Obtaining health insurance coverage in California is hard enough. If you are a woman without employer-provided health insurance, or do not qualify for a public program, your only option is the individual insurance market, a market where insurers are free to charge women more than men for comparable coverage. This practice was banned nationally in the employer-provided benefits setting more than 30 years ago.

A report released in September by the National Women's Law Center (NWLC) found that women in California under 55 years old paid up to 39 percent more than men for the same health coverage. In California, two bills in the Assembly and Senate this year, Assembly Bill 119 (Jones) and Senate Bill 54 (Leno), aim to end this discriminatory and arbitrary practice of gender rating, which is unlawful in 10 other states.

Gender rating hurts women and can put affordable coverage completely out of their grasp. The economic data supporting this is clear. Women are much less likely than men to be insured through their jobs, 38 percent vs. 49 percent, respectively, meaning they are more likely to need to turn to the individual insurance market for coverage.

Women also have less buying power than men, earning on average 77 cents for every $1 earned by men, so the increased premiums require them to spend a much larger percentage of their income on health care coverage, if they can afford it at all.

Besides harming women and their families, gender rating hurts society as a whole. Women who are forced to forgo preventive care or cannot optimally manage other health conditions like diabetes experience higher rates of adverse pregnancy outcomes like premature birth and low birth weight. The costs of caring for these children are often paid for by the taxpayer.

The city and county of San Francisco is challenging gender rating because it places a greater burden on county governments when women are forced into getting their health care from San Francisco General Hospital and city clinics.

Insurers attempt to defend gender rating by stating that it is actuarially justified, reflecting actual differences in the costs of providing health care to women vs. men. They don't apply this logic to any other class, such as race. Regardless, the study by the NWLC showed this argument to be spurious. If indeed the reason for gender rating is based on the costs of care, then the differences in premiums charged should be comparable within a given market. They found, instead, wide variation in gender-based premiums across the country, with women paying anywhere from 4 percent to 48 percent higher premiums than men. Even within the same state there was wide variation in gender-based premiums. Women in Missouri could pay 15 percent to 140 percent more than men depending on the insurer.

Furthermore, in South Carolina and California only some insurers choose to gender-rate even though all are allowed by state law. This wide range of differences in premiums charged to women clearly demonstrates the discriminatory and arbitrary basis for the practice.

The American College of Obstetricians and Gynecologists, District 9 (California), representing almost 5,000 OB/GYNs in the state, is committed to working to achieve health care coverage for all women in California. We are co-sponsors of AB 119 and SB 54 because we believe that a fairer private individual insurance market is a necessary component to achieve universal health care due to the number of our patients who rely on it as their only option to obtain health coverage.

Please call or e-mail Gov. Arnold Schwarzenegger and urge him to sign AB 119 and SB 54 when they reach his desk later this summer.

Philip J. Diamond, MD, is vice chair of the American College of Obstetricians and Gynecologists, District IX (California). He practices in Sacramento.