Across the country, policymakers are revisiting the idea of expanding catastrophic health plans as a lower-cost alternative to the insurance market. These plans are marketed as affordable because they come with lower monthly premiums. But what often gets lost in the conversation is what they don’t cover until thousands of dollars are covered out of pocket.
For black women, this gap is not theoretical. It’s personal.
Catastrophic plans are designed to protect against worst-case scenarios such as major accidents or life-threatening emergencies. They generally require very high deductibles before most benefits kick in. Regular specialist visits, diagnostic imaging, ongoing medication management, and other essential services often fall into the deductible phase.
On paper, this looks like a consumer choice. In practice, underinsurance may occur.
A real life scenario
Imagine Monique, a 32-year-old black woman living in Atlanta. She is self-employed, building her own consulting business after quitting a corporate job to care for her mother. Buys insurance on the individual market. Faced with rising premiums, she chooses a catastrophic plan because it’s the only one that feels financially manageable from month to month.
Monique has hypertension and a history of fibroids. She gets pregnant.
Under her catastrophic plan, she must meet a high deductible before many services are covered. Every prenatal visit, lab test, and ultrasound add up. She delays scheduling a specialist visit when her blood pressure starts to fluctuate because she worries about the cost. She later develops gestational diabetes in the 2nd trimester. When properly treated, this condition can lead to healthy outcomes. But when care is delayed or inconsistent, it increases the risk of pre-eclampsia, premature birth, C-section and long-term health complications for both mother and baby.
What began as a cost-saving insurance decision now creates medical and financial vulnerability at the same time. This is how insurance design intersects with maternal health equity.
This scenario is not far-fetched. It reflects the structural realities many women face.
The maternal health connection
Black women are three times more likely to die from pregnancy-related causes than white women. Pregnancy is not a catastrophic event in insurance parlance. It is a continuum of care. It requires follow-up, early intervention and post-partum follow-up. When insurance models are constructed to respond only to the point of crisis, they fail to address the very conditions that cause inequalities.
This issue is directly linked to BWHI’s policy pillar of Maternal and Reproductive Health Equity. We support systems that focus on prevention, comprehensive coverage and accountability. Health insurance planning is part of this system.
The dimension of economic justice
Black women carry disproportionate student loan debt, are more likely to be primary breadwinners, and often support extended family members. High deductible plans shift financial risk from insurers to individuals. This shift does not occur in a vacuum. It lands harder on those with the least financial cushion.
As Candace Bond-Theriault, Esq., LL.M., Senior Policy Director at the Black Women’s Health Imperative, explains:
“When policymakers promote catastrophically expensive plans as affordable, we must demand affordability for whom and at what cost. For black women who already face higher health risks and financial strain, high deductibles can translate into delayed care, unmanaged chronic conditions, and worse outcomes. Insurance design is not neutral.
Her words highlight a critical truth. Politics is not abstract. It shapes who gets care early and who gets care late. It determines if prevention is possible or if the crisis becomes inevitable.
The larger policy issue
The debate over catastrophic plans reflects a larger philosophical divide. Is health coverage simply intended to prevent bankruptcy in a medical emergency, or is it intended to promote continued health and stability?
For BWHI, the answer is clear. Our advocacy focuses on advancing health equity through comprehensive, accessible, and preventive care. Expanding insurance options that prioritize low premiums over meaningful coverage risks setting us back.
We encourage our community to stay informed as federal and state conversations unfold. Decisions made in policy rooms today will shape the lived experiences of Black women tomorrow.
