With another Affordable Care Act open-enrollment period in the rearview mirror, policymakers remain mystified as to why men lag behind when it comes to obtaining health insurance. And young men sometimes catch the blame for high insurance rates, since this relatively healthy segment of the population tends not to buy coverage.
There is no mystery. Women receive substantial gender-based services that personalize health insurance for them and that provide strong incentives to buy coverage. But under the ACA, there are no gender-based services for men and no incentives to buy health insurance other than fines and penalties, which are designed to punish men for not participating in a program that fails to provide for their basic needs.
The economic benefits of preventive health care are well-known. Screening for various conditions such as high cholesterol, high blood pressure, sexually transmitted infections, and some cancers, along with regular medical checkups, have improved and lengthened the lives of millions of Americans. And it keeps people whose conditions are caught early from getting sicker.
Employers know that preventive health care reduces sick days and disability payments and increases workplace productivity. Insurance companies know that preventive health care lowers their costs and generally support it. Always happy to jump on the bandwagon, politicians espouse the benefits of preventive care, which is why these services were included as an important part of the ACA and now cover many Americans.
A clear provision in the ACA prohibits discrimination “on the basis of race, color, national origin, sex, age, or disability.” But that doesn’t square with reality. Women and girls are covered, mostly for free, for a variety of preventive services, while men and boys are eligible for far fewer preventive services, some of which are also important for maintaining the good health of women and girls.
Is it any wonder that men have disengaged from discussions of health care? Here’s a closer look.
Sexually transmitted infections
Under the ACA, non-pregnant women age 24 and younger, as well as older, high-risk women, can receive free screenings for chlamydia. And all sexually active women can receive free screenings for gonorrhea. Tests for detecting these diseases are equally effective in both sexes, but males aren’t eligible for free screenings. Since chlamydia and gonorrhea are both transmitted sexually, what’s the point of screening only females?
According to the CDC, “Women whose sex partners have not been appropriately treated are at high risk for re-infection.” Besides reducing the painful symptoms that sexually transmitted infections cause in boys and men, screening them could interrupt the cycle of infection. The same is true for oral human papillomavirus. Anti-HPV vaccines exist for both males and females, but females are more likely to get the vaccine. Males, as a result, are 3.6 to six times more likely to be infected with the virus (depending on the strain), which can cause genital warts and several types of cancer.
Annual visits for preventive care
The ACA provides for an excellent, comprehensive annual Well-Woman Visit at no cost. These visits, as defined by law, “include a full checkup, separate from any other visit for sickness or injury,” and “focus on preventive care for women,” including shots (such as flu and pneumonia vaccines), education, counseling (diet, exercise, smoking cessation, etc.), and mental health screenings for depression and suicide risk.
No comparable “Well-Man Visit” is provided, despite the well-documented fact that across all races and ethnicities, men live sicker, significantly shorter lives than women. Most premature deaths are avoidable through preventive care. And there’s little doubt that effective mental health screening could reduce the horrifying statistic that males are four times more likely than females die by suicide.
To prevent premature deaths, boys and men must learn about their own health needs. But that’s unlikely to happen unless the messages come in person from a health professional. Well-man visits would inform men of their health needs and encourage them to become actively engaged in their health. They’ll also give providers the chance to catch problems while they’re still treatable or curable.
Prostate cancer screening
Under the ACA, breast cancer screening for women is provided “without charging a copayment or coinsurance,” even for women who haven’t met their deductibles. Screening for prostate cancer — which is the No. 1 cancer in men — isn’t covered at all. Why not?
The risk of developing prostate cancer is much higher for African-American men and veterans exposed to Agent Orange and other chemicals, and more than doubles with a family history of the disease. Routine screening for high-risk men can catch potential prostate cancer earlier, which can prompt earlier treatment (if necessary) and may increase the patient’s lifespan and quality of life.
Besides the terrible toll that prostate cancer takes every year on men, tens of thousands of wives, mothers, sisters, and daughters are devastated by the emotional, physical, spiritual, and economic impacts of this disease.
The ACA requires that health plans cover counseling and contraception for women, including barrier methods, implanted devices, birth control pills, emergency contraception (“morning after” pills), and sterilization procedures. For men? Nothing. Covering contraception for women reduces unintended and unwanted pregnancies. Covering condoms and vasectomies for men would undoubtedly have the same effect.
Although we think of breast cancer and osteoporosis as women’s diseases, both conditions affect men as well. At-risk men should receive the same no-cost screenings that women do.
Denying basic, no-cost preventive care based solely on gender is clearly discriminatory. Congress, health insurers, and each one of us have a moral obligation to ensure that the baseline of mandated benefits for males is not inferior to the baseline for females. To be clear, we’re not advocating rolling back any coverage or benefits that are currently available to females. Rather, our concern is for equality, equity, and the removal of gender-based discrimination so boys and men will have the same chance at a long and healthy lives as girls and women.
Providing equity would also give men an incentive to buy insurance and to get preventive medical visits, which would improve and extend their life, and could lower insurance costs for everyone else.
Jean Bonhomme, M.D., is the founder and president of the National Black Men’s Health Network and member of the board of directors for the Men’s Health Network. Armin Brott is the editor-in-chief of TalkingAboutMensHealth.com and the author of 10 books on fatherhood. Ana Fadich is the vice president of the Men’s Health Network and chair of the American Public Health Association’s Men’s Health Caucus.