Contest Entries

Pre-existing Condition: Female

Entrants: Jenny Deam, Diane J. Salvatore

Affiliation: Prevention Magazine

Health Policy

Year: 2011

Place: Honorable Mention

Provide a brief synopsis of the story or stories, including any significant findings.

Judges’ comments: Outstanding research. Glaring flaw in health care coverage ... has been written about elsewhere, but this article nails it. This well-written investigative story …. brought new light to  an often overlooked policy issue that affects millions.

Media outlet that published or aired this entry

Prevention magazine

See this entry.    

Provide names of other  journalists involved.

Roberta Caploe, Executive Director
Jessica Branch, Health Director

List date(s) this work was published or aired.

This piece was published in the December issue, which was on the newsstands from Nov. 1 - Nov. 28, 2011. Reaching newsstands just before the Nov. 2011 midterm elections, our story was primed to empower readers to check the views of their representatives and vote their interests, and its momentum only increased when that same month the Supreme Court decided to consider the constitutionality of health-care reform. By alerting our readers to this danger – and many wrote to say that they had been unwitting victims before reading our article – we have made insurance discrimination part of the discourse of health care reform.

Provide a brief synopsis of the story or stories, including any significant findings.

A husband and wife sit at their home computer, applying for health insurance policies with different companies: She's 35 and healthy; he's 43, smokes a pack a day, and recently threw his back out. But everywhere they look, the wife would have to pay nearly twice as much as the husband for the exact same coverage – and some places won't take her at all. Crazy? Illegal? Just plain impossible? Guess again: Women are charged as much as 84% more than men for health insurance – or turned down outright – simply for being women, and that discriminatory practice is alive and well and legal in 37 states, where 95% of companies take full advantage of it. Prevention blows the whistle on this biased business-as-usual, which is scheduled to be outlawed by President Obama's Patient Protection and Affordable Health Care Act in 2014. However, this act is under attack in Congress, and attempts to repeal it are a real threat to many women's hopes of getting health insurance. In classic Prevention tradition, we combine rich reporting with an advocacy edge to delve into the roots of "gender rating" and dissect the insurance company rationale – that women use more preventive health-care services -- that essentially penalizes women for taking care of their health. Our piece showcased real women who had been charged unaffordable rates or flat-out denied coverage for reasons ranging from having given birth by Cesarean section to being a survivor of rape or domestic abuse to being proactive about controlling conditions such as fibromyalgia. Our ultimate goals: to make our readers aware of this insidious practice and advise them on how to navigate around such discrimination, and to call on our elected officials to recognize that preventive health practices save the entire system money in the long run.

Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?

This story came about mostly on a hunch that something was amiss. A story in the local paper during the run-up to the Affordable Care Act had a buried paragraph about a Colorado woman who was denied all future health coverage after having a C-section until she was either past child bearing age or could prove sterilization. The writer, Jenny Deam, was appalled and half figured it was a mistake. She tracked the woman down and she told her of another woman who had the same experience. From there she contacted ICAN (International Cesarean Awareness network, an advocacy group) who confirmed this was the practice of one insurance company. In addition ICAN had sponsored the original Colorado woman to testify before a Senate subcommittee in the fall of 2009. Deam read that testimony which led her to uncovering not only gender bias in other insurance denials, but also talked about a little known but widespread practice of gender rating in which women can be charged more for their health insurance simply because they are women. Again, the writer figured it must be a mistake. To learn more about gender rating she turned to the National Women's Law Center which did two exhaustive studies on women and insurance in 2008 and 2009 called "Nowhere to Turn" and "Still Nowhere to Turn." Once it was confirmed that existed but was perfectly legal in the majority of states, she set out to find real women who had experienced not only gender rating but also gender-based denials.

Explain types of human sources used.

The writer, Jenny Deam, spent days doing Internet searches on insurance discrimination. That led her to a newspaper account of a woman who had been denied after being raped. She contacted her through SOAR (Speaking Out Against Rape). She also contacted the Kaiser Family Foundation who pointed her to a publication that mentioned a New Mexico woman who had been denied insurance after being a victim of sexual assault as well as a Pennsylvania business owner who was charged more for her group plan because most of the employees of her visiting nurses business were women. This was a breakthrough because previously it was believed that women in group plans were immune and that gender rating only occurred in the individual market. From there Deam was able to track both women down who told me their stories. In the meantime she sent out a Help A Reporter Out request asking for women who had been denied insurance based on gender. Deam received nearly 50 replies. Among them were insurance brokers and advocacy groups who help women get insurance when they have been denied. Through those sources she was able to find more women to share their experiences including Pamela Rice who was unable to get insurance for herself but her husband could – even though he had preexisting medical conditions and smoked. When Deam asked her how she knew it was her gender triggering the denials she casually mentioned she had grown suspicious and she set up her own test and applied first as a man and then as a woman with identical profiles. As a man she was accepted for coverage, as a woman she was not. Deam also spoke with the head of a support group for young cancer survivors who spoke about a woman in Chicago who paid more than men even within the safety net of the state-run high risk pool. When the writer contacted this individual, she gave Deam the Illinois rate sheet which was incontrovertible. Much of the source work came from sheer legwork. Deam did hundreds of Internet searches on insurance denials and women and worked backward when she got a name. To get the other side Deam had several conversations by phone and email with the insurance industry. Also, because this has become a political issue the writer tried to contact members of both political parties to find out what they expected to happen to the scheduled 2014 prohibition against gender rating if the Affordable Care Act is repealed. No one from the Republican leadership would answer.

Results (if any).

The story was part of a discussion panel on a CBS Early Show segment which was then picked up by affiliates across the country. Editors were also interviewed about the issue on at least a half dozen radio shows. In nearly every case no one knew that this was happening to women.

Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.

No correction or clarification.

Advice to other journalists planning a similar story or project.

Follow your hunch. Deam knew early on that she was onto a big story and just kept digging. Once she had the study, she spent the bulk of her time trying to find real women to illustrate the different points. The surprising thing was that even though they felt they had been wronged they had convinced themselves that theirs was an isolated case. They were eager to talk and said they were so grateful Prevention was doing the story because so few women knew about it. By telling their experience they said they felt they were helping others. The most important thing is to stay focused. The subject of women and insurance is so huge it could have been easy to go off into other areas. By keeping it tightly focused just on gender rating and gender-based denials it was stronger and more powerful.