The recent economic downturn has left more people worried about losing their jobs, and for the 54% of our population relying on employer-sponsored insurance (ESI), losing a job also means losing health insurance.

Some of those who lose ESI will be able to pay their full premiums, including the share formerly handled by their employers, and extend their coverage for up to 18 months under COBRA. (According to the Kaiser Family Foundation, the average annual premium in 2008 for is $4,704 for individuals and $12,680 for families – not easy amounts to come up with if your paychecks have stopped.)

Others will try to buy insurance on the individual market – but as a new report from the National Women’s Law Center shows, that’s a difficult task, especially for women.

Nowhere to Turn: How the Individual Health Insurance Fails Women is based on NWLC’s analysis of information on over 3,500 individual health insurance plans, and it paints a grim picture.

Obtaining individual coverage can be difficult because it’s issued under different rules from group coverage. Within a group, risk can be spread among a large number of members, so insurers often offer group policies that are more comprehensive and affordable than individual ones. The NWLC also emphasizes the fact that some important anti-discrimination protections apply to employer-provided health insurance, but not to insurance sold on the individual market. For instance, employers with 15 or more employees can’t charge employees different health-insurance premiums based on gender or other factors, but that requirement doesn’t apply to plans sold to directly to individuals.

Here’s what the report has to say about the implications for women seeking insurance on the individual market:

  • Women often face higher premiums than men. Under a practice known as gender rating, insurance companies are permitted in most states to charge men and women different premiums. NWLC research determined that this costly practice often results in wide variations in rates charged to women and men for the same coverage; these arbitrary differences harm women’s ability to get the health care they need. The Center found that among insurers who gender rate, the majority charge women more than men until they reach around age 55, and then some (though not all) charge men more. The Center found huge and arbitrary variations in each state and across the country in the difference in premiums charged to women and men. For the capital city in each of 47 states and D.C., NWLC sampled two plans for the same-aged men and women among individual insurance plans. The Center found that insurers who practice gender rating charged 25-year-old women anywhere from 6% to 45% more than 25-year-old men; charged 40-year-old women from 4% to 48% more than 40-year-old men; and charged 55 year-old women premiums that ranged from 22% less to 37% more than 55-year-old men. […]
  • It is difficult and costly for women to find health insurance that covers maternity care. The vast majority of individual market health insurance policies that NWLC found do not cover maternity care at all. A limited number of insurers sell separate maternity coverage for an additional fee known as a “rider,” but this supplemental coverage is often expensive and limited in scope. Moreover, insurers that sell maternity riders typically offer just a single “one size fits all” rider option. Typically, a woman has no option to select a more or less comprehensive rider policy—her only option is to purchase the limited rider or go without maternity coverage altogether. […]
  • Insurance companies can reject applicants for health coverage for a variety of reasons that are particularly relevant to women. For example, it is still legal in nine states and D.C. for insurers to reject applicants who are survivors of domestic violence. Insurers can also reject women for coverage simply for having previously had a Cesarean section (C-section).
  • While both women and men face additional challenges in the individual insurance market, these problems compound the affordability challenges women already face. Insurance companies also engage in premium rating practices that, while not unique to women, compound the affordability issues caused by gender rating. These include setting premiums based on age and health status.

The situation varies from state to state, and women will generally face fewer gender-related hurdles in the ten states that prohibit gender rating (Maine, Massachusetts, Minnesota, Montana, New Hampshire, New Jersey, New York, Oregon, Vermont, and Washington). Check the report’s appendices to see how much more women in your state are likely to pay for individually purchased health insurance; how much more women of childbearing age might pay for maternity coverage, if it’s available at all; and whether your state has laws protecting against the use of gender, age, and health status to set premiums in the individual market.

NWLC notes at the start of the report that only 7% of women purchase health coverage on the individual market – although, my guess is that many of the 18% of women who are uninsured would like to purchase that coverage but can’t afford it. Given that both presidential candidates’ health plans could affect the relative numbers of people getting employer-based coverage vs. seeking it on the individual market, it’s crucial for voters to understand what conditions are like on the individual market today.

Nowhere to Turn concludes with policy recommendations. The first is to reduce or eliminate the need for the individual market altogether; the second, acknowledging that such change will take time, calls for making individual coverage easier to obtain and afford. Finally, NWLC urges lawmakers to ensure that all policies include coverage for vital health services such as maternity care.

The prospect of a taxpayer-funded $700 billion bailout for Wall Street means that non-revenue-neutral healthcare reforms will be even harder to achieve than they would’ve been under better economic circumstances. Passing laws that ban gender rating or require maternity coverage in health plans on the individual market is one way improve women’s health that doesn’t require large amounts of taxpayer money.

Lawmakers should also realize that while economic circumstances might make healthcare reforms harder to pass, they can also create more of a push for change. If millions of people lose their employer-based coverage and are suddenly faced with the prospect of premiums double or quadruple what they’re used to paying, their anger about our broken healthcare system will only intensify.