The Economic Benefits of Fighting the Inaccessibility and Inequality in Women’s Healthcare
EXECUTIVE SUMMARY
Women are facing financial and legal barriers that inhibit their ability to access adequate and equitable healthcare. The current political climate has dictated much of the conversation surrounding women’s healthcare, with little regard to the societal benefits that are possible by addressing inefficiencies and opportunities for growth in the healthcare system. Current policy trends related to women’s healthcare continue to restrict access to necessary resources related to reproductive health. Many women are trapped in the poverty cycle, as their agency is restricted by barriers to healthcare institutions. In the long run, investing financial resources into women’s healthcare institutions will generate a large return by allowing women to participate in the workforce in a larger capacity and by increasing labor productivity, as health will not be as large of an inhibitor of work capacity. The political dimensions of this issue require judicial action to address inequitable legislation for the implementation of an effective investment program and a more equitable legal basis for this complex issue. In order to address disparities and inequality in healthcare for women, economic investment into women’s healthcare institutions and services coupled with judicial advocacy to address and change laws related to women’s healthcare would spur long term economic growth. With these two strategies working together, the additional resources allocated to women’s healthcare are able to be implemented properly due to the lack of judicial restrictions and will generate widespread benefits in the long run.
INTRODUCTION
The United States healthcare system is extremely fragile. The COVID-19 pandemic highlighted the weaknesses of healthcare institutions and exposed the widespread inequalities in the US healthcare system. Political, financial, and judicial pressures impact the accessibility and equality of healthcare in the United States. The women’s healthcare sector, in particular, bears a large amount of the burden that these pressures place on the healthcare sector.
Progress in healthcare accessibility was made via the implementation of the Affordable Care Act (ACA) in 2010, however, while the benefits generated aided white, childless adults, racial inequalities in healthcare were not adequately addressed (Lee). This legislation addressed disparities in access to insurance, due to both financial difficulty and pre-existing health conditions, allowed for insurance coverage over a wider range of health issues, and expanded Medicaid access (Borchelt). These changes did not make a significant impact on minority communities, as racial inequalities in healthcare continue to persist (Lee). Additionally, two years after the ACA was passed, the Supreme Court ruled that states were not required to expand Medicaid, leaving 18 states with no Medicaid expansion (Lee). The ACA was a half-hearted attempt to make progress in healthcare inequality, yet it failed in its methodology, perpetuating state-level sexism and racism in healthcare (Rapp).
While there has been advancement in the areas of Medicaid and insurance opportunities for low-income, white women, the current policies addressing inequalities in the women’s healthcare system are not enough to address the disparities that many women still face in regard to sexual and reproductive health. The ACA did make a slight impact on healthcare accessibility, noticeably decreasing the number of adults who did not have a yearly health exam, were uninsured, and who did not recive care due to healthcare costs (Lee). These results had a large difference between white and non-white populations, emphasizing the continual inequality in healthcare (Lee). Significant policy changes are needed to alter the climate and discussion surrounding women’s healthcare and reproductive rights. The possibilities for economic and societal growth have not been adequately addressed through medical care legislation. The implementation of politically-divided policy has lost sight of the long-term benefits a comprehensive and informed healthcare policy can bring to women, doctors, and the economy. Before continuing, it must be acknowledged that this issue has a strong political dimension and can be extremely difficult to address objectively. The goal of this briefing is to highlight the cumulative effect of the benefits generated by economic investment in the women’s healthcare sector.
RATIONALE
INACCESSIBILITY
Access to women’s healthcare institutions and services varies across the US, with the majority of US states restricting access to family planning services and reproductive health clinics. Currently, only 6 states require private insurance plans, Medicaid, and Affordable Care Act providers to cover abortion on full coverage plans, while 34 states restrict insurance coverage to the Hyde Amendment qualifications (“Interactive…”). This amendment restricted the use of federal funds for abortion, with exceptions (Kalist). The implementation of mandatory waiting periods, multiple appointment requirements, and the closing of many healthcare institutions, forces women to travel further distances and makes access more difficult (“Crisis in the South”). These legal restrictions affect all women, but disproportionately affect low-income and working women, as these women tend to have limited flexibility due to work, transportation issues, and financial difficulty.
Basic reproductive health needs are not being met, jeopardizing the health of women across the country. From a survey conducted in 2021, only 1 in 5 uninsured women had a gynecological exam in the last year (Frederiksen). These exams are necessary to address reproductive health, sexually transmitted diseases, and proactive cervical cancer screenings, among other necessary services. And while the ACA has helped increase the number of women covered by insurance to 90% (“Interactive…”), the remaining 10% are not receiving essential care. Structural inequities based on wealth, race, and gender continue to persist. Low-income women who benefit from federally funded healthcare are unable to get the medical attention and services that are necessary to maintain their health, even with the provisions of the ACA.
