For gender-equal health care, enact Medicare for All

President Obama’s health reform proposal is not good for women, so it’s ironic he’s pushing it through during Women’s History Month.

His plan amounts to “a giant leap backward for women,” says the National Organization for Women (NOW).

This assessment is based on three main problems: a failure to ban gender rating in a timely fashion, a failure to ban age rating, and a real threat to abortion coverage.

Gender rating refers to the practice in which insurance companies charge women more for their premiums than men for identical coverage. This applies not only to individual women policyholders, but also insured groups with a predominantly female work force.

This discriminatory practice is widespread, being banned in only 11 states. The National Women’s Law Center, as part of its campaign entitled “Being a woman is not a pre-existing condition,” describes how women constitute a special group in the actuarial tables of for-profit insurance companies.

On average, women under 55 are charged premiums up to 48 percent higher than those for men of the same age – and this is with maternity coverage excluded.

Obama’s health care reform bill would only partially remedy this. On his Web site, the president claims, “Once the [insurance] exchanges are up and running, insurance companies will be banned from setting different premiums based on gender.”

But not right away. Although insurance exchanges (which would not begin until 2014) would prohibit the sale of policies that discriminate on the basis of gender, this ban would not apply to companies with more than 100 employees. For these groups, gender rating will remain legal at least until 2017.

For-profit insurance companies regard gender rating as good business practice. Women cost these companies, on average, more than men. Women have babies, Pap smears and mammograms, and they generally visit the doctor more during youth and middle age than do men.

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Lawmakers who see health care as an individual responsibility rather than a collective right tend to share with the insurance companies this “pre-existing condition” view of women. Sen. Jon Kyl, R-Ariz., infamously asked why he should be forced pay for a policy with maternity coverage when he didn’t need it.

Another serious flaw in the president’s proposal is the retention of age rating, NOW says. Middle-age and older women could be charged up to three times more than their younger counterparts for the same coverage.

Then there’s reproductive choice. Obama’s proposal would require that women write a separate premium check to their private insurer for an abortion rider on their policy. Payments would go into separate accounts.

This cumbersome segregation of funds, experts predict, would cause many insurers to restrict or drop abortion coverage, denying coverage to millions of women who have it now.

Instead of the president’s proposal, we need a single-payer health care plan. It would end the view of women as expensive liabilities who get in the way of maximizing profit. Under an improved Medicare for All, women and men would get the full range of medical services whenever they need it.

The savings from eliminating wasteful paperwork and bureaucracy – estimated at $400 billion annually – would be more than enough to cover everybody.

All women, and every man born of woman, even senators, must ultimately admit the fairness of this approach. It’s the remedy we need.

Dr. Sheila Leavitt is a retired physician in Newton, Mass., and a member of Physicians for a National Health Program ( She can be reached at