Dear Future President — What Women Want for Healthcare in America

This report was created in partnership with Manatt Health, with additional support from Merrill Research.

Overview

Women are economic and political powerhouses, with the ability to shape economies and sway elections. Despite making up just over half of the U.S. population, women control 85% of purchasing decisions—including 80% of healthcare decisions—and clock in with a whopping $7 trillion in annual purchasing power. As such, women are typically the de facto "Chief Medical Officer" for not just themselves, but their families and extended families. Moreover, in every presidential election since 1984, women have turned out to vote at a higher rate than men.​

At the same time, women have been disproportionately impacted by the events of 2020, which is coloring their thinking about the impending election. Given the global pandemic, the resulting unstable economy, work-from-home and “Zoom school” pressures, and the concomitant public policy controversies over gender equity, women have experienced unprecedented stress. As a result, 1 in 4 women either have exited the workforce or are considering doing so to attend to their families at the expense of their careers. These economic and personal stressors amplify existing societal and health challenges that women face. For women of color and those in “essential worker” roles, the impact of this stress is even more profound.​

With the 2020 presidential election drawing near, it’s no surprise that healthcare is a top-of-mind issue for female voters planning to cast their ballots. For many, the fulcrum of the election rests on this topic. But what exactly do women think about the direction of healthcare in the United States?

Given women’s hefty stake in the election’s outcome, understanding what women want and need from the healthcare system—and how they expect the future U.S. President to drive policies that deliver it—is key to understanding the type of mandate that female voters will or will not deliver. To shed light on these issues and better understand women’s healthcare priorities, Tia, Inc. partnered with Manatt Health, LLC to commission a survey of 900 women ages 22 to 45, representing all income levels, races, ethnicities, and geographic regions in the United States. We also considered respondents’ answers through the lens of their stated political beliefs, marital status, motherhood and insurance type, though these factors were not nationally representative. The online survey, which was co-designed and administered by Merrill Research, a leading market research firm, was conducted September 16-22, 2020. In this survey, respondents were asked how they would advise the next U.S President, regardless of who it is, on their healthcare priorities for the upcoming term. Notably, the top-level findings from the survey include:

The balance of this report discusses the detailed results underlying these findings, highlights women’s view on key health policy priorities for the upcoming Administration and poses final considerations for readers.

Across All Groups, Women Agree More Than They Disagree

Despite the many demographic and philosophical differences among those surveyed, there was a surprising level of accord in how women think about health. The survey found that, for many policy issues, the single most important quality to inform opinions on healthcare was, in fact, being female. This was true across virtually every demographic category—including age, income, geography, race and ethnicity, and even political party in many cases. With some variation between categories, women surveyed expressed nearly universal sentiment on key issues such as safeguarding current protections for individuals with pre-existing conditions; ensuring coverage parity for mental health and substance use disorder care; requiring insurance coverage for pre- and post-natal care, and equal coverage for telehealth; supporting policies that expand access to affordable health insurance; and implementing new national policy to fight COVID-19.

Healthcare Insurance Issues

While there are mixed feelings about the Affordable Care Act (ACA) when called out by name, women in the study overwhelmingly support the underlying pillars that make up the ACA when those items are considered individually. For instance, there is remarkably broad support for policies that (1) require insurance coverage for pre-existing medical conditions (88%); (2) increase access to affordable health coverage by providing subsidies that pay for health insurance (79%); and (3) result in the expansion of Medicaid to cover more people (71%). With respect to the latter, women across all income brackets and party lines care deeply about protecting insurance coverage for those with pre-existing conditions, with almost 9 in 10 women supporting the provision and over half ranking this as a top healthcare priority.

Beyond ensuring access to affordable health coverage, there is broad support for policies that limit the out-of-pocket cost of healthcare,

• Manage drug prices by making laws that limit cost (84%);
• Regulate the price of health insurance by limiting profits made by health insurers (82%);
• Limit how much money people have to pay out-of-pocket for healthcare (78%); and
• Require health insurance to cover key services, including:
  • Pre- and post-natal care (83%);
  • Mental health and substance use disorder care (80%);
  • Telemedicine, at the same level as in-person services (83%);
  • Gender-specific care (75%); and
  • Contraception and birth control (74%).

