Gender equality was one of the many arguments that the Affordable Care Act’s backers mounted six years ago in support of the landmark overhaul of the nation’s health care laws.

The law barred health insurers from pricing their plans based on a customer’s gender. Or, as Nancy Pelosi announced, “Being a woman is no longer a pre-existing medical condition.”

But a new analysis of 109 qualified health plans by the National Women’s Law Center and the Commonwealth Fund finds that insurers regularly refuse to cover a range of medical services that are disproportionately used by women.

The most common prohibition — exercised by 42 percent of the examined health plans — relates to any condition that is the result of a noncovered service, such as cosmetic surgery. The logic there seems tenuous. Skateboarding is not a “covered service,” either, but presumably injuries resulting from it are covered, right?

Twenty-seven percent of the health plans do not cover maintenance therapy, a broad range of services that are geared towards maintaining, but not necessarily improving, health. Conditions that often call for that type of treatment include lupus, depression and chronic pain, conditions which women are more likely to suffer from.

Fifteen percent of the plans excluded genetic testing, a service for which demand is mounting as researchers begin to connect the dots between genes and illnesses that a patient is likely to develop, such as breast cancer, as well as conditions that are likely to affect their future children, such as sickle cell anemia and Tay-Sachs disease.

Similarly, a number of insurers won’t cover procedures that people often choose to undergo after discovering they have a genetic predisposition toward a certain condition, most commonly breast cancer or ovarian cancer. Removal of breasts or ovaries is a recommended medical service for women of a certain genetic profile.

Fourteen percent of health plans said they would not cover fetal reduction surgery, in which a woman opts to abort one of multiple fetuses she is carrying. Doctors might recommend the procedure for the health of the mother or to improve the chances that the remaining fetus develops and is delivered successfully.

Finally, in an attitude that runs directly counter to the push for parity between mental and physical health, 11 percent of health plans refuse to cover “self-inflicted” conditions. That might mean damage incurred by an eating disorder or a suicide attempt. Women are more likely to survive both.

Instant Insights /

Medical services insurers refuse to cover: Most are for women

More From HR Executive

Related Stories

Recommended For You