gloom! Despite these challenges, positive changes can be made, as long we keep talking about wage disparities and the specific reasons behind the high costs for women's healthcare. There is potential for change.

Topics include:

• Why it's so hard for women to access affordable healthcare insurance, even when premiums are the same
• Why exceptions and legal responses, such as religious and moral grounds for not covering contraceptives, still impact women's healthcare costs, despite the ACA and Medicaid
• What's the "pink tax"?
• The effect that wage disparity - along gender and race lines - has on affordability of healthcare
• The growing gender gap in higher education enrollment and graduation rates, and why that will be good for the cost of women's healthcare 

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Resources mentioned in the episode

Gender Wage Gap
The Gender Wage Gap Endures in the U.S. | Pew Research Center

Geographic Location
Cuyahoga, Ohio | County Health Rankings & Roadmaps

Menopause Transition
Menopause transition: effects on women’s economic participation - GOV.UK (www.gov.uk)

Education and Enrollment
Why the gap between men and women finishing college is growing | Pew Research Center

Disclaimer
The information in this podcast is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions you may have regarding a medical condition or treatment.

The personal views expressed by guests on Women's Digital Health are their own. Their inclusion here does not constitute an endorsement from Dr. Brandi, Women's Digital Health, or associated organizations.

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Transcript

 Welcome back to episode four. And in this episode, we'll be exploring the state of women's health. But more specifically, we'll be talking about why is health care so expensive for women? It is not in your head, ladies. You're paying a lot more for your health care. And I'm going to tell you why. In this episode, we'll be talking about those gender disparities that show up in your health insurance premiums. We'll be discussing how that wage disparity impacts your ability to pay for your health insurance, even if your health insurance premiums are the same across the board. We'll be talking about where you live, because geographically, where you live does impact how much you're paying for health care. We'll explore that pink tax and what that means. We'll talk about the postmenopause and the menopausal transition, because the menopause transition surprisingly does impact your ability to pay for health care and also your employer's experience with you as an employee. Welcome to the Women's Digital Health Podcast, a podcast dedicated to learning more about new digital technologies in women's health. We discuss convenient and accessible solutions that support women with common health conditions. Join us as we explore innovations like mobile health applications, sensors, telehealth, and artificial intelligence, plus more. Learn from a board-certified anesthesiologist the best tips to fill in some of your health experience gaps throughout life's journey. You know, healthcare in the United States has changed significantly in the last 15 years. And more specifically, you know, in the last 13 years, a lot of legal changes have been made. Before 2010, there was this assumption that, hey, if you're a woman, you know, you're going to pay more for health care insurance. You know, you go to the doctor more. You might care more about your health, and that's why you go to the doctor. And well, you know, you live longer, so you should pay more. And oh, and by the way, you do get pregnant, so you're going to use more health care resources anyway. So you should just pay more. And that was kind of the underlying assumption. And before 2010, women pay a significant amount more for their health care insurance just because they're a woman. But in 2010, that is when the Affordable Care Act was stated. And under that was a patient protection part that said that we understand that women are paying more for their health insurance premiums We know that they're higher and that's no longer legal. You can't do that. You cannot charge a woman more for your health care insurance. And so that's great. Yeah, you know, ACA went in, actually protected women from this gender premium difference. Now I did get some clarity on which health care insurance plans actually are required or mandated to adhere to eliminating gender disparity in health care insurance plan premiums. And I got affirmation that all major health care plans in this country, whether it is on the Affordable Care Act marketplace or not, it can be on the exchange or it is not on the exchange, All major health care insurance plans in this country cannot discriminate based upon gender, but we'll talk about some other ways in which they do discriminate and why you might see a little bit more impact on your pocketbook. So yay. And I do mean yay because ACA did a lot in terms of protecting women. And in the context of this episode, I'm primarily talking about single women, you know, women who don't have dependents, are not married. But I will include pregnancy in this particular scenario, which is that before ACA, pregnancy was considered a pre-existing condition. And if you were pregnant, it was very difficult for you to get insurance, let alone pay for it. And if you did pay for it, you were paying more. That even impacted expecting dads. So if you were a dad who was getting ready to have, you know, a baby, you could be excluded from getting health care insurance simply because, you know, your partner was expecting a child. So it is a big deal