Covid-19

Despite staggeringly different levels of COVID-19 contagion and impact among demographic groups, 70% of women agree that a new national strategy is required to fight COVID-19. Moreover, women in the study also show consensus regarding the policies and actions in such a strategy, like social distancing and mask-wearing, with the vast majority preferring a stricter approach. Specifically, the majority of women believe that:

• The federal government should pay wage subsidies to those who are out of work due to COVID-19 (78%);
• Healthcare workers should be given priority access to any approved COVID-19 vaccinations (78%);
• The federal government should pay for the testing and treatment of COVID-19 (77%) as well as the costs of contact tracing (76%);
• Social distancing should be required until a COVID-19 vaccine is readily available (75%);
• Mask-wearing policies should be required nationally and remain in place until the COVID-19 pandemic ends (68%); and
• The pharmaceutical industry should comply with a standard trial and testing process before deploying the vaccination publicly (68%).

Women View “Women’s Health” as More than Just Reproductive Medicine

Historically, healthcare issues encompassed by the term “women’s health” have focused narrowly on so-called “bikini medicine” categories, such as gynecology and breast cancer. Rarely does public discourse or public policy in this field go beyond the physical and reproductive health categories, into which women’s health is all too commonly reduced. But when women in the study were asked, “When it comes to your own health, what are your biggest personal health issues?” none of these issues top the list, even among women of child-bearing age, on whom this survey focused. While issues related to gynecology, maternal health, and/or other “bikini medicine” categories are clearly important to women, they are first and foremost focused on mental health, COVID-19, stress management, the cost of healthcare, and being overweight, among other issues unrelated to reproduction.

Furthermore, 1 in 5 women in the study cited mental health as the single most important health issue that needs to be addressed by the incoming President, even ahead of Covid-19 and the cost of healthcare.

While the order of importance attributed to these responses varies among the different subgroups surveyed, key issues remain the same across every single category of women in the study. Two subgroups where the ranking notably differed: women making less than $26,000 (whose top policy priorities are mental health, COVID-19, and being overweight, immediately followed by the cost of healthcare) and Black women (whose top policy priorities are COVID-19, mental health, and stress management, immediately followed by the cost of healthcare).

Despite having other first-level priorities, women do care deeply about issues related to pregnancy, contraception, abortion, and fertility. A majority of women surveyed believe that insurance should cover a wide range of reproductive health services, including pre- and post-natal care, contraception, fertility treatments, abortion, and other gender-specific care coverage. There are varying levels of support for coverage of certain services, however, based on political affiliation, race/ethnicity, and income level.

For instance, although 77% of the U.S. population supports the right to abortion protected by Roe v. Wade, among women included in this survey, 52% believe that insurance companies should be required to cover abortion services, with greater support amongst Democratic women. Support for coverage of contraceptives and abortion is highest among females with no children and women who identify as Democrats.

Conversely, women across all demographics consistently support coverage for pre- and post-natal care as well as fertility treatments, with a higher level of support yet among single Black and Hispanic women for the latter.

Women Want Healthcare Solutions That Address Social and Economic Factors Beyond What Happens at the Doctor’s Office

Women consider social and economic policies and supports to be deterministic of and essential to their health and well-being, at a level that significantly exceeds any other healthcare-related issues. In fact, women overwhelmingly think about health as much more than traditionally defined “healthcare” and believe that the most critical services in their lives address far more than medicine and biology, as evidenced by the most common responses to the survey question, “What is the single most contributing item to improving the health and well-being of women, not just during the pandemic, but generally?”

Even women with no children ranked affordable childcare and payment for family caregiving among the top three contributors to women’s health, as did women across all income levels.

Following support for caregivers, women ranked “access to healthy, affordable food” as highly essential to their health and well-being. Intuitively, most people know how fundamental healthy food is to good health, but strategies to navigate access in the healthcare system are rarely addressed. Given that so many women cited “being overweight” as a top personal health concern, it is clear that women need assistance appropriately linking the impact of food on weight and health in their healthcare system experiences. Effective policy should recognize this challenge and mitigate its impacts through physician education, nutrition and food security screenings, referrals to and enrollment support for public nutrition services (e.g., the Supplemental Nutrition Assistance Program), and creative approaches to insurance coverage.

Still, there are noticeable differences in what were named as the most contributory factors to health when breaking down the results by race and ethnicity, highlighting disparities among certain minority populations. Black, Hispanic, and Asian women more frequently cite income-related factors, such as a higher minimum wage, having employment, or

Recommendations for Our Next President and Other Healthcare Policy Leaders

Across the spectrum of healthcare issues, the results of this survey are clear: A majority of women do not believe the United States is on the right track — 73% say they believe our country is headed in “the wrong direction.”

