Cost of Health Insurance Isn't All About Fairness

Should women have to pay more for health insurance than men? That has been a critical question for opponents of Republican health-care reform, and it requires grappling with the fundamental nature of insurance, market prices and fairness. Related are questions about how much older people should pay relative to the young, or to what extent individuals with pre-existing conditions should be vulnerable to higher premiums.

The Affordable Care Act limited the ability of health insurers to charge women more than men, and more generally imposed greater uniformity of policy prices. Under Republican plans, those provisions are repealed. The return of many decisions to the states would most likely mean more differential pricing, namely higher policy prices for people with higher expected health-care expenses. After all, women’s lifetime costs are expected to be much higher than for men, by about $100,000 by one estimate.