How do we end insurance company discrimination against women? 

Simple. Insurance companies think such practices are wrong and would gladly end them, said Karen Ignagni, President and Chief Executive Officer of America's Health Insurance Plans, in testimony before the Senate Finance Committee this week.  

But, it seems there is a catch, or two. First, Congress has to require that every American have health insurance. Second, lawmakers must promise not to give private health insurance plans any competition by creating a government-sponsored health insurance option that might be cheaper and fairer. 

Of course, Ignagni wasn't quite that blatant about it. But, the message was pretty clear: the insurance industry is so desperate to avoid competition from a proposed public insurance plan that it will pledge to do away with a number of longstanding, and outrageous, business practices.

"Gender rating" in health care

As a recent report from the National Women's Law Center explains, private insurance companies often charge women higher premiums than men in what is known as the individual health insurance market. This is where women end up if they want health insurance, but aren't lucky enough to have access to it through an employer or union, and are not eligible for Medicaid or Medicare. Almost six million women in this country have been forced to buy individual insurance policies, often with extremely expensive premiums and poor coverage.  

The practice of charging women more than men is known as "gender rating." Historically, insurers have justified it by citing women's higher use of health care services, such as for maternity care, compared to men. If you might use more health care, you have to pay more, the insurers declare. They have similar practices for other groups of people who tend to use more than an average amount of health care. For example, older people may be charged more than younger people through a practice referred to as "age rating." These practices are prohibited in some states, but allowed in many.  

Massachusetts Senator John Kerry has introduced legislation called the Women's Health Insurance Fairness Act that would prohibit insurers from charging women more than men for individual health insurance. It would also require insurers to provide maternity coverage, and stop insurers from refusing or limiting coverage based on whether a woman is pregnant.  

Insurers: Let's make a deal

Faced with this legislation, and with general public outrage about a number of insurance company practices - including refusing coverage for "pre-existing conditions" - America's Health Insurance Plans are scrambling to offer Congress a deal.  

They will agree to do away with gender rating and other unpopular insurance company policies if Congress enacts a health reform plan that does two key things: 1) Impose a mandate on every American to have health insurance; and 2) Drop the idea of creating a public plan option that would compete with private health insurers.  

So, the insurance industry CEO, Karen Ignagni, was all sweetness and agreeability on Capitol Hill in a Senate hearing this week, when Senator Kerry pressed her on the subject of gender rating. "Gender rating is a pretty common insurance practice and women are charged higher premiums than men for identical coverage," Kerry said. "So it seems to me that's insurance discrimination." 

Ignagni readily agreed, saying insurers already have proposals to do away with it: "We don't believe that gender should be a subject of rating," she said. "In our reforms, we have not recommended that (it) be continued."

National Women's Law Center Co-President Marcia Greenberger rightly was delighted with this turnabout: "Fortunately, the insurance industry finally came around to the unfairness of charging women more for health insurance, and it's about time," she said in a press release. "For too long, gender rating has caused hardship to many thousands of women, who have either had to forgo health insurance altogether, or sacrifice to cover the extra premium cost."  

But, notice that Ignagni did not announce that the insurance industry would move to immediately drop this discriminatory policy, which they could do tomorrow. Instead, they are offering to accept stricter regulation of the private insurance industry in exchange for having the public plan option dropped. And, they would love to have a mandate requiring all Americans to get health insurance, as is the case in Massachusetts now under that state's reform plan, since, absent a public option, Americans would then be forced to purchase it from the insurers. 

This kind of a trade-off would be a bad deal for women, and a bad deal for all Americans. Ending discrimination against women should not be contingent on giving private health insurance companies a monopoly to sell us high-priced health coverage. Gender rating can and should be ended as soon as possible, either by the insurance companies themselves or through enactment of Kerry's legislation.  

The public plan option is a good idea, and should be explored fully by Congressional committees working on health reform legislation. As President Obama has suggested, a little competition from a public plan might be just what we need - and give women now struggling to afford individual health insurance a much better alternative.