WOMEN AND HEALTH REFORM: THE MARRIAGE PROBLEM.

While men are more likely than women to be uninsured, women's health coverage is more volatile. Why? Because only 38 percent of women have health coverage through their own job, compared to 50 percent of men. That means women are about twice as likely as men to depend on a spouse or partner's employer-provided health plan. The negative outcomes here are pretty obvious: For an American woman, the end of a romantic relationship is often not just emotionally tumultuous but medically tumultuous as well, for both herself and her children.

A study in the journal Health Services Research concluded that a husband's transition from employer-based coverage to Medicare at age 65 can be especially problematic for his younger wife or partner. She must give up her dependent coverage before she herself is eligible for Medicare. Women who experience such disruptions in health care "had a greater probability of experiencing a change in usual clinic/provider (71 percent), delaying filling or taking fewer medications than prescribed because of cost (75 percent), going to the emergency room (52 percent), and had lower average mental health scores than women who did not experience an insurance disruption," the authors write.

So what does this mean for health reform? The House and Senate bills would represent some progress for dependent women. Instead of being left on the open market if they're kicked off a partner's health plan, they could participate in the health insurance exchanges, which are supposed to lower coverage costs through increased competition, including competition with any eventual public health plan. In addition, the expansion of Medicaid coverage to 133 or 150 percent of poverty would cover many more women.

But if the health insurance exchanges end up being weak, and thus bad at bringing down costs, women will remain seriously disadvantaged by a system tethered to employment. To solve the "marriage problem" for women's health care, the exchanges must be robust, and there must be significant subsidies to help poor and middle-class individuals afford an insurance plan.

--Dana Goldstein

More posts in the "Women and Health Reform" series:
--What Will Health Reform Mean for Reproductive Rights?
--Interview with NARAL Prez Nancy Keenan on Abortion and Health Reform

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