Accessibility to women’s healthcare options and reproductive services is being judicially challenged by many states, as strict bills being proposed across the country threaten the necessary medical institutions that women rely on for basic healthcare needs. Approximately 20% of women utilize federally funded healthcare services or other clinics like Planned Parenthood (Frederiksen). Threats to these institutions and the lack of implementation of ACA legislation affects the populations that benefit the most from federally funded healthcare. The inaccessibility of healthcare institutions, doctors, and services based on financial and legal barriers disproportionately affects underrepresented communities and inhibits economic growth.
INEQUALITY
Access to healthcare tends to vary by income level, putting many low-income and minority communities in disadvantaged positions when it comes to healthcare access. The inability of women to enter the workforce because of health concerns that have not been addressed or unwanted pregnancies continue the cycle of poverty in low-income communities (Foster). Further, healthcare inequities perpetuate wealth inequality in the US. The wealth gap is connected to the racial wealth and health disparities in the US. The poverty cycle continues as publicly-funded healthcare clinics are more likely to be attended by low-income communities and underserved populations (Long), yet the barriers and restrictions to accessing these healthcare services disproportionately affect the institutions that these communities frequent.
The significant inequities in the women’s healthcare sector can be identified when looking at other health determinants. “Social determinants of health” are indicators that show what areas and populations are not receiving adequate healthcare services. These determinants include transportation usage, housing certainty, finances, and food related stability (Long), as these factors contribute to the ability to access healthcare services. These important indicators help identify the communities that need the federal healthcare and insurance programs, however, only 13% of women were asked about transportation and access to food by their doctors (Long), indicating a lack of concern and understanding of the current healthcare system by healthcare providers.
Structural wealth inequality and the poverty cycle are perpetuated by the structure of healthcare and insurance in the US. The private nature of healthcare in the US compared to other countries leaves uninsured and low-income communities at a disadvantage and further reduces the ability to get much needed health care services. The lack of accessibility to basic healthcare harms long term economic growth, perpetuates the cycle of structural racism-based poverty, and maintains the large wealth gap in the US.
POLICY OPTION #1: JUDICIAL ADVOCACY
To look more closely at the successes of increased access to reproductive health services via legal means, the case study of Roe v. Wade is important in understanding how the legalization of abortion impacted the labor market and labor force and, in the long run, had positive effects on the economy, women, and future generations. In a study conducted in 2004, researchers looked at labor force participation rates before and after Roe v. Wade expanded abortion rights. They found that in states that legalized abortion prior to Roe v. Wade, the likelihood that women were participating in the workforce in a moderate capacity increased by 2% (Kalist). Further, in states that legalized abortion prior to Roe v. Wade, the probability of black women in the labor force increased by 6% and the probability of white women in the labor force increased by 1.6%, as compared to non-abortion states (Kalist 510). This increase is significant as the issue of access was not a major part of this ruling. It merely allowed more flexibility with the types of services women could choose. If access was addressed, it is likely that the participation of women in the workforce would increase in a much larger capacity.
Labor is a leading input in the Classical economic “Production Function,” indicating that labor is necessary for economic growth (Kim 35). The productivity and skill level of the labor force also impact long-run economic outcomes (Kim 35). The legalization of healthcare services directly aids women in becoming more productive and educated, increasing their future value as human capital, further spurring long term economic growth. However, the aforementioned legislative challenges, such as legislation aiming to delegitimize Roe v. Wade, places the issue of women’s healthcare in a particularly complex situation, as women’s healthcare is so much more than access to abortion.
By retrospectively looking at the rise of contraceptive use and the decrease in barriers to obtaining oral contraception, the benefits of judicial action related to women’s healthcare can be understood once again. The legalization of contraception in the court case Griswold v. Connecticut (1965) provides insight into the positive effects that widespread access to contraceptives had on women and the economy. This ruling repealed laws restricting the sales of contraceptives based on obscenity statutes (Bailey). Contraceptive and birth control advocates significantly influenced the outcome of this case by surveying public opinion via the media and identifing the public’s general view towards contraceptives (Bailey). Public calls to action made a noticeable impact on the legal standing of this women’s health issue, indirectly increasing flexibility in healthcare services. We are able to see the short and long term effects of this monumental change in women’s healthcare. From an economic standpoint, it is estimated that access to contraception decreases the probability of women in poverty by 0.5–1% (Browne). While this seems to be a relatively small number, contraception is just one aspect of women’s healthcare. This case still imposed restrictions on what groups were able to access birth control, however, it was a major step forward in the judicial standing of reproductive rights.
