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.

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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.

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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.

Contraceptives

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.

Other screenings

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.

Conclusion

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.

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  • If more men who value their dignity and privacy knew the gauntlet of women they would be exposed in front of during male specific intimate care, many more men would speak up against what the medical community has done.

    The system freely discriminates against male patients on a daily basis.

    Problem is men won’t speak up & put a stop to it.

    When men find their voice & speak up things will have to change for the better.

    If you don’t want to do it for yourself, think of your sons, and grandsons.

    Speak up now and stop the discrimination.

    Regards,
    John

  • They’ve now advised against continuing the PSA blood test & DRE exam to detect prostate cancer in men.

    That basically leaves men totally defenseless. Many won’t know they have it until it’s too late.

    The American healthcare system is yet again turning their backs on the male population.

    Research into a non-invasive reliable test and new surgical techniques to better protect the patient from the possible life changing sides effects must be done.

    It’s time we used the power of the vote to get the deaf ears in Washington to listen.

    Regards,
    John

  • Amazing how this article makes very valid points and shows the blatant discrimination in healthcare where only women’s health matters. Yet most commenters shrug off the facts and attempt to divert attention to this. Feminists and women’s rights groups will quickly shout about how men want to take away women’s rights to healthcare especially but neglect to mention it is the same women’s rights groups that ensure to never give men the same rights they have. This anti male platform permeates the feminist movement who ensured the ACA specifically staten men should be denied the same reproductive rights such as vasectomies and preventive care visits women get for free. We should promote the benefits to men for preventive care more, not ignore men’s health. Mens lives matter too.

    • Hi Howard:

      The healthcare system as it currently stands has been pro female for years for one simple reason.

      One day a long time ago women didn’t like that the medical community ignored their right to privacy and didn’t respect them as human beings (the same crap that’s still happening today to males), they were furious.

      So they banded together, found their voice, and in one LOUD roar told the medical community your system as it was running was unacceptable.

      Change it.

      They kept the pressure up spoke loud and clear and the medical community listened & made changes. You won’t see a male mammographer giving a woman her annual mammogram. The chances are also are nill that you’ll find a male nurse in a woman’s labor & delivery room.

      These changes all came about simply because women spoke up until they were heard & changes were made.

      Men on the other hand, have basically been silent. Many afraid to tarnish that “Macho” image that society branded on the sex ages ago.

      It’s that image that the medical community has preyed upon for years that’s allowed facilities to hire mainly female personnel.

      Facilities expect men to hand over their dignity & respect at the door and take anything thrown at them. Unless the male has had previous experience with the system, that’s what they will do to maintain the “macho” image.

      If they went in for something intimate related, they may come out a different person if they had any modesty issues.

      A man goes to a male urologist. 99% of the urologist’s supporting staff whether it be in the office or hospital, will be females. Why? Because men haven’t spoke up.

      If men want to have a say in their healthcare, they MUST start speaking up like the women did & keep yelling until the voice is heard. That’s the only way change for men will come about.

      The system is broke.

      We need people banding together to tell our elected officials we want the system changed to a healthcare system based on Choice Privacy Respect, (CPR) for all Americans.

      The needs of the many, outweigh the needs of the few or the one.

      Change can come about only when people come together & say enough is enough.

      Regards,
      John

  • Do men have to jump through the same hoops & delays to get male reproductive services as women?? Are they required to make 2-3 trips over several days just to get sterilized??? Do Federal & state legistlators require legal consent of others for men to use Viagra???
    Are men eager to seek to improve their diets, exercise levels & obesity ratings???

  • This is an interesting article but my sense is that the absence of gender specific services for men is just a tiny part of the story. More relevant is (1)women tend to be responsible for the health of their families (2)women’s normal processes tend to be medicalized (3)from a young age, girls are encouraged to think of themselves as frail.

  • It seems to me that the fact that men are generally reluctant to go to the doctor is being overlooked here. Ask any wife, or mother of an adult male, their opinion on this and I think they will concur.

    • I agree with you Barb.

      Many men have never had any real interaction with the medical community other than their family doctor.

      The first time their doctor sends them to a hospital for a test (especially if the test is male related), they are in for a shocker. They will find themselves faced with a young female most of the time doing the test. And, she may bring alone a female chaperone with her.

      Many men are not comfortable with that situation and after being humiliated and embarrassed they choose to step away from needed healthcare rather than hand over their dignity and respect at the door.

      The situation happens on a daily basis all over this country.

      The worse part about it is the healthcare industry refuses to acknowledge men have been getting the short stick for a long time.

      Brothers, fathers, grand-fathers, boyfriends, husbands, and sons will continue to die at a young age because the healthcare industry continues to trade men’s lives for the almighty dollar.

      Until enough men and their family’s stand with them and say enough is enough, this will continue to happen.

      The system needs to employ CPR for their male patients.

      Choice, Privacy, Respect.

      A patient centered healthcare system cannot truly be patient centered without Choice, Privacy, and Respect for all built into it.

      Regards,
      John

  • Thank you for writing this piece. It escapes me that the media ignores all of the points you make, but I think it is part of the general focus on women. I am a woman myself, but I have two 30 year old sons who are jazz musicians in NYC. They can no longer get catastrophic and are paying more than $450 each a month with a deductible over $7,000. Most of the musicians we know fudge their income and get Medicaid. Thanks again.

    • I agree these services would have been worth covering. However, the biggest cost with “healthy young males” is injury, contributed to by the fact they have the feeling they are invincible. That is the real reason I think you have trouble getting this group to engage.

    • This is one big issue with ASA. Young men really only need catastrophic insurance. Many people, in fact, only need catastrophic insurance.

      Right now much of medical insurance isn’t ‘insurance’ in the strict definition of the word. It’s just shifting costs from heavy users to non-users/light users.

  • The value of preventive services is overstated here, especially when comparing genders. The authors make several claims with no citations. Screening for cervical cancer and for hypertension are especially effective. Controversy surrounds screening for breast cancer, prostate cancer, colorectal cancer and treatment of high cholesterol in low risk patients for primary prevention. If prevention of PID is the goal, STI screening is of value only in women.
    Besides screening, women are known to be heavier utilizes of healthcare resources. So it’s no surprise that young healthy men opt out. I like that the ACA is a first approximation of universal healthcare but this is an obvious problem.

    • I agree about the overestimation of preventive services. Screening men for prostate cancer in particular is not necessarily doing them any favor.

      I do agree that it would be GREAT to mandate free coverage of contraception including vasectomies for everyone. This is one medical service that in the long run pays for itself — in women AND in men.

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