Sheila W, a young mother in New York, was covered by her husband's employment-based health insurance when she was diagnosed with breast cancer two years ago. The insurance paid for her mastectomy. But when her husband lost his job recently, Sheila lost her coverage and could no longer afford potentially lifesaving chemotherapy. Unable to qualify for Medicaid (federal health insurance for the poor), Sheila now waits and worries, just like 41 million other uninsured Americans who cannot afford the health care they need. 

Federal policy proposals to assist uninsured or low-income adults have looked to tax credits to help buy health coverage. But a recent study by The Commonwealth Fund, a private foundation in New York, found that proposed tax credits would not be high enough to make health insurance affordable to women with low incomes. 

Based on an analysis of plans offered in 25 cities, the study found that tax credits of $1,000 or $1,500 per person would leave even healthy young women with a choice of plans with deductibles that would be high relative to their incomes. In some places, no plans were available at premium rates even for women as young as 25. Older women fared even worse: in most cities studied, no plan was offered with premiums in this range for them. 

The study also found that tax credits would buy less coverage for young women than they would for young men in many cities, despite the fact that policies typically exclude maternity benefits. In four of the 25-city studies, no individual policies were offered with premiums in the $1,000 to $1,500 range for healthy women aged 35. 

"Health insurance is particularly important for women because they have a greater need for health care than men over their lifespan, due in part to pregnancy and childbirth earlier in life, and higher rates of chronic illness later in life," noted Karen Davis, president of The Commonwealth Fund. "Policies available to women typically don't include maternity coverage, putting low income working women and their families at risk for high health care costs. Tax credit proposals that rely on the individual insurance market simply don't pass the reality test." 

According to the study, 'Health Insurance Tax Credits Will They Work For Women?', older women fare even worse than younger, working women. A low-income woman, age 50, could spend more than half of her annual income on deductibles for plans with premiums at or below $1,000. The report concluded that unless tax credits are coupled with options to buy into group insurance, individual insurance market reforms, or other protections, participation rates among low-income women are likely to be low. 

The crisis in American health care is not only about cost. It is also about quality of care. Hospital infections are now the fourth leading cause of death in the US, behind heart disease, cancer and strokes, according to the Centre for Disease Control and Prevention. Medical errors have climbed to eighth, killing more people than car accidents, breast cancer and AIDS. "Patient safety" and "quality of care" have become major concerns within the health care industry, while consumers struggle to find accurate, unbiased, and easily understood information to help them make informed choices. 

Some state legislatures are calling for major changes in hospital accountability. Annual "report cards" informing communities about "quality of care, clinical outcomes, and other performance measures" are being required in some states, and Public Oversight Commissions are being put in place. Some advocates are calling for the release of information about medical errors, diagnostic mistakes, equipment failures, and more. (A 1999 report by the Institute of Medicine revealed that between 44,000 to 98,000 people die in hospitals each year from medical errors, costing the nation more than $37 billion.) 

At a national health policy conference earlier this year, Democratic Senator John Breaux bemoaned the state of health care in America. He noted that in 2001, "Americans saw their health premiums go up nearly 13 per cent...the largest increase in a decade for those with employer-sponsored health insurance - and the second consecutive year of double-digit increases." Advocating comprehensive health care reform and universal coverage, he called access to affordable, high quality health care "simply our duty as a nation." 

Breaux and others want to see a "new social contract" that combines "individual involvement with the best care options offered by the private sector, backed by the resources and oversight of federal and state governments." At a minimum, they are calling for all Americans to have "a basic insurance package, defined by the federal government and similar to the standard benefits packages available to all federal employees". 

Advocates of this plan are also calling for government-supported "child wellness" benefit packages and "individual health accounts" for low-income Americans. While a hybrid proposal that relies on a private/public sector partnership, the Breaux proposal moves the country toward universal coverage in a way that may be more palatable to centrist voters and policymakers who are loathe to embrace a nationalized health care system. 

A more forceful commitment to universal health care is articulated in a statement of Health Care Principles recently drafted by the Vermont Commission on Women. "Every [citizen of the state] should have meaningful access to comprehensive health services, including emergency and preventive care services, reproductive health services, dental care, mental health and substance abuse treatment, treatment for acute and chronic conditions, and rehabilitative and long-term care services." 

The document calls for a well-trained and supported health care workforce (recognizing that the vast majority of health professionals/workers are women), and emphasizes prevention. And it calls upon societal institutions "to promote healthy lifestyles and offer incentives to reduce the incidence of sexual and domestic violence, obesity, smoking, substance abuse, inactivity, poor nutrition, risky behaviors, and other behavior patterns that contribute to health problems". 

In a reprise of 1970s activism toward improved health care, it seems that women will once again be centre-stage advocates. This, while health care policymakers grapple with the pressing problems of a population which is ageing in the face of serious deficits in accessible, affordable, quality health care.