that ACA was actually able to come in and say, hey, listen, you can't discriminate against a woman because she's a woman and you certainly can't exclude men or women from getting health insurance simply because they're pregnant. Having said that, there have been some major legal responses to, you know, the ACA being the state for the entire country. And I'll go into kind of how these gender disparities still show up in your healthcare insurance premiums depending on who you're employed by and where you live. So, yes, ACA made it illegal for women to be charged higher, but there's some caveats. The first is that in 2014, Hobby Lobby filed a suit, and that suit basically cited that, you know, employers should not have to share in the cost of contraceptives based upon their religious and moral grounds. And they actually won that suit. And under the previous administration, they upheld that not only Hobby Lobby could cite religious and moral grounds, but other institutions and employers could also cite that as a justification for not covering the cost of contraceptives. So that meant that contraceptives now had to either be covered by the insurer or women have to pay out-of-pocket for reliable forms of contraceptives like IUDs. And the reason I bring up IUDs is because IUDs is one form of contraceptive. Certainly there's, you know, birth control pills and other forms, but it's the most reliable. And it's also one that has more expensive upfront costs. And so If you are a woman who's bearing that cost, that's kind of saying that because you're trying to find health care, you have to now pay this out-of-pocket expense. Additionally, if you were to adhere to the purest form of the ACA, that meant that ACA expanded Medicaid, and Medicaid applies for those women who have a low income based upon the federal poverty line. You know, if you make less than, I believe it's $21,000, which I believe is like about 133% of the federal poverty line, if you make less than that, that or less, You qualify for Medicaid advantages like preventative care and contraceptive subsidies. And that was what the ACA was intending to do, to cover the cost for low-income women. But unfortunately, 12 states, to be exact, have opted out of this Medicaid expansion. So if you live in those 12 states, you don't get the benefit of actually getting some of these preventative care and contraceptive advantages that the ACA was meant to cover. And lastly, let's say you don't qualify for Medicaid, you make too much for that, but you don't really make enough to really afford some of the health insurance premiums on the marketplace. That happens. You know, there's still a considerable number of women who say, like, I still can't afford the premiums. That's still an issue. And so even with the fights that we have seen contesting in court about the ACA, for all its benefits, we still have a ways to go in terms of making sure that all women are able to actually afford health care insurance. So that is how gender disparities still show up in health care insurance premiums, despite the ACA's wonderful attempt to try to cover women and not punish them for being women and trying to take care of themselves. All right, so that's healthcare insurance premiums. I'm gonna move on now to how the percentage of your income impacts your ability to pay for your healthcare insurance. In other words, the gender disparity, the amount of income that you make significantly impacts your ability to actually pay for the premiums. So I'm gonna give you an example. And this is a merit for merit example. So let's say for this example, we talk about wage earners based upon their merit. So we're talking about, you know, a male engineer to a female engineer, a male veterinarian to a female veterinarian, a male lawyer to a female lawyer. And just for the sake of this argument, we're going to say the standard wage is $1,000 a month. I know that it's just easy for me to just say $1,000 a month. So if the standard wage is $1,000 a month, according to Pew Research, the gender wage gap works like this. So if the standard is $1,000 a month, A male will make $1,000 a month, but compared to men, women can make anywhere between 10% less all the way up to 40% less, depending on her ethnicity. And let's say the company that they work for, they use ACA and you cannot use gender disparity to impact the premium. So everybody pays $100 a month, okay? So a man gets paid $1,000 a month, He pays $100 a month for his insurance premium. Therefore, he pays 10% of his income to health insurance. A woman, depending upon her ethnicity, we can start with Asian women who typically make about 10% less than men. So she's getting paid $900 a month compared to the standard $1,000, which means she's paying about About the same, closer to 11% for her healthcare insurance. A white woman is making anywhere from 15 to 20% less, so she's at about $800 a month. So her health insurance premium, that same $100 now is 12% of her income. When you look at the gender gap for black women, you're talking about a 30 to 40%. So let's just say compared to the standard $1,000 for white males, a black woman will be paid $700 in income a month. So she's paying $100 for her healthcare insurance as well, but that's 14% of her income. And the Hispanic women, they are making anywhere from 35% to 40% less compared to white male counterparts. So they're taking home $650 a month. And that $100 per month premium works out to about 15% of their income. They're paying 15% in their health insurance premiums. And so the important thing here is that even if you keep the health care insurance premium the same, if you don't address the income wage