Come for the politics, stay for the snark.

We are builders in a constant struggle with destroyers. keep building.

A thin legal pretext to veneer over their personal religious and political desires.

Come for the politics, stay for the snark.

Bad people in a position to do bad things will do bad things because they are bad people. End of story.

Be a wild strawberry.

Fight them, without becoming them!

Peak wingnut was a lie.

“Perhaps I should have considered other options.” (head-desk)

No Kings: Americans standing in the way of bad history saying “Oh, Fuck No!”

After dobbs, women are no longer free.

If you cannot answer whether trump lost the 2020 election, you are unfit for office.

“Loving your country does not mean lying about its history.”

Let’s bury these fuckers at the polls 2 years from now.

Donald Trump found guilty as fuck – May 30, 2024!

This blog will pay for itself.

Fuck these fucking interesting times.

Jack be nimble, jack be quick, hurry up and indict this prick.

To the privileged, equality seems like oppression.

Why is it so hard for them to condemn hate?

Democracy cannot function without a free press.

It’s all just conspiracy shit beamed down from the mothership.

If you don’t believe freedom is for everybody, then the thing you love isn’t freedom, it is privilege.

President Musk and Trump are both poorly raised, coddled 8 year old boys.

The lights are all blinking red.

You are here: Home / Anderson On Health Insurance / Gender differences in ACA take-up

Gender differences in ACA take-up

by | 12 Comments

This post is in: 

In this month’s American Journal of Health Economics, Hopkins et al estimate the percentage of people who take-up ACA health insurance for the eligible pool for the 2015-2017 plan years. They use a combination of de-identified micro-data from Healthcare.gov and the American Community Survey to generate these estimates. They find a few expected things including that when people have the ability to make a good faith estimate that either qualifies them or disqualifies them from benefits, those estimates will be optimistic. Take-up was fairly low but it increased by age.  One of the things that really leapt out at me was the gender splits:

Gender differences in ACA take-up relative risk ratios

They offer a few of the standard explanations. Women are socialized to engage in more health seeking behavior is a common explanation. One of the ones that was not mentioned in the text but I think needs to be explored some more is partisan take-up. We know from Lerman et al (2017) that political identity meant a lot in early ACA take-up:

First, we find that partisanship has a strong and statistically significant relationship to whether individuals have health insurance. The evidence indicates that, all else equal, Republicans are 6 percentage points more likely than Democrats to be uninsured. Second, we find that partisanship is strongly associated with opting to purchase marketplace plans. With the full set of controls, we find that Republicans are fully 12 percentage points less likely to purchase marketplace plans than Democrats.

Gender is not a bad first pass predictor for partisan affiliation and identity.  Opposition to the ACA was a highly visible and salient component of Republican identity in 2015-2017 when this study was conducted.  I am curious if some of the take-up effects that are being captured in the Hopkins et al article is really a political effect rather than a health economics health seeking behavior effect?

Reader Interactions

12Comments

  1. 1.

    Anonymous At Work

    Why can’t the take-up effects be both political and health-seeking behaviors as a result of women’s health issues driving the gender-based partisan gap?  The underlying assumption for men is that health care for them is standard, ‘women’s issues’ is extra/superfluous.

  2. 2.

    narya

    Women want that yearly gynecological exam. Many women who didn’t have access to the HPV vaccine probably had an abnormal Pap smear at some point and want to make sure it doesn’t recur/get worse. Good luck taking care of that w/o insurance. Also: access to some forms of contraception requires (used to require? don’t know what the current situation is) that visit as well: oral contraceptives, LARCs, etc. That is, I don’t think the “socialization” argument is complete–managing fertility requires that visit, and it will be prohibitively expensive w/o insurance.

  3. 3.

    NutmegAgain

    Super interesting. Curious what happens if you add parental status to your model? When I saw the gender difference, I immediately thought that mothers are far more commonly the ones who engage the health care system on behalf of their kids. (See for example the current Help! Advice! column in WaPo, which is yet another plea for help in getting husband to take on more of this behavior. But seriously.) I have no data to point to, so this is very much a seat of the pants, anecdotal type of query. But I’d be interested. The intersections of gender, family roles, and caretaking behavior of all sorts is certainly documented.

  4. 4.

    H.E.Wolf

    @narya: I don’t think the “socialization” argument is complete–managing fertility requires that visit, and it will be prohibitively expensive w/o insurance.​

     Indeed. Gendered socialization re: health care would be a “necessary but not sufficient” reason.

    In addition to the important issues mentioned by narya, there are many other fertility-connected matters relevant to women and girls, which might be an incentive to seek health care and health insurance (bearing in mind that health insurance and health care are two separate things):

    dysmenorrhea; uterine fibroids; ovarian cysts; menstruation-related anemia; infertility; pregnancy; abortion.

