Dear Future President — A National Survey of What Women Want for Healthcare in America

“I am woman, hear me roar
In numbers too big to ignore”
-Helen Reddy, I Am Woman

We are a little more than two weeks away from the 2020 election and we are, as usual, deep in the throes of men telling women what’s good for them.  If you listen between the lines of the Amy Coney Barrett hearings, you hear a bunch of men speaking through her to get their policies represented.  Yes, they found a woman who agrees with them, but make no mistake:  men make policy at the federal level in America. Women do not hold a majority of seats in the Senate, the House or on the Supreme Court.  There has never been a woman President. Thank goodness for the barely-hanging-on rule of law, or women would all be wearing those Handmaids Tale outfits, or so it sometimes seems.

And yet, women make up just over half of the U.S. population, control 85% of purchasing decisions—including 80% of healthcare decisions—and represent $7 trillion in annual purchasing power. In every presidential election since 1984, women have turned out to vote at a higher rate than men.  So why aren’t they holding the pen when it comes to health and healthcare policy that affects them?

Because it would be not just nice, but appropriate to ask women what they want to see from the next Administration when it comes to health policy, the powerhouse women behind Tia, Inc. teamed up with a few of us x-chromosome bearers at Manatt to issue a national poll asking younger women, specifically those age 22-45, what is important to them when it comes to health, healthcare, and health policy. We also asked them what they want the next President, regardless of who it is, to focus upon when making this policy.  Together we have authored THIS REPORT on the findings, entitled “Dear Future President – A National Survey on What Women Want for Healthcare in America.”

It is our hope that this information will work its way into the public discourse and, ultimately, into policy-making that reflects how women actually feel, not the way men assume women feel.

“I want to talk to the ladies tonight
About a situation I'm pretty sure why y'all be able to relate to"
-Mary J. Blige, PMS

Given how much impact the election may ultimately have on women, who have already been adversely affected by the pandemic in a manner disproportional to men, it is no surprise that women are thinking hard about health and healthcare.  Tia Health, Inc. and Manatt Health, LLC commissioned a survey of 900 women in the United States, ages 22 to 45, representing all income levels, races, ethnicities, geographic regions, and political beliefs to better understand their healthcare priorities. The online survey, which was co-designed and administered by Merrill Research, a leading market research firm, was conducted September 16-22, 2020. In this survey, respondents were asked how they would advise the next U.S President, regardless of who it is, on their healthcare priorities for the upcoming term. The top-level findings from the survey include:

1. Across all demographic groups, women agree more than they disagree about health and healthcare priorities;
2. Women view “women’s health” as more than just reproductive health—it encompasses physical, mental, and emotional wellbeing; and,
3. Women want healthcare solutions to address social and economic factors beyond what happens at the doctor’s office, including factors such as lack of affordable childcare, unreliable access to nutritious food, and wage inequality.

So those are some interesting findings. While women come in all shapes, sizes and political parties, and while there are some differences in how they feel, they are largely aligned on key healthcare issues that intersect with policy issues. Polarizing politics be damned, women have a pretty consistent view on what is important to them ono the health and healthcare front.

Chief among those views is that healthcare is NOT bikini medicine, as it is so often represented by men (and even sometimes by women). Women care about reproductive medicine and breast cancer of course, but their view on what constitutes good personal health doesn’t start there – far from it.  In fact, when women in the study were asked, “when it comes to your own health, what are your biggest personal health issues?” none of these issues topped the list, even among women of child-bearing age, on whom this survey focused.

When asked to identify their biggest personal health concerns from a list of 30 separate items—ranging from heart disease to infertility—1 in 3 women selected mental health or stress management as their top concern. Black mothers were off the charts on this topic, though it  is a pretty profound one for the entire survey population.  In fact, nearly one-fifth of women in the study cited mental health and substance use disorder care as the single most important health issue that needs to be addressed by the incoming President. After mental health, women’s primary personal health concerns related to COVID-19, the cost of healthcare, and being overweight.  Note to policymakers: women are more than their sex organs.

"Every time I say something they find hard to hear,
They chalk it up to my anger
And never to their own fear, 
Imagine you're a girl"
-Ani DiFranco, Not a Pretty Girl

But here’s the set of statistics that really made me blink hard, not that it should have.  Here’s what women say when you ask them, “What is the single most contributing item to improving the health and well-being of women with children, not just during the pandemic, but generally?”

 

Can we take a good look at this list for a moment? Do you see anything in the top 3 that look like what we talk about in the healthcare system as part of a core medical issue?  Yeah, me neither.  It looks a lot more like Maslow’s Hierarchy of Needs than my health benefits coverage booklet. We all know, at least intuitively, that the complex of stuff that we now call Social Determinants of Health, are massively important when it comes to the ability to actually be healthy, but we have done so little to act on that within the healthcare system itself.  There have been some steps forward, but there aren’t too many health insurance plans that cover these issues, outside of a few Medicaid programs and Medicare Advantage plans, and commercial insurance has largely ignored these issues altogether.  Wages and childcare? Healthcare says, “Sorry, not my table.”  Mothers say, “Well, it’s my table so sit down and listen.”

Notably, even women with no children ranked affordable childcare and payment for family caregiving among the top three contributors to women’s health, as did women across all income levels.  There are notable differences among some of the survey’s subgroups; for instance, Black, Hispanic, and Asian women more frequently cite income-related factors, such as a higher minimum wage, having employment, or equal pay to men, as bigger factors to their health than do white women. For instance, approximately 30% of Black women named “higher minimum wage” as the most essential need to health and well-being, compared to just 18% of white women. Once again, health policy makers rarely talk about any of these items in the context of health policy.

