Insuring Working Women's Health and
Wellness: Where Are We
Richmond WOMAN, Vol.
2, Issue 10, October 2004, pp. 6 and 10
In June, I had the privilege of addressing the 7th Annual
Women’s Health Virginia Conference focused on working women’s health,
and I served on a panel at the Governor’s Second Annual Conference on
Virginia’s Uninsured. Both were wonderful opportunities to
learn more about a critical issue of concern toRichmond’s businesses
and its women and their families – the high cost of health care and the
consequent lack of affordable health insurance.
While experts share a common understanding of the problem,
there is little common agreement about a solution. What is clear,
however, is that we can reduce costs is by preventing the diseases and
injuries that cause us to require health care in the first place.
of the Problem
Insurance is A Significant Problem for Working Women and Their
An estimated 44 million people live without health insurance in the
United States and roughly three quarters of a million of these
individuals live in Virginia. According to the Dean of the
University of Virginia Medical School, 75% of Virginians without health
insurance are in families with at least one full-time worker, and 60%
of the working uninsured are employed by firms with fewer than 50
The problem is especially critical for women. More than one-fifth
of women with children under 18 lack health insurance. Half of
working mothers are not paid when they miss work to take care of a sick
child. Ten percent of all women ages 18-64 provide care to
family members who are sick or disabled; 43% of these caregivers have a
chronic health condition; 25% of caregivers are medically uninsured,
according to “Women, Work and Family: A Balancing Act,” an Update on
Women’s Health Policy, Henry J. Kaiser Family Foundation, April 2003.
Businesses and employees both agree that health insurance is an
important benefit. According to the Society of Human Resources
Management (SHRM), employees consider health insurance to be the most
important fringe benefit an employer can offer.
Working Virginians Are Uninsured
When it so widely considered such an important issue, why are so many
working Virginians without insurance? A number of factors account
for this problem:
Insurers charge small firms more per
employee for health
insurance than they charge large firms. Premiums for all
businesses increased by 12.7% in 2002m which presents a problem for
every employer, regardless of size. At the same time, however,
premiums for firms with between 10 and 500 employees rose 18.1%.
Smaller firms routinely face the highest rate of increase.
employers say that they cannot afford to offer health insurance as a
benefit. For example, 76% of women entrepreneurs at the Women
Entrepreneurship in the 21st Century Conference said that cost was the
biggest obstacle to providing health insurance benefits (refer to http://www.dol.gov/21cw/Women_3_18/Conference_Report.htm).
High cost is also a factor for employees. Even when firms do
offer health insurance, not all eligible employees enroll. This
is particularly true for lower wage employees and employees at smaller
firms. At firms with fewer than 25 employees, only 13% of
eligible employees earning less than $10 an hour enrolled in a plan for
which they were eligible, while 42% of those earning $10 or more hourly
enrolled. At firms with greater than 25 employees, 46% of workers
making less than $10 were enrolled in an available health plan
contrasted to 79% of those making $10 or more. (“The
Uninsured US and Virginia,” presentation by P.J. Maddox, Second Annual
Governor’s Conference on the Uninsured, http://cnhs.gmu.edu/imv/agenda.html).
Part of the problem for employees is that benefit premiums for health
insurance have risen faster than wages. While premium costs were
up by almost 13% in 2002, wages rose only 4 %. Since most
employers do not offer fully paid insurance, the disparity between wage
increases and premium increases makes insurance less and less
affordable even where available. (Id.).
Half of small firms responding to
another survey said that they did not
know that health insurance premiums are 100% tax deductible to the
employer. Over half believed incorrectly that employees
purchasing insurance on their own could deduct 100% of their premiums.