gap, the percentage of income that women are paying for the insurance is still significantly higher. And that has huge impacts on their ability to pay for health care insurance and certainly the additional out-of-pocket expenses that I'm going to talk about next. All right, so the next thing we're going to be talking about is the pink tax. And this is another reason why, you know, the funds in the bank account might feel a little lighter, even though you're working so hard or you anticipated not spending as much as you thought you would. And that's with regards to the pink tax. Initially, when I learned about the pink tax, I thought the pink tax was just, you know, that you're going to pay more for your menstrual hygiene. You're going to pay more for your pads, tampons, menstrual cups. You're just going to pay more and that's just the price of being a woman. But that's not in fact what the pink tax is, as I dug a little deeper. The pink tax actually refers to the fact that marketers for numerous years will take things like a T-shirt, for example, and they will charge anywhere from 5% to 10% up to 13% more for that T-shirt just because they put the word woman on there. It could be the same exact t-shirt. As soon as you put the word woman on there, marketers have historically just charged you more. And this impacts all sectors of hygiene and clothing just across the board. It could be the same razor or shaving cream. As soon as you put the word woman on there, you're charging more. And this has impacts on, certainly we just talked about the gender wage disparity. So you're making less, you add inflation. So we're all paying more, but women are clearly paying even more. And we have, you know, these additional amenities to maintain our appearance, our hygiene, just to keep the job. So yeah, if you're feeling like the bank account is a little lower, look into that pink tax. All right, now, ladies, if you're fired up at this point, you know, if you're driving right now, I need you to keep your hands on ten and two. If you're walking or running on that treadmill, you know, put it on a little bit of incline, because I definitely resonate with, you know, the emotions that many of us feel and hear when we're hearing, you know, how much we are impacted by gender disparity in income. and I promise I am going to be giving you some good news. I want you to just keep these reasons in mind as you enter conversations about wage disparities because oftentimes these conversations get very general and we don't have the specifics as to what is that exactly happening. So the point is not to upset you, but it's to give you information about why and where things are with the opportunity for us to all change the direction of this ship. And I promise the good news is coming. You know, we're going to get into some other differences in why women are paying so much and why things are so much more expensive for women. But there is some good news to follow. Hey listeners, it's Dr. Brandi. Thanks for listening to this episode of Women's Digital Health. Subscribe to Women's Digital Health on your favorite podcast platform. If you want to know even more about how to use technology to improve your health, subscribe to our newsletter on womensdigitalhealth.com. Follow us on Instagram, Facebook, YouTube, and LinkedIn. Enjoy the rest of this episode. All right, so next we're gonna talk about how where you live actually impacts how much you're paying for your healthcare. So without a doubt, whether you go to healthcare.gov or any private insurance company, they will all tell you that where you live does impact your healthcare insurance premiums. And so this website I'm gonna give you is super geeky. You don't have to go to it, but I will put it in the show notes. It's called penaltyhealthrankings.org. is sponsored by the Robert Wood Johnson Foundation. And what they do is if you put in the county that you live in, it will rank your county where you live and how your county compares within the state. And then it'll tell you whether or not your particular county's outcomes are the least healthy to the most healthiest. But more importantly, it will tell you what specific factors actually contribute to whether or not the county is healthy or in the middle or, you know, the healthiest. So things like smoking, your access to exercise, opportunity. the amount of drinking, adult obesity, et cetera. It'll give you like a percentage of what are the factors that are at play in that particular county. But it will compare that to your state, how you do in the state and how you do in the country compared to other counties and states in the United States. And I thought this was incredibly helpful because you can really target your clinical visits based upon these different factors. I don't think it necessarily means that you need to leave the county simply because, you know, your county is ranked lower or higher. I do think that it can actually help, you know, improve your health outcomes because now you know what things in your particular county might impact your specific health rather than going from general, you know, health risk factors. You can now target it based upon where you live. And, you know, like we said, it does matter. You know, your health insurance premiums are based upon where you live. And if there are things that you can modify on your own, regardless of where you live, well, you can target your clinic visit based upon what this county ranking says about your county. Okay, next we're going to talk about the menopause transition, that transition from the perimenopause, the menopause, postmenopausal state. And this is one that I think gets