It’s remarkable that Hillary Clinton is the first female nominee to head a major party ticket, given the fact that 100 years ago, millions of women in the United States could not cast their vote in a presidential election. Yet even with this incredible progress, women are in some ways still treated like second-class citizens, especially when it comes to the cost of and access to health care.

Over the last sixty-five years, the percentage of women in the workforce has increased from 34 percent to 46.8 percent. Yet overwhelmingly more women work part-time than men. While part-time work has been applauded because it creates space for caregiving responsibilities, it often comes at the expense of low wages and a lack of health care benefits. For instance, women are paid approximately 79 cents to the man’s dollar, and part of this pay discrepancy is due to the high number of women who work part-time.

The high percentage of women who work part-time also leaves too many women without adequate access to health care. While the implementation of the Affordable Care Act (ACA) has helped 9.5 million women gain access to health care, 12.8 million women are still uninsured; much of this is because not all part-time employees are provided health care by their employers, leaving too many women piling up debt, forced to choose between health care and groceries, and in some cases even facing bankruptcy.

Implications of the ACA

The ACA has had major effects on the uninsured population. While there are still millions of people living without insurance, it is estimated that the ACA has granted health care coverage to over 20 million Americans since 2010, which brings the country to its lowest uninsured rate in history. Additionally, the cost of health care has decreased; according to a recent report from the Brookings Institute, 2017 premiums would have been 30–50 percent higher without the ACA.

The benefits of the ACA have had an enormously positive impact on women in terms of access, scope, and cost. According to the Department of Health and Human Services, “between 2010–15, the uninsured rate among women ages 18 to 64 decreased from 19.3 percent to 10.8 percent, a relative reduction of 44 percent.” This new insurance includes preventative care benefits that fully cover services such as mammograms, well-woman visits, and breastfeeding support for 55 million women.

In addition, the ACA has made significant progress in reducing gender discrimination in health care. Before the ACA was implemented, women were collectively paying as much as $1 billion more than men for identical private health insurance plans. Now, women are charged the same price as men, as the ACA mandated that people can’t be charged more for an identical plan based on one’s gender.

Health Insurance Gaps

With that being said, there are some areas in which the ACA could improve access and cost of health care for women. While men are more likely to be uninsured overall, when one compares male and female employees, men fare far better. According to research from the The Henry J. Kaiser Family Foundation, women are more likely than men to be uninsured despite being employed; just 34 percent of employed women are covered by insurance compared to the 43 percent of employed men who have coverage.

According to statistics from the National Women’s Law Center, almost 64.2 percent of part-time workers are women. Even with the introduction of the ACA, part-time workers—who are defined as working less than thirty hours a week—are not all legally required to have health insurance provided by their employers, unless their employers are subject to the employer shared responsibility provision.

In addition, despite the ACA’s provision that health insurance companies can’t charge more per plan based on one’s gender, women still pay almost 70 percent more for out-of-pocket health insurance costs.

In addition, despite the ACA’s provision that health insurance companies can’t charge more per plan based on one’s gender, women still pay almost 70 percent more for out-of-pocket health insurance costs. This is due to a variety of factors, including high premiums for long-term care and difficulties gaining insurance after becoming widowed or divorced. Women also tend to receive far more routine preventative care than men, so the actual number of doctor visits is often much higher for women.

These high costs coupled with low, part-time salaries can help to explain why women experience such a high degree of economic inequality. The average woman already starts off with less money than men due to the gender wage gap of 79 percent. While white non-Hispanic women make approximately 75 cents compared to each dollar white men make, it’s much worse for women of color, as African-American women make 60 cents and Hispanic women make 55 cents. Therefore, women are starting out with less money to pay for health care, when health care is already more expensive for women than it is for men.

Table 1. Gender Pay Gap by Race
Race Earnings (as compared to a white man)
Asian American women 83.5 cents
White Non-Hispanic women 75.4 cents
Women overall 78.6 cents
Black women 60.5 cents
Native American/Asian Pacific Islander women 58.6 cents
Latina women 54.6 cents
Source: “We Can’t Talk About the Pay Gap without Talking About Race,” Mashable

Policy Recommendations

Ideally, every American worker would have adequate access to affordable, equitable health care, including the part-time workforce. But given the political polarization in Congress and the difficulties of altering the ACA, expansion of the law’s benefits may not be possible in the short term. In the near term, advocates and policymakers could focus on expanding access to low- and middle-income people and addressing women’s economic inequality so they can afford these high costs.

These initiatives could be executed in a variety of ways. For instance, while the ACA expanded Medicaid to reach more low-income men and women, nineteen states have opted out of this decision, leaving approximately 4.8 million people without insurance. As a result, the federal government could begin to assume the cost of the ACA’s Medicaid expansion. According to Planned Parenthood, if all states expanded Medicaid, it could lead as much as 7 million women, many of whom are low-income, to be provided with adequate health care for preventative screenings.

Even if the federal government covers the Medicaid expansion, there are still many people who do not qualify for Medicaid because they earn too much, yet still cannot afford health insurance; often, subsidized marketplace plans or unsubsidized marketplace coverage is too expensive for workers, despite the fact that they are income-based. In 2014, the number of people that could not afford unsubsidized marketplace plans was an astonishing 3.7 million. With that in mind, it may be beneficial to expand Medicaid yet again, in order to cover more of the uninsured population.

Any changes in health care reform strategy must also involve targeted outreach toward women.

Any changes in health care reform strategy must also involve targeted outreach toward women. For instance, President Obama recently announced that he wants to be more aggressive in signing people up for Obamacare in the marketplace. The president should include a special outreach effort to educate and assist women working part-time to sign up for ACA benefits.

Finally, raising the minimum wage, ensuring that all women have paid family leave, and looking at more ways that part-time jobs can have greater parity with full-time jobs, could leave women with more money to adequately cover the cost of health insurance if they do not qualify for Medicaid. It is not enough simply to provide affordable health care; we must also begin to address the rampant economic inequality in this country.