  5. 5.

    H.E.Wolf

    @NutmegAgain: ​When I saw the gender difference, I immediately thought that mothers are far more commonly the ones who engage the health care system on behalf of their kids.

     Another excellent point, and another good example of gendered socialization [I’m making this phrase do a lot of work].

  6. 6.

    Anonymous At Work

    @H.E.Wolf: It’s a great point but likely to be victim to limitations on de-identified/anonymous data sets (helloooooo, day job!).

    I’d want to see marital status and employment information (type, wage/salary estimates, etc.) since this is ACA enrollment, separate from employer-provided.

  8. 8.

    Another Scott

    Interesting, and seems to fit with other datasets. E.g. KFF.org (from December 12):

    […]

    Uninsured

    On average, women have lower incomes and have been more likely to qualify for Medicaid than men under one of Medicaid’s eligibility categories; pregnant, parent of children under 18, disabled, or over 65. As a result, women are more likely than men to qualify for Medicaid and less likely to be uninsured. In 2023, 13% of men ages 19-64 were uninsured compared to approximately 10% of women in the same age bracket (9.3 million women).

    Uninsured women often have inadequate access to care, get a lower standard of care when they are in the health system, and have poorer health outcomes. Compared to women with insurance, uninsured women have lower use of important preventive services such as mammograms, Pap tests, and timely blood pressure checks. They are also less likely to report having a regular doctor.

    Women with lower incomes, women of color, and women who are non-citizens are at greater risk of being uninsured (Figure 2). One in five (17%) women with incomes under 200% of the FPL ($31,700 for an individual in 2023) are uninsured (Table 2), compared to 7% of women with incomes at or above 200% FPL. One in five Hispanic (20%) and American Indian and Alaska Native (19%) women are uninsured. A higher share of women in single parent households are uninsured (10%) than women in two-parent households (7%) (data not shown).6

    […]

    Scope of Coverage and Affordability

    The ACA set national standards for the scope of benefits offered in private plans. In addition to the broad categories of essential health benefits (EHBs) offered by marketplace plans, all privately purchased plans must cover maternity care which had been historically excluded from most individually purchased plans. In addition, most private plans must cover preventive services without co-payments or other cost sharing. This includes screenings for breast and cervical cancers, well woman visits (including prenatal visits), prescribed contraceptives, breastfeeding supplies and supports such as breast pumps, and several STI services. There have been several legal challenges over elements of the preventive services policy, including in the pending case, Braidwood Management Inc. v. Becerra, which could affect whether the preventive services requirement remains intact in the future. Twenty-five states have laws banning coverage of most abortions from the plans available through the state Marketplaces. These restrictions were in place prior to the Supreme Court’s decision to overturn Roe v Wade.

    Affordability of coverage continues to be a significant concern for many women, both for those who are uninsured as well as those with coverage. The leading reason why uninsured adults report that they haven’t obtained coverage is that it is too expensive. Under employer-sponsored insurance, the major source of coverage for women, 60% of all covered workers with a general annual deductible have deductibles of at least $1,000 for single coverage. Thirty-seven percent of women with employer sponsored coverage report that it is difficult to meet their deductibles.8

    […]

    Much more at the link.

    Thanks and HNY to you and yours.

    Best wishes,
    Scott.

  9. 9.

    sab

    @narya: I agree. My family is remarkably healthy. None of us needed any kind of medical attention except for prescribed birth control.

    And I am old enough to remember when a single woman could not get health insurance period. It was only available through her husband’s policy.

  10. 10.

    NutmegAgain

    @H.E.Wolf: Once upon a time I was a (genuine, certified) social scientist who studied stuff like gender & medicine. Evidently I can still rub a few of those brain cells together!

  11. 11.

    justsomeguy05

    I enjoy how the “male” color is the one closest to pink, and the “female” color is the one closest to blue. I know they are not ACTUALLY pink & blue, but at first glance some might assume the genders in that chart are the opposite of what is depicted.

  12. 12.

    EmbraceYourInnerCrone

    @Anonymous At Work: Its also fun when one has to repeatedly seek treatment for a health issue and have it be put down to anxiety and oh have you tried losing weight…umm I had a form of severe endometriosis but thanks for ignoring my pain for years docs…same with migraines.  I suppose I could have ignored the tachycardia too  oh yeah I did until the bradycardia landed me in the ER..”why didn’t you say something sooner”  well cuz I m pretty sure I would have been ignored again or told I was having a panic attack. Narrator: she was not in fact having a panic attack…did get a shiny new pace maker tho…

Comments are closed.