underestimated because there's not a lot of funding and research around this transition, although that's changing and we'll talk more about that in the investment part of this episode. But I just want to put out there that The transition in Excel, the menopausal transition can be expensive. It can be expensive not only to you, but it can be expensive to your employer. This menopausal transition state, it changes your biophysiological state. And so in that regards, for some, not all, it can impact your productivity. It can reduce your productivity. you know, you can lose work hours from this. And if you're losing work hours, activity that might reduce your eligibility to health care benefits. So, you know, this is something we want to be paying attention to. And if you want to learn more about that, check out my interview with Dr. Larissa, who is a menopause, perimenopause expert, and she talks in a lot of depth about this transition and what you can do about it. So check out that, subscribe to my newsletter, and you can listen to her give a very in-depth description of what's happening. But just for the sake of cost, to focus on cost, you know, there's a study out of the UK. You can check out the gov.uk menopause transition study. and they looked at the economic impact. During this transition, women are seeking out more resources. And those resources are costing upwards of about two grand to about two and a half grand annually. And so this is definitely costing money. Keep in mind, Like I said, you may not be working as much. You may not be able to work as much as you're going through this transition. So, you know, you're getting hit both ways even there. So we need to keep in mind that menopause can be expensive and Women's Digital Health is here to try to help you hone in on some of those resources to save you time and effort trying to figure out what's going on. You know, the point of this episode is to get us ready, get our pocketbooks ready for, you know, that additional expense as well. All right, I do have to interject here and add some good news, because there's some great news actually coming out the state of women, which has huge implications on the state of women's health. The first is that there's actually a growing gender gap in higher education, both in enrollment and graduation rates. So as of 2021, Young women are more likely to be enrolled in college today compared to young men among those age 25 and older. The gap is growing even much wider in young adults age 25 to 34. And it's not just enrollment. It's the, it's the graduation rates. It's getting bigger and bigger, which has implications for the labor force. So that's really important, you know, because if you have more women who have the education to actually run businesses, you know, we can change the tide of this gender disparity and things like health insurance premium and pink tax much more quickly. Great news is that as of 2022, 42% of small businesses are owned by women in the United States. you know, average about 1800 new businesses are starting every day by a woman. You know, the last 20 years, there's been 114% increase in the number of female entrepreneurs and actually 40% of all women owned businesses are owned by women of color as of 2022. But these are all great signs. It's all point to, you know, the response that women do have in terms of their ability to make money in the current state. They want to change that. They want to own that and have more control. And I think this trend is going to continue and will have huge impacts on the ability for us to pay for our health care and have more understanding about our health care and certainly more control. So I'm happy to hear that. So that concludes episode four. This episode, we discussed gender disparities in healthcare insurance and premiums. We talked about how gender wage gaps impact your ability to actually pay for your healthcare. We talked about the pink tax and the menopause transition, as well as how geographic location impacts your ability to pay for your healthcare. We often discuss the good news, you know, more women are becoming more educated, more women are starting businesses. That will definitely impact the way in which employers attract top talent and certainly drive the way in which legislators make decisions on health insurance premiums in the future. So women's health is looking brighter. In our next episode, we will sit down and interview Dr. Samantha Butts, the chair of the Reproductive Endocrinology Department at the University of Pennsylvania. We'll ask her more in-depth questions about how digital health is showing up in fertility. Are these new innovations convenient and accessible as they say they are? Are they effective? We will leave those answers to Dr. Butts. In episode six, we will extend more on the state of women's health. We'll discuss federal and private funding, how federal dollars are being used to fund women's health. What are private equity firms doing to respond to the growing need for more women's health technologies? And what does the federal and private equity funding state say about the state of women's health? Although I'm a board certified physician, I am not your physician. All content and information on this podcast is for informational and educational purposes only. It does not constitute medical advice and it does not establish a doctor patient relationship by listening to this podcast. Never disregard professional medical advice or delay in seeking it because of something you heard on this podcast. The personal views of our podcast guests on women's digital health are their own and do not replace medical professional advice.