The economic benefits of contraception access has been analyzed by looking the long-term effect on economic indicators. In a study looking at a fifty year timeline of contraception access and the legalization of the Pill, increased access to the Pill supported long-term benefits in wages, income, labor force participation, and education levels for the next generation (Bailey). The effects on these economic indicators directly impact long-term growth and productivity. Decreases in the poverty rate and increases in income create more wealth, leading to future investment, consumption, and productivity, as discussed with the “Production Function” above. Legal measures had the direct effect of giving women choices for their health, translating into economic gains. This short run and almost immediate change had long lasting effects, both individually and economically.
POLICY OPTION #2: ECONOMIC INVESTMENT
Economic investment is the most beneficial action that can be taken to address inaccessability and inequality in women’s healthcare. In the long run, labor force participation will increase, as increased access means workers are healthier and, therefore, more productive, and an increase in productivity will increase household income, leading to more public consumption and tax revenue for the government. The return on social investment in the healthcare sector is positive in the medium to long term, according to empirical findings by researchers Soo-Wan Kim and Sang-Hoon Ahn, emphasizing the benefits of addressing healthcare inefficiencies.
The recency of the COVID-19 Pandemic has given the scientific and healthcare communities the opportunity to look at the impact of social investment into various forms of healthcare. In a study looking at the benefits of investing in at-home healthcare, the labor force is significantly impacted by increased funding. This study looks specifically at in-home healthcare, however, the benefits of healthcare investment are similar, especially with women being large parts of the at-home healthcare workforce. In terms of job creation, this study found that for every $1 billion dollars invested, 33,501 jobs were created, in both direct and indirect employment roles and across various industries, including retail, healthcare, and real estate (Palladino). This job creation leads to active participation in the labor force, generating a larger return in the long-run.
Investing in healthcare is like investing in human capital, a resource that is extremely important to the economy (Laruffa). Socio-economization policies in Europe emphasize the impact of correctly implemented financial policy, as it was found that for each pound invested into the issue of homelessness, 2.20 pounds were saved in other welfare programs (Laruffa). In the long run, these savings add up, benefiting both the government and the individual. Women are able to better support themselves and benefit from healthcare services while the government will get a return via upward mobility, progress through education, job attainment, and increased savings elsewhere. By addressing the health of the general population now, public healthcare costs are likely to be lower in the future (Laruffa).
Like many economic phenomena, the benefits of increased access to healthcare will be felt by every party in the long run. There will be noticeable short run changes, such as almost immediate increases to healthcare options and facilities, for the general population. However, the long-run benefit of investing in healthcare reaches nationwide by promoting economic growth, increasing the productivity of labor, and by addressing structural inequalities.
POLICY RECOMMENDATION
Both legal and economic issues persist in healthcare and the inequalities that exist cannot be adequately addressed by only focusing on one policy method. In order to work towards a more equitable healthcare system for women’s health, legal and financial policies must be jointly altered to create a comprehensive and action-driven policy that reduces barriers to access and provides the largest opportunity for growth in the long run.
Combining economic and judicial action creates a more powerful policy and enhances the benefits of each method. The legal backing for healthcare services allows for economic investment to aid the women’s health sector more deeply and efficiently. Without the legal protections, many states would not follow investment regulations and guidelines, as there is no legal standing required. The Affordable Care Act is facing this issue, as states are not required to implement the program. A risk of judicial action combined with economic assistance may lead to the questioning of the reach of federal power over state legislation, an issue that has been discussed with the ACA. Separating these two policy methods risks the lack of implementation of the economic investment, continuing to restrict access to services and supporting the barriers barring women from adequate healthcare. The impact of increased funding would be voided as access would still be restricted and long-run growth potential will not be maximized.
The following actions are recommended to reduce disparities in women’s healthcare:
- Increase investments in Federally Qualified Health Centers (FQHC) and outside public clinics and institutions similar to Planned Parenthood.
- In a study conducted in 2009, researchers found that the long-term impact of public investment in the healthcare sector is much greater than that of private investment (Kim 36). The return is larger, as there is a more equitable distribution of expenditures and effects felt are more widespread.
- Diverse population distributions across the country impact the accessibility of institutions. A minimum requirement of women’s healthcare institutions should be required and paid for through economic investment.
- Population density or distance constraints are two methods to create adequate access to women’s healthcare institutions. A minimum number of institutions per a set population threshold or a certain number of institutions within a certain square mile radius can address the factors that influence accessibility.
- Build on the Affordable Care Act and address the lack of Medicaid expansion by various states through incentives.
- This will push more state funding towards the issue and force states to develop women’s healthcare infrastructure.
- The privatized nature of healthcare in the US means that finances will always play a role, however, by addressing the role of private insurance companies can help with leverage and coverage, mitigating financial barriers.
