With the Great Recession driving millions of Americans into the ranks of the unemployed, the fallout for many has included the loss of employer-sponsored health insurance. Women of reproductive age (15–44) have been hit particularly hard: according to a Guttmacher Institute analysis of new data from the U.S. Census Bureau, the number covered by private insurance fell by 2.3 million over the course of a single year, from 39 million in 2008 (63.3% of that population) to 36.7 million in 2009 (59.5%). This rate is lower and has fallen considerably faster than the rate for the U.S. population overall.
Medicaid and the Children's Health Insurance Program (CHIP) have managed to mitigate some of these losses, despite the fiscal crisis that has led almost every state to take action to restrict the programs' enrollment and expenses. Nationally, the number of reproductive-age women on Medicaid or CHIP rose by one million over the same time period, to 9.1 million in 2009 (14.8%). For a greater number of women, however, this safety net failed them. The number of women of reproductive age without any insurance at all increased by 1.3 million, to a total of 13.7 million (22.3%). Indeed, even among those below the federal poverty level—$18,310 for a family of three—Medicaid and CHIP covered only four in 10 (39.7%) women of reproductive age, because eligibility for the programs is highly restrictive in many states, leaving another four in 10 (41.3%) uninsured.
Patterns of insurance coverage among women of reproductive age vary widely across the states, reflecting differences in levels of unemployment and poverty, state fiscal difficulties and eligibility criteria for Medicaid and CHIP. The proportion who were uninsured in 2008–2009 ranged from less than 7% in Massachusetts—reflecting in part the success of that state's early efforts at health care reform—to nearly 35% in Texas (see table, page 18).
| INSURANCE GAPS | ||||||
|---|---|---|---|---|---|---|
| Although Medicaid can help to fill the gap, states with relatively low levels of private insurance coverage also top the list for levels of uninsurance. | ||||||
| Women Aged 15–44, 2008–2009 | ||||||
| Total | % on Medicaid or CHIP |
% privately insured | % uninsured | |||
| U.S. TOTAL* | 61,605,801 | 14.8 | 59.5 | 22.3 | ||
| Alabama | 941,940 | 13.4 | 62.7 | 20.6 | ||
| Alaska | 139,627 | 9.8 | 49.8 | 24.8 | ||
| Arizona | 1,290,756 | 20.2 | 53.6 | 23.4 | ||
| Arkansas | 556,617 | 13.8 | 53.7 | 29.0 | ||
| California | 7,721,474 | 15.7 | 57.3 | 24.7 | ||
| Colorado | 1,022,668 | 8.8 | 65.5 | 20.9 | ||
| Connecticut | 684,016 | 12.6 | 72.1 | 13.3 | ||
| Delaware | 175,710 | 15.8 | 65.2 | 16.1 | ||
| District of Columbia | 149,688 | 19.4 | 67.9 | 11.8 | ||
| Florida | 3,444,632 | 9.3 | 56.6 | 29.0 | ||
| Georgia | 2,067,302 | 8.8 | 60.4 | 25.0 | ||
| Hawaii | 247,372 | 14.9 | 61.3 | 10.5 | ||
| Idaho | 300,012 | 9.3 | 65.6 | 22.6 | ||
| Illinois | 2,653,944 | 15.6 | 64.2 | 17.7 | ||
| Indiana | 1,264,771 | 14.9 | 63.8 | 20.0 | ||
| Iowa | 572,538 | 12.5 | 69.4 | 16.5 | ||
| Kansas | 546,268 | 8.9 | 68.0 | 17.9 | ||
| Kentucky | 859,624 | 15.7 | 57.3 | 24.2 | ||
| Louisiana | 925,621 | 11.8 | 60.6 | 25.1 | ||
| Maine | 244,584 | 25.5 | 59.0 | 12.1 | ||
| Maryland | 1,174,509 | 8.9 | 71.3 | 16.7 | ||
| Massachusetts | 1,353,253 | 23.0 | 69.4 | 6.7 | ||
| Michigan | 1,956,539 | 16.3 | 63.7 | 18.1 | ||
| Minnesota | 1,031,196 | 14.1 | 72.2 | 12.2 | ||
| Mississippi | 595,298 | 19.7 | 53.1 | 23.2 | ||
| Missouri | 1,175,046 | 12.8 | 66.2 | 18.6 | ||
| Montana | 181,613 | 12.9 | 61.8 | 21.0 | ||
| Nebraska | 352,122 | 10.5 | 70.0 | 14.8 | ||
| Nevada | 521,503 | 8.9 | 62.2 | 25.6 | ||
| New Hampshire | 257,101 | 9.3 | 73.1 | 14.6 | ||
| New Jersey | 1,727,261 | 11.6 | 67.5 | 19.1 | ||
| New Mexico | 397,730 | 15.3 | 48.0 | 30.8 | ||
| New York | 4,036,727 | 22.2 | 59.0 | 17.6 | ||
| North Carolina | 1,900,115 | 13.4 | 57.3 | 22.4 | ||
| North Dakota | 125,319 | 11.0 | 71.3 | 13.5 | ||
| Ohio | 2,252,642 | 16.5 | 65.4 | 15.6 | ||
| Oklahoma | 724,728 | 11.6 | 59.5 | 23.1 | ||
| Oregon | 752,014 | 11.9 | 64.8 | 21.3 | ||
| Pennsylvania | 2,396,244 | 15.7 | 68.7 | 13.7 | ||
| Rhode Island | 214,039 | 20.0 | 61.8 | 16.1 | ||
| South Carolina | 903,082 | 11.1 | 63.2 | 22.1 | ||
| South Dakota | 151,961 | 9.3 | 67.4 | 18.0 | ||
| Tennessee | 1,259,089 | 18.0 | 56.5 | 19.6 | ||
| Texas | 5,143,582 | 9.6 | 52.4 | 34.6 | ||
| Utah | 600,869 | 6.7 | 73.2 | 17.7 | ||
| Vermont | 118,532 | 21.9 | 62.2 | 12.3 | ||
| Virginia | 1,597,040 | 7.2 | 66.4 | 17.1 | ||
| Washington | 1,337,166 | 12.7 | 64.5 | 16.5 | ||
| West Virginia | 342,321 | 16.8 | 54.9 | 23.5 | ||
| Wisconsin | 1,094,072 | 17.1 | 69.8 | 11.0 | ||
| Wyoming | 104,911 | 9.4 | 65.1 | 19.4 | ||
| *2009 data. Source: Guttmacher Institute tabulations from the Current Population Survey, 2009–2010. | ||||||
These trends are very much in line with a series of other findings on how the recession is affecting women's reproductive health preferences and decisions and their ability to access the care they need to carry out those decisions. A 2009 Guttmacher study found that the recession had led nearly half of low- and middle-income women to decide to delay pregnancy or limit the number of children they have, but that many of them have faced major problems affording and accessing the care they need and may have ended up trying to stretch their monthly supply of pills or putting off a health care visit as a result (see article, Winter 2010, page 8). As they lost insurance and ran low on money, many women have turned to safety-net providers for free or subsidized care, and indeed a separate 2009 study of family planning centers found that nearly nine in 10 had seen an increase in poor and low-income clients and in those without insurance. Yet, facing their own budget crises, more than half of those providers reported serious challenges in meeting their clients' needs, such as staff layoffs, hiring freezes and cutbacks in the range of contraceptive methods they offer. —Adam Sonfield