Another reason businesses do not offer insurance coverage is lack of
knowledge. According to a Kaiser Family Foundation Survey, one-third of
the businesses surveyed that were not offering health insurance
coverage admitted that they did not know how much it costs. Those
who said that they did know overestimated the average premium cost by
Are Policy-Makers Doing To Fix This Problem?
complexity and resource issues: Small business owners do not
staff, time or resources to manage the administration of benefit
programs. Small business owners who do not have ready access to
human resources professionals are overwhelmed by the amount of
information about benefit options and put off by regulations (ERISA,
Mostly, policy-makers are debating what should be done and by
whom. The presidential candidates have competing solutions.
President George W. Bush endorses association health plans as a method
to reduce costs for small business. His challenger John Kerry offers
refundable tax credits and entrance into the Congressional health
plan. Lieutenant Governor Tim Kaine has convened a small business
commission to investigate options at the state level. He plans to
present legislation in the 2005 session of the Virginia General
Assembly. The bottom line is that it is unlikely meaningful change will
occur soon at either the federal or state level that would
significantly affect either affordability or accessibility of health
insurance or would reduce health care costs.
What Can We Do?
What then can individual women, business owners and community leaders
do to help address the high cost of health care and health insurance
while we wait for policy makers to act?
Some communities (with or without state support) are already exploring
alternative ways of providing lower-cost access to health care for the
uninusured. One such community-based initiative is Project
Access, a physician initiated program started in North Carolina that is
now being replicated in Roanoke and Danville (www.apaonline.org).
Another alternative model is the Muskegon Community Health Project (
There is one step that we can all take, however, to reduce health care
costs and, consequently, to increase affordability of insurance.
We can work together to prevent injuries and diseases that drive up
costs. We must make individual lifestyle choices for ourselves
and our families, run our businesses (including hospitals) safely and
in a way that encourages health and wellness, and we must adopt public
policies that encourage investments in prevention.
The Health Advancement Research Organization (HERO) points out that
most of the current experimental means of reducing the cost of health
“ … economic: increas[ed] premium cost for employees, higher co-pays,
reduction of benefits, employee-driven health care plans and health
saving accounts.” HERO argues that “[t]hese approaches have
questionable potential to control costs in the long term, because the
problem is a health issue…more specifically, it is a lifestyle choice
problem. Obesity, smoking, inadequate physical conditioning, inability
to manage stress, poor nutrition and similar lifestyle choices are the
cause of 50% to 70% of all illness and medical problems,” and,
consequently, these factors have led to the high cost of care and
Obesity alone is a major contributor to the health care cost
crisis. Health care costs for a person who is morbidly obese are
36% higher and medicines for morbidly obese persons cost 77% more than
cost for people who are not obese ( “Countering A Weight Crisis” by
Robert Grossman, HR Magazine, March 2004)
According to Glenn Gaesser, professor of exercise physiology at the
University of Virginia and author of Big Fat Lies: The Truth about Your
Weight and Your Health (Gurze, 2000), improved fitness alone can reduce
risk of major diseases by 25 to 50%.
The federal Department of Health and Human Services (HHS)
estimates that health promotion and disease prevention programs result
in median savings of $3.14 for each dollar spent. (HHS 2003
Report, Prevention Makes Common “Cents”).
Injury prevention is less expensive than correcting problems after
they’ve occurred. The American Association of Safety Engineers
estimates that for every $1 invested in a safety and health program, $4
to $6 is saved as a result.
Business has proven that enhancing wellness works to reduce costs. HHS
estimates that 80% of workplaces with more than 50 employees and almost
all employers with 750 workers or more offer health improvement
programs, most with an obesity component. Bank of America
conducted a health promotion program for retirees. The cost was
$30 a person; insurance claims were reduced by an average of $164
compared to a $15 increase for nonparticipants. Coca Cola
reported savings of $500 per year for employees enrolled in their
fitness program. Prudential reported a reduction of major medical
costs from $574 to $312 for each participant in their wellness
program. (Worksite Health Promotion Directory,
Clearly, both business owners and employees can contribute to reduced
health care costs by investing in wellness and practicing
prevention. And, each of us as individual women can have a
meaningful impact on the health care cost crisis simply by choosing
healthy lifestyles for ourselves and for our families.