The implications for policy are clear. It is essential for the next President to prioritize efforts to:

• Ensure that people cannot be denied health insurance if they have pre-existing conditions (88%), but also ensure that health insurance is broadly available, affordable, and inclusive of all of the issues considered to impact health.
• Extend coverage for telemedicine and virtual care so they are on parity with in-person services (83%), especially for hard-to-access services.
• Require insurance companies, employers, and Medicaid to make mental health and substance use disorder care more accessible and affordable through coverage parity (80%).
• Increase access to affordable health coverage by:
  • Subsidizing the cost of health insurance for those who cannot afford it (79%); and
  • Requiring that state Medicaid plans extend coverage to more people (71%).

Further, as policy makers consider the design and implementation of such policy priorities, they should ensure that such policies address broader societal inequities existing among and between women. To accomplish this, policy makers must:

Broaden policies to incorporate integrated solutions that enable whole person care and specifically address unmet social needs—including caregiver support, adequate and equal wages, and education about and access to healthy foods. Women’s health begins with supportive social policies and structures, many of which are considered outside the lines of traditional healthcare. It is time to redraw the lines and evolve innovative ways of serving and paying for these needs.

Design policies that enable women to get all of their health needs addressed, whether related to reproductive health, overall physical health, or mental health. Women’s health is full mind and body health, and nothing less.

Actively identify and correct for health disparities among women. Even where concordance exists at an aggregate level, racial and financial disparities further highlight and exacerbate health challenges for women of color and with lower incomes. These disparities have a multiplier effect for health risk and must receive greater attention.

Final Considerations

Beyond policy makers, there are clear messages here for others with broad impact on how women receive healthcare, such as insurance companies and health systems that, by and large, serve as gatekeepers to health services and determine what is considered “healthcare,” “medically necessary,” or “cost-effective.” These entities must broaden their definition of women’s health to be inclusive of the holistic definitions deemed essential by the vast majority of women in the country. This broader definition creates an opportunity for such entities to design and implement strategies that incorporate social needs like childcare or affordable nutrition into the healthcare system in a meaningful way—an effort that has gained widespread attention from payers, providers, and advocates alike in recent years. Moreover, this is a clarion call for fair and equal wage laws to finally have their moment.

At a time of polarization within our nation, it is notable that, at least when it comes to health, there is far more agreement than disagreement among women in the age group 22-45, a group that comprises more than 50% of all women in the United States. Even the supposed divisions between Republican and Democratic women have far less of an effect than is publicly represented. Health for women is an opportunity to make investments in issues where there is common ground, which is an opportunity for the President and others to make a positive difference with a large voting constituency. Women may play the central role when it comes to making family healthcare decisions, but it is time for the male policy-making majority to walk a mile in women’s shoes and contribute to the betterment of the nation as a whole.

Appendix

About Tia

Founded in 2017 by Carolyn Witte and Felicity Yost, Tia is a full-service women’s healthcare platform architecting a new, female-centric model of care with a blend of in-person and virtual services. The company has built a personalized healthcare model by fusing OB/GYN, primary care, mental health, and evidenced-based wellness services into an integrative experience that’s convenient, collaborative, and focused on prevention. From the Tia health advisor app to the Tia Clinic, Tia makes women healthier, providers happier, and the business of care delivery stronger.

About Manatt Health

Manatt Health integrates legal and strategic business consulting expertise to better serve the complex needs of clients across the healthcare system. Combining legal excellence, first-hand experience in shaping public policy, sophisticated business insight, and deep analytic capabilities, we provide uniquely valuable professional services to the full range of health industry players. Our diverse team of more than 160 attorneys and consultants from Manatt, Phelps & Phillips, LLP, and its consulting subsidiary, Manatt Health Strategies, LLC, is passionate about helping our clients advance their business interests, fulfill their missions, and lead healthcare into the future. For more information, visit www.manatt.com/health.​

About the Authors

Carolyn Witte, Co-Founder and CEO, Tia, Inc.
Felicity Yost, Co-Founder and Chief Product & Operating Officer, Tia, Inc.
Lisa Suennen, Managing Director, Manatt Health and Lead Partner, Manatt Ventures.
Morgan Craven, Consultant, Manatt Health, LLC.

For More Information Contact:

Libbey Baumgarten, Senior Vice President, Jennifer Bett Communications, tia@jenniferbett.com
Samuel Eisele, Media Relations Manager, Manatt, seisele@manatt.com​