How a ‘pink tax’ on women can hurt their health, especially for breast cancer patients

By Jen Christensen, CNN

(CNN) — Two new reports show that women are paying what’s become known as a kind of “pink” tax for their health care. They are spending more out of pocket than men, and when it comes to breast cancer, the extra expenses are causing such a significant burden that it may be costing them their health.

In the United States, women who have health insurance through their jobs pay about $15.4 billion more in out-of-pocket health care costs than men with similar insurance, not including premium costs, according to a new report from the financial services firm Deloitte.

While women pay about the same premiums as men, the actuarial value of their coverage is about $1.34 billion less, according to the analysis, which looked at more than 16 million people with employer-sponsored health insurance between 2017 and 2022.

While the report finds that women go to the doctor and use their benefits more than men do, with women having 10% more health expenditures, their out-of-pocket expenses are still 18% higher, even after removing the high cost of maternity care. It is 20% higher with maternity costs.

“So there’s still a disproportionate cost that women have to pay that is above and beyond the cost that’s related to differences in utilization,” said Dr. Kulleni Gebreyes, an author of the report.

Insurance companies seem to be covering a smaller portion of services for women, compared to men. Breast cancer screenings, for example, can often cost more than many other cancer screenings.

“Think about the gender wage gap that exists, and then you’ve got the increased out-of-pocket costs, and we know that financial well-being and physical health and well-being are strongly correlated,” Gebreyes noted. “We were surprised to find the ‘pink tax’ in health care.”

Gebreyes said she hopes with as many women in the workforce today, benefits managers will take a closer look at the way their company’s insurance plans are designed and make them more equitable.

A separate report, published Monday by the Susan G. Komen organization, finds the high cost of breast cancer treatment is a significant burden for patients, so much so that it may actually be hurting the success of their treatment.

Komen, a nonprofit that helps fight breast cancer, has a program that provides financial assistance to qualified breast cancer patients who are having trouble keeping the lights on due to the high cost of their treatment.

The program provided nearly $9.1 million in grants to nearly 16,000 patients from April 2022 through March of this year. To understand who it was helping, Komen took a closer look at what people used the money for: housing, transportation to treatment, and utility bills were the biggest financial stressors, as well as paying for food and medicine.

In addition to worrying about their treatment, the report noted that up to 73% of adult cancer survivors also worry about paying for medical costs.

Cait Diamond Stone, vice president of community health at Komen, said she still gets teary over a thank you note she received from one of the women the program helped. The woman said she had been fired from her job because she couldn’t work enough hours while she was going through chemo, but she wasn’t writing to complain. Instead, she wrote about how happy she was that Komen’s assistance helped her pay the rent, and she had just enough left over to buy a pizza to celebrate her twins’ birthday.

“It was the joy that something so simple brought,” Stone said. “The stories of the people we help will rip your heart out.”

Out-of-pocket costs for cancer are high, with bills averaging $2,900 just for the first month of diagnosis alone, according to a 2020 study. It’s an expense many patients can’t afford. They must dip into their savings, borrow money, or put bills on their credit cards, if they even have these options, the report said.

And while cancer is one of the most expensive conditions to treat in the US, research has shown that breast cancer has the highest treatment cost of any cancer, according to the US Centers for Disease Control and Prevention. And the expenses are getting even more burdensome.

In the US, total spending on all cancer care has increased dramatically just in the last decade, and the costs are expected to get a lot worse, research shows. Compared to the last decade, innovations with biologics and chemotherapy drugs have become increasingly expensive, all while commercial insurers have shifted more of the direct medical care costs to patients, charging higher deductibles, coinsurance, copayment rates and high premiums, research shows. Add to that the stress that patients don’t know exactly what treatment will cost until they open the bill they get in the mail.

Women in the US already tend to be more often on the financial edge than men, since women still make less. In 2022, women made only $0.82 to every dollar a men made. For Black and Latina women, it’s even worse. Black women earned only $0.63 and Latina women only $0.58 for every dollar White men made, according to the US General Accounting Office, the investigative arm of Congress.

It’s no wonder then that the Komen report found that almost half of breast cancer patients said that even a mild financial strain will impact the choices they make about their cancer care. If they have to decide between spending money on their bills or their cancer treatment, which can include bills for labs, medications, surgeries, hospital stays and outpatient treatments – not to mention spending time away from work for all this care – or feeding their family, they may opt to delay care or not get it at all. That can have devastating and even deadly consequences.

The financial burdens can be even worse for women of color, younger women, people who are not married, and those who live on a limited income, studies show.

“The financial toxicity associated with a breast cancer diagnosis has been an important issue for Komen and for many others for a long time, but with the changes in our economy post-Covid, the need for financial assistance for people with breast cancer has increased,” Stone said.

A breast cancer survivor herself, she said that with a diagnosis there are so many things people have to manage that sometimes the financial piece isn’t even a “blip on the radar until it is too late.”

“It’s hard to put one foot in front of the other sometimes,” Stone said.

The financial assistance her organization offers is one of the most important things they can do to help ease some of the stress of cancer, she said.

“I know from experience, and if you talk to any survivor they’re going to tell you the same thing, the better mental state you are in as you are going through treatment, the better it is for you and for your family,” she added. “They just need to think about the living part and the getting well part.”

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