While shopping for health insurance last year, 26-year-old Hillary McCormack was rejected because she had, for two months in 2007, taken a fertility drug. The Salt Lake City lawyer's older husband, though, was approved.
Insurers told Leane Jensen she had three strikes against her. The 33-year-old freelance photographer had been uninsured for some time, had once suffered a minor back injury and was of child-bearing age.
They didn't know it, but both women fell prey to "gender rating." It's a strategy insurers use to charge women higher premiums, or deny them coverage for pre-existing conditions such as pregnancy, a previous Caesarean section delivery and domestic violence.
Gender is among many factors, including age and address, that insurers use to predict a consumer's "healthiness" and medical costs. Industry groups call it smart business. National women's health advocates call it gender discrimination.
In Utah, the practice has drawn scant attention. A ban on gender rating by companies selling policies to individual consumers was struck last month from House Speaker Dave Clark's reform bill with hardly a whimper of protest.
If signed by the governor, HB294 will still ban the practice for policies sold to small groups, which advocates say protects companies that tend to employ a lot of women, such as day care centers, dentist offices and nonprofit groups.
It's a good first step, said Korey Capozza, senior health policy analyst with Voices for Utah Children. But the policy question of "who pays for the cost of procreating" warrants more thorough debate, she added. "Women don't get pregnant on their own."
Gender rating is most acutely felt by women who don't have employer-sponsored coverage: the unemployed or independently employed, such as freelance writers and designers, real estate agents and consultants.
The practice is illegal in 11 states and tightly regulated in two others.
But not in Utah, where a 25-year-old woman will pay up to 17 percent more than a man for the same coverage, according to price quotes obtained by The Salt Lake Tribune from three of Utah's largest insurers on ehealthinsurance.com.
A more thorough 2008 survey by the National Women's Law Center found Utah women in their 20s, 30s and 40s can expect to pay even more -- up to 37 percent more.
A monthly difference of $23 might not seem like much, but it adds up, said Capozza. Overall, women are poorer than men and tend to earn less on the dollar, she said. "It's like a double-whammy."
Jensen and her 42-year-old husband, also a photographer, live in fear of losing their coverage, which they were finally able to secure with a doctor's note saying Jensen's herniated disk had healed and likely wouldn't recur.
They spend more in premiums than they do on their mortgage and have decided, for financial reasons, to put off having kids. And had Jensen not finagled coverage, her recent heart surgery would have bankrupted them.
"You feel so completely helpless," Jensen said.
Companies say women should pay higher premiums because they cost more to insure. In addition to maternity costs, women are more likely to visit their doctors, actuarial data show. They're also more likely to use prescription drugs, though much of that is for birth control.
"If someone's a less safe driver, they generally pay more for insurance than someone who is a safer driver," said Mike Tatko, spokesman for Regence BlueCross BlueShield.
The tables turn around age 55, when men require more medical care. But that shift isn't mirrored in Utah's health plans -- at least not those offered by Regence BlueCross BlueShield and Altius, the Tribune found.
Intermountain Healthcare's SelectHealth shows no gender gap in pricing. The company weighs other factors, including family size and age, said spokesman Jason Burgess.
Brigette Courtot, a health policy analyst at the National Women's Law Center in Washington, D.C., asks, if one insurer can abandon gender rating, why can't others? Under criticism a few years ago, insurers stopped using statistics to justify "race rating," she said.
McCormack began shopping for a policy last year when the deductible on her husband's plan at work rose to $8,000, after a string of surgical and cancer treatment claims.
She applied to Regence BlueCross BlueShield and Altius, dutifully noting any health problems (there were none) and any medications used.
Within weeks, she received word that she was being rejected because she had taken Clomid. Ironically, the drug had been prescribed to remedy her husband's infertility problems, not hers.
"They were willing to cover an older infertile male, but declined to cover a younger, healthy female because a year ago I took 10 pills," she said. "They figured we wanted to have kids and would likely pursue treatments -- that we'd nevertheless have to pay for out of pocket -- that could raise the risk of eventually developing conditions, ahem, pregnancy."
Industry lobbyist Kelly Atkinson said insurers would drop gender rating if lawmakers mandate that everyone purchase insurance. Otherwise, premiums for young, healthy males would go up, potentially forcing some to forgo insurance and adding to Utah's ranks of uninsured.
"But in Utah," he said, "there's just not the political will."