Across the country, policymakers are revisiting the idea of expanding catastrophic health plans as a lower cost alternative in the insurance marketplace. These plans are marketed as affordable because they come with lower monthly premiums. But what often gets lost in the conversation is what they do not cover until thousands of dollars in out of pocket costs are met.

For Black women, that gap is not theoretical. It is personal.

Catastrophic plans are designed to protect against worst case scenarios like major accidents or life threatening emergencies. They generally require very high deductibles before most benefits kick in. Routine specialist visits, diagnostic imaging, ongoing medication management, and other essential services often fall into the deductible phase.

On paper, this looks like consumer choice. In practice, it can become underinsurance.

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 leaving a corporate job to care for her mother. She purchases insurance on the individual marketplace. Faced with rising premiums, she selects a catastrophic plan because it is the only one that feels financially manageable month to month.

Monique has hypertension and a history of fibroids. She becomes pregnant.

Under her catastrophic plan, she must meet a high deductible before many services are covered. Each prenatal visit, lab test, and ultrasound adds up. She delays scheduling a specialist consultation when her blood pressure begins to fluctuate because she is worried about the cost. She later develops gestational diabetes in the 2nd trimester. When properly managed, this condition can lead to healthy outcomes. But when care is delayed or inconsistent, it increases the risk of preeclampsia, preterm birth, cesarean delivery, 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 language. It is a continuum of care. It requires monitoring, early intervention, and postpartum follow up. When insurance models are built to respond only at the point of crisis, they fail to address the very conditions driving disparities.

This issue directly ties to BWHI’s policy pillar on Maternal and Reproductive Health Equity. We advocate for systems that center prevention, comprehensive coverage, and accountability. Health insurance design is part of that system.

The Economic Justice Dimension

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. That shift does not happen in a vacuum. It lands hardest on those with the least financial cushion.

As Candace Bond-Theriault, Esq., LL.M., Senior Director of Policy at the Black Women’s Health Imperative, explains:

“When policymakers promote catastrophically expensive plans as affordable, we have to ask affordable for whom and at what cost. For Black women who already experience higher health risks and economic strain, high deductibles can translate into delayed care, unmanaged chronic conditions, and worse outcomes. Insurance design is not neutral. It either advances equity or deepens disparities.”

Her words underscore a critical truth. Policy is not abstract. It shapes who receives care early and who receives care late. It determines whether prevention is possible or whether crisis becomes inevitable.

The Broader Policy Question

The debate over catastrophic plans reflects a larger philosophical divide. Is health coverage meant to simply prevent bankruptcy in a medical emergency, or is it meant to promote ongoing health and stability?

For BWHI, the answer is clear. Our advocacy centers on advancing health equity through comprehensive, accessible, and preventive care. Expanding insurance options that prioritize low premiums over meaningful coverage risks moving us backward.

We encourage our community to stay informed as federal and state conversations evolve. Decisions made in policy rooms today will shape the lived experiences of Black women tomorrow.