With respect to the pay issue, I think it is very interesting that whenwe talk about this on the policy front, it is always in the context of what’s “fair.” Equal pay for equal work, the saying goes. But for women, this is  about much more than what’s fair; it’s about what’s necessary to enable health for themselves and their families.  We need to change the narrative.

Also worth noting that when you poll women about the Affordable Care Act (ACA),the results are all over the map when it comes to support.  But when you ask them about specific key pillars of the ACA, there is pound the table level support in the aggregate.  It’s kind of like how people say they hate “Congress,” but when you ask how they feel about their Congressperson, they are emphatic supporters (aka Fenno’s Paradox).  Note to all, buzzwords are a buzzkill.

Check out this chart:

Do you know what it feels like for a girl?
Do you know what it feels like in this world for a girl?
-Madonna, What it Feels Like For A Girl

As a fun and entirely unscientific thought experiment, it occurred to me to ask a bunch of men, all of whom are in my mostly liberal, Democratic, white, healthcare-savvy, college educated, older than 44 (on average) crew, to answer two of the questions that women were asked, “When it comes to women’s health, what should be women’s Top 3 biggest personal health concerns (from a list of 30 items)?  e.g., what are the top 3 health issues that women, specifically, should be most worried about?”  I also asked them this follow-up question, similar to the women’s survey, “Of all of the health concerns listed above, what is the one, single most important issue that you believe the next President should work to address to satisfy women in the next four years, regardless of who is elected?” Why this group? Well, they look an awful like who makes most of the policy out there for women, with the exception that they are mostly Democrats, who aren’t exactly setting the tone at this moment.

Again, entirely unscientific, but I figured that these guys would be a bit savvy and “in tune” with what women would prioritize, so at least they had half a chance at getting women’s thoughts right, aside from the usual Mars/Venus thing.    Despite sending the survey to 50 men I know reasonably well, I only got 20 responses back, so at least I know that men are listening to what a woman asks them to do at their typically low rate.

And here’s what the men said were the top 3 issues that affect women’s personal health, in order:  heart disease, mental health and accessibility of healthcare.  So, the good news: there is widespread recognition among Friends of Lisa that mental health is a burning issue.  Maybe it’s because they hang around me, but I think they know it’s a more widespread problem than that, so that’s a relief.  But on the other two fronts, they did not match the women’s responses (women said COVID-19 and the cost of healthcare, not access to it were the next most worrisome personal health issues).  It is true that heart disease is the top killer of women, so there is good science too suggest it’s a good answer (remember science? I miss science!).  But it’s not what women are focused on when you push them to pick their top 3.

When responding to what they believed the next President needed to work on, health policy-wise, to satisfy women, men’s answers were quite similar to women’s, but in a different order. Women’s top three responses to the question were (1) equal coverage of and easier access to mental health and substance use disorder care, (2) more COVID-19 policies and actions and (3) lowering the cost of healthcare.  Men ranked COVID-19 policy 1^st , access to healthcare 2^nd, and had a tie for 3^rd  between the cost of healthcare and mental health.  It’s great that they are close, but it’s interesting that they show up in such a different order.  Given how hard women are wishing to pound the table about healthcare improvements, it’s important to see this difference in prioritization.

I deeply regret I did not ask the men to answer the question about the single greatest contributor to women’s health.  I suspect, though I don’t know for sure, that the issues would be quite different than those the women cited.  I have a hard time believing that men, even my enlightened pals, would have put access to healthy food and equal wages on the leader board of health issues. They might have gotten the caregiving one right, given that so many men, including some I know well, are getting their first real taste of what it’s like to have to deal with that issue all damn day.  It’s pretty poignant right now how big of an issue this is for everyone, yet I have heard little from Washington, DC about it (see essential reads HERE and HERE about the impact of COVID-19 on caregivers). FYI, if you are seeking great information about caregiving and caregiving resources, go to the Archangels  website, found HERE.

Maybe people who are in their mid-late 70s don’t think about this so much (although they should be, because someone is going to have to help them with a whole bunch of activities of daily living pretty darn soon) – note that the average age in the current Senate is 63 years old.  The average age.  To either of the prospective inhabitants of the 2021 White House, that looks like a bunch of young whippersnappers. Note that the average American is 20 years younger than their Congressional representative.  The average age of women in the U.S. is 38.   No wonder there is a disconnect between what women want on the health policy front and what is happening.  Who thinks that people their parents’ or grandparent’s age really “get” them at a fundamental level?

I'm about to give you all of my money
And all I'm askin' in return, honey
Is to give me my propers
-Aretha Franklin, Respect

In the end, what matters is that “We the People” means all the damn people who pay taxes, and about 51% of those are women, FYI (‘round here, that is called “a majority”).  Policy makers need to listen to their majority constituency closely and respond appropriately.  We hope that the report we have produced is a step in the right direction.

There are so many juicy findings in the report that I’m tempted to repeat them all here, but I won’t.  Rather I will suggest you go read it for yourself which you can do RIGHT HERE.  Take a little trip down the information superhighway to he Tia website and you can read the full report, entitled: Dear Future President — What Women Want for Healthcare in America, and see the data for yourself.  If you’re a person who has the power to influence US healthcare policy, thank you for stopping by!

"If I'm shinin', everybody gonna shine"-Lizzo, Juice


Special thanks to Tia, Inc. for making this project possible.