The combined effect of unemployment, poverty, and single marital status make women with disabilities much less likely to have private health insurance than non-disabled women.
The 1994-1995 National Health Interview Survey revealed that private health insurance was available to 47 percent of women with three or more limitations and 60 percent of women with one or two limitations, compared to 75 percent of women with no limitations.
Studies have documented the refusal of many physicians to treat patients who do not have private insurance, and who are covered only by Medicaid or Medicare. Thus, women with disabilities have access to a smaller pool of physicians, who may lack experience treating women with their disabilities.
Inadequate capitated payment levels to health care providers create disincentives to accepting women with disabilities and chronic conditions such as multiple sclerosis.
Women with disabilities who have public or private health insurance often do not have coverage for certain prescription drugs, physical or occupational therapy, assistive devices, medical equipment, medical supplies, or in-home attendant care services.
These services are denied through very restrictive definitions of medical necessity, which are based on a health care system designed to treat short-term health conditions rather than chronic conditions. Services needed to maintain physical or mental functioning, or to slow the progression of disease or functional loss are routinely denied.
A recent state study consisting of 71 percent women found that having a chronic condition decreased the probability of having adequate health insurance coverage by 10 percent, and 25 percent if the individual was also single. Men had a higher probability of having adequate coverage. Health insurers are legally permitted to reduce coverage for a specific chronic condition, or to raise the cost of premiums for those who have certain chronic conditions and disabilities. In effect, this reduces health insurance coverage for women with disabilities who cannot afford the high premiums.
Men and women with disabilities and chronic conditions in managed care plans are generally less satisfied with accessibility, technical care, communication, choice, interpersonal relations and quality of outcomes than those in fee for service plans. However, managed care plans designed to address specific needs associated with disability improve both access and outcomes compared with other health care sources.
Due to uncovered health service expenses, payment of the full deductible, and having to pay higher coinsurance costs, men and women with disabilities and chronic conditions bear a larger burden of out-of-pocket expenses for health care than do able-bodied persons. The greater the number of chronic conditions, the higher the level of out-of-pocket spending. Large out-of-pocket health care expenses comprise a greater proportion of lower income for women, which impedes access to care, impairs health status and quality of life, and leaves insufficient income to cover other necessities.
Medicaid is better than Medicare and private insurance for covering supportive services needed by persons with functional limitations, making those with low incomes eligible for a wider array of services than a middle-income person. Nearly two-thirds of those with functional limitations who live in the community rely exclusively on family, friends, and volunteers for personal assistance services.
Nearly 15 percent of women with functional limitations in the 45-64 age range have no health care coverage at all.
Women in this age range are particularly vulnerable to lacking health care coverage because the prevalence of chronic conditions begins to rise in midlife at the same time that they are vulnerable to age-related employment discrimination or asked to retire early, leaving them without private group health insurance, while not being old enough to qualify for Medicare.
Those with no health insurance are less likely to access health care for serious symptoms than are those with health insurance.