- Enhance public understanding of the issue of women’s healthcare.
- Direct judicial action is difficult due to the nature of the institution, however, by educating the public and outlining the benefits that economic investment can have, this can help with altering public opinion.
- The media and public opinion surveys are extremely powerful tools. This power can be harnessed to address the disparities being faced.
- Legal action tends to take longer to be implemented into society and the effects felt may be delayed. This aspect of legal action must be considered when planning the timeline of future policy.
Access to contraception, education, and annual exams allows for longevity due to increased life expectancy and future contributions to society. By making women’s healthcare institutions as a whole more accessible through adequate legislation and investment practices, the economic benefits could be of a greater scale than we have seen with past changes to health policy. When looking at policies related to homelessness in the U.K., this statement summarizes the difficulty in balancing societal rights and economic issues. “Arguably, social investment involves the economisation of social policies for homeless people, whereby the cost–benefit rationale tends to crowd out and override the social logic of rights” (Laruffa). To address this major social issue stemming from structural sexism and racism, we must make a strong economic case on why access and equality matter. As much as it seems impersonal, the way to make a difference is through conveying and generating financial benefits.
REFERENCES
Bailey, Martha J. “Fifty years of family planning: New evidence on long-run effects of increasing access to contraception.” Brookings papers on economic activity, Washington D.C., Brookings Institution Press, 2013, pp. 341–409. https://uosc.primo.exlibrisgroup.com
Borchelt, Gretchen. “The Impact Poverty Has on Women’s Health.” American Bar Association, Human Rights Magazine, vol. 43, no. 3, 1 Aug. 2018. https://www.americanbar.org/
Browne, Stephanie P. and Sara LaLumia.“The Effects of Contraception on Female Poverty.” Journal of Policy Analysis and Management, vol. 33, no. 3, 2014, pp. 602–622. https://uosc.primo.exlibrisgroup.com/
“Crisis in the South.” Center for Reproductive Rights. 4 June 2015. https://reproductiverights.org/crisis-in-the-south/
Foster, Diana G., et. al. “The Economic Consequences of Being Denied an Abortion.” National Bureau of Economic Research, 2020. https://uosc.primo.exlibrisgroup.com/permalink
Frederiksen, Brittni, et. al. “Women’s Sexual and Reproductive Health Services: Key Findings from the 2020 KFF Women’s Health Survey.” Kaiser Family Foundation, KFF, Women’s Health Policy, 21 Apr. 2021, https://www.kff.org/womens-health-policy/issue-brief
“Interactive: How State Policies Shape Access to Abortion Coverage.” Kaiser Family Foundation, KFF, Women’s Health Policy, 17 Aug. 2021, https://www.kff.org/womens
Kalist, David E. “Abortion and Female Labor Force Participation: Evidence Prior to Roe v. Wade”. Journal of Labor Research, vol. 25, no. 3, Sep. 2004, pp. 503–514. https://uosc.primo.exlibrisgroup.com
Kim, Soo-Wan, and Sang-Hoon Ahn. “Social investment effects of public education, health care, and welfare service expenditures on economic growth.” Asian Social Work and Policy Review, vol. 14, 2020, pp. 34–44. https://onlinelibrary-wiley-com.libproxy2.usc.edu/doi/
Laruffa, Francesco. “Promoting social goals through economisation? Social investment and the counterintuitive case of homelessness.” Policy and Politics, London, vol. 49, no. 3, 2021, pp. 413–431. http://libproxy.usc.edu.com
Lee, Hyunjung, and Frank W. Porell. “The Effect of the Affordable Care Act Medicaid Expansion on Disparities in Access to Care and Health Status.” Medical Care Research and Review, vol. 77, no. 5, 2020, pp. 461–473. https://journals-sagepub-com.libproxy1.usc.edu/doi/pdf/10.1177/1077558718808709
Long, Michelle, et. al. “Women’s Health Care Utilization and Costs: Findings from the 2020 KFF Women’s Health Survey.” Kaiser Family Foundation, KFF, Women’s Health Policy, 21 Apr. 2021, https://www.kff.org/womens-health-policy/issue-brief
Palladino, Lenore. “Public Investment in Home Healthcare in the United States During the COVID-19 Pandemic: A Win-Win Strategy.” Feminist Economics, vol. 27, 2021, pp. 436–452. https://uosc.primo.exlibrisgroup.com/permalink
Rapp, Kristen S., et al. “State-Level Sexism and Women’s Health Care Access in the United States: Differences by Race/Ethnicity, 2014–2019.” American Journal of Public Health, vol. 111, no. 10, 2021, pp. 1796–1805. https://uosc.primo.exlibrisgroup.com/permalink/01USC_INST/273cgt/cdi_proquest_miscellaneous_2569375670
