The Health-Care Gender Gap

New research reveals many fast-growing professions for women lack health insurance. Dana Goldstein on why reform proposals stiff “pink-collar” workers.

John Moore/ Getty images

It was sold as the silver lining of the recession: With the national unemployment rate inching toward 10 percent—and the bloodletting especially severe in testosterone-fueled industries like finance and manufacturing—women were supposedly doing dandy. Federal stimulus dollars protected typically female jobs in nursing and teaching. The New York Times trumpeted that laid-off dads were picking up more chores around the house while “opt-out” moms headed back to the office, saving their families from financial destitution. For the first time in American history, women accounted for 49 percent of the labor force. Within the next few weeks, it is likely that more than half of all workers will have two X chromosomes, a milestone that would have been unimaginable to previous generations.

It’s true that men account for four-fifths of all layoffs since the downturn began nearly two years ago. But scratch the statistical surface and you’ll find that American women are hardly sailing through the economic storm. A new report by California's first lady, Maria Shriver, and the Washington-based Center for American Progress contains some encouraging news on shifting attitudes about gender. It finds that both men and women are enthusiastic about increased gender diversity in the workplace, and men are taking on more responsibility at home. But it also finds that most American women remain mired in unstable jobs with few employee benefits.

The Baucus bill slams single moms in the midst of a recession, when many are scrounging to make ends meet.

With the exception of nursing, the fastest-growing professions for women workers—retail sales, customer service, food service, and home health aides—are not only poorly paid with irregular hours, but also typically lack health-insurance coverage. That’s why women are more than twice as likely as men to depend on a spouse for insurance; only 38 percent of women receive coverage through their own job, compared to 50 percent of men. Yet the number of female-headed households, in which women and children don’t have the option of relying on a man for benefits, is growing. Forty percent of all American births are to unmarried moms, and 30 percent of all U.S. households are headed by a single woman. Do the reform proposals kicking around Congress do enough to provide stability to these “pink-collar” workers and their families?

In the past month, the White House has certainly emphasized reform’s benefits for the fairer sex, focusing on insurance company discrimination against women who’ve had C-sections or who have been the victims of domestic violence. In a Sept. 18 speech on the topic, Michelle Obama hit insurers hard. “In many states, insurance companies can still discriminate because of gender,” she intoned. “And this is still shocking to me. These are the kind of facts that still wake me up at night.” Female senators echoed the message in congressional hearings and on the floor. When Jon Kyl (R-AZ) opposed a minimum benefits package, using the excuse, “I don’t need maternity care,” the feisty Debbie Stabenow (D-MI.) snapped back, “I think your mom probably did.”

The reform plans kicking around Congress would represent some real improvement for women, forcing insurance companies to cover pre-natal care and ending the practice of “gender rating,” in which women are charged more than double what men pay for the same insurance. (Insurers’ excuse for the discrimination? Women use more health-care services.)

But some of the threats to women’s health are coming from Washington itself. The chief culprit is buried in Sen. Max Baucus’ Senate Finance Committee bill, which is more moderate than the House and Senate HELP Committee drafts, and largely viewed as the blueprint upon which the final legislation will be built. To woo Maine’s Olympia Snowe, the only Republican so far to vote in favor of health reform, Baucus’ draft is the only plan without an employer mandate, or requirement that companies provide health benefits. Instead, Baucus forces companies to reimburse the federal government for a percentage of the health-care costs of uninsured workers and their dependents—because after the overhaul, those without employer-provided coverage will be eligible for affordability subsidies.

It sounds simple enough: Companies with dinky or non-existing benefits packages—such as many of the beauty salons, restaurants, and temp agencies where pink-collar women work—will have to help government shoulder the burden of health coverage for their employees, the working poor. But in reality, this “free rider provision” is one of the most controversial elements of health reform, drawing particular ire form the left. Washington Post health-care blogger Ezra Klein has called it a “no good, very bad, horrible policy,” possibly “the worst policy…in the world.” Why the venom? Because the law would add an estimated $4,000 to $5,000 to the cost of employing a single parent—encouraging bosses to hire workers without kids, or with spouses who can provide benefits. “This is a significant cost for employers,” says Judy Solomon, a health-care expert at the Center on Budget and Policy Priorities. “It creates a disincentive for employers to hire people who may need government assistance to afford insurance.”

In other words, the Baucus bill slams single moms in the midst of a recession, when many are scrounging to make ends meet. Research shows that highly educated moms who work full-time often wish they could scale back their hours or work from home. But less educated, poorer mothers usually report they’d like to work more to earn more. If employers are dissuaded from hiring them by the Baucus bill, moms and kids will suffer.

What are the alternatives? Democrats to the left of Baucus are pushing for the Finance Committee to embrace a real employer mandate, which would fine companies for not offering health coverage, regardless of whether individual workers are eligible for a spouse’s policy. Business groups hope the final legislation will drop employer requirements entirely. “Clearly, the employer lobby has been effective with Sen. Baucus,” says Jessica Arons of the Center for American Progress. “We’re going to have to wait and see.”

In the meantime, feminist organizations and their congressional allies are pressuring the White House to stand tough against Baucus’ compromises. There’s been no evidence, though, that the Obama administration will stick their neck out on this issue, which they’ve avoided discussing. Referring to the process by which the various reform plans will be merged into final legislation, Solomon predicts, “This is an issue that’s going to stay alive till conference.”

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Dana Goldstein is an associate editor and writer at The Daily Beast. Her work on politics, women’s issues, and education has appeared in The American Prospect, Slate, BusinessWeek, The New Republic, and The Nation.