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DAYTON, Ohio – Since the early days of the Affordable Care Act, insurers and others have worried that a disproportionate number of older, sicker Americans enrolling in the health insurance marketplaces would push up premiums for everyone to cover higher-than-expected medical costs. Now that Americans are signing up for coverage, another cost threat has emerged: too many women.

Women comprised 55 percent of the 3.3 million Americans who signed up for coverage in state and federal marketplaces through Feb. 1, according to government figures.

Most female enrollees selected higher-value health plans that require insurers to cover a greater share of their medical costs after their deductibles are met. At least 66 percent of women in the marketplaces have selected “silver” plans, which require insurers to cover at least 70 percent of medical costs.

And women tend to use significantly more services and spend more health care dollars than men, said Kevin Coleman, head of research and data at HealthPocket.com, a health insurance cost-comparison website.

“In almost every age bracket, women have higher medical use, on average, than men. So, all things being equal, if you have significantly greater representation by women, then, yes, you could have higher health care costs and higher premiums in the marketplaces,” Coleman said.

An analysis of the government’s 2003 Medical Expenditure Panel Survey – which tracks health care costs among more than 50,000 U.S. adults – found that median annual health care spending among non-elderly adult women was $1,844, or more than double the figure for men, $847.

The biggest cost driver for women was maternity care, which accounted for 16 percent of overall health plan costs in the annual survey conducted by the U. S. Census Bureau.

With the cost of an uncomplicated pregnancy ranging anywhere from $6,000 to $10,000, including labor and delivery, women of child-bearing age have a built-in incentive to sign up for health insurance to reduce the amount they’ll have to pony up themselves, said Lucy Grosz, co-founder of Alta Vista Benefits in Columbus and president of the Ohio Association of Health Underwriters.

Despite the flood of women into the marketplaces, insurers haven’t started to panic – yet. That’s because it’s too early to tell what the final mix of marketplace enrollees might be, said Scott Streator, vice president of the health insurance marketplace for Dayton-based CareSource, which sells its CareSource Just4Me brand health insurance products on the marketplace.

“Health care reform is a marathon, not a sprint, and it will take data from several enrollment periods to understand the demographic mix,” Streator said.