This month marks the third anniversary of the enactment of the Patient Protection and Affordable Care Act, the landmark health care reform legislation that was a victory in many ways for women’s health. Thanks to the Affordable Care Act, women’s access to high-quality, affordable health care will increase dramatically, as key reforms are implemented and the country moves toward near-universal health coverage.
Due largely to the high cost of health care coverage—especially for women without access to employer-based coverage—19 million American women between the ages of 18 and 64 were uninsured in 2011. Uninsured women receive lower-quality care, and they generally have poorer health outcomes than insured women. Beginning October 1, 2013, however, millions of Americans will be able to shop for health insurance and compare plans through marketplaces known as exchanges, where some consumers may also be eligible for subsidies to help them afford coverage. The reform has also expanded access for low-income women by expanding Medicaid, and many states have already agreed to expand coverage under the program.
Below are the top three achievements to celebrate, the top three things to look forward to, and the top three items that we need to put on our agenda in order to advance women’s health through the Affordable Care Act.
Most of the law’s benefits will begin to take effect in 2014, but the law is already having an impact in a number of ways. Here are the top three benefits that have taken effect so far.
Since August 1, 2012, the Affordable Care Act has required all new, nongrandfathered health care plans to provide women with no-cost coverage for all methods of contraception and sterilization approved by the Food and Drug Administration, as well as host of other preventive services, including annual well-woman visits; lactation consultation and supplies; screening and counseling for interpersonal and domestic violence; screening for gestational diabetes; DNA testing for the human papillomavirus, or HPV, for women ages 30 and older; counseling for sexually transmitted infections; counseling and screening for HIV; and more.
Nearly 27 million women have already accessed at least one of these no-cost preventive services as of March 2013, and millions more are expected to access these services when the law’s major coverage expansions are implemented in 2014.
Women make the majority of health care decisions for themselves and their families. They can now rest a little easier knowing that there are fewer barriers to getting the coverage and care that their children need.
The Affordable Care Act has already made it illegal to deny children coverage because of a pre-existing health condition. In other words, plans may not exclude children who are under the age of 19 based on a health problem or disability that the child developed before a parent applied for coverage.
In addition, the law has already allowed young adults to stay on their parent’s health insurance policy until they are 26 years old, which has benefited young women who would otherwise be uninsured. More than 3 million young people have gained coverage though this provision, and the rate of insurance coverage for young women ages 21 to 25 increased from 71.2 percent to 77.5 percent since the law went into effect.
Finally, the law requires plans to cover preventive services for children such as vaccinations and well-baby and well-child visits without a co-pay.
Prior to the passage of the Affordable Care Act, 39.5 million women and 28 million children were enrolled in health insurance plans that had lifetime limits on their coverage. Women were hit especially hard by these limits, as they are more likely than men to suffer from chronic conditions. This meant that a woman who was diagnosed with a chronic condition or serious illness such as breast cancer, or a woman who had a child with a serious condition, would find that her insurer would cover only a fixed amount of medical costs and refuse to cover any additional expenses. These families would essentially lose coverage for their medical care precisely when they needed it most.
The Affordable Care Act has already prevented insurance companies from imposing lifetime limits on coverage, and it has begun phasing out annual limits on coverage, which have had a similarly detrimental effect. Beginning in 2014 annual limits will be eliminated entirely.
Here are the top three reforms for women that are in the pipeline for 2014.
Prior to the Affordable Care Act, women were denied coverage for certain gender-specific conditions such as breast cancer or having had a Caesarean section. Even sexual assault and domestic violence were sometimes categorized as pre-existing conditions. But as of 2014 it will no longer be legal to deny women coverage because of a pre-existing condition.
In 2014 the Affordable Care Act will also end gender rating, a common practice in the individual insurance market where insurers frequently charged women as much as 150 percent more for their premiums solely because of their gender. One study found that women were charged $1 billion more per year in premiums for the same coverage as men. The new provision, however, will ensure that women have coverage for the care that they need without receiving this discriminatory treatment.
Having a baby is an expensive endeavor. One study found that the average cost of a healthy birth in the United States is more than $8,000 for prenatal care and delivery alone—and costs only increase for complicated deliveries. Prior to the Affordable Care Act, 88 percent of individual-market insurance plans did not cover maternity care, which has created a significant barrier to obtaining needed care during pregnancy.
Beginning in 2014, however, all nongrandfathered health plans in the individual market will have to offer an essential-health-benefits package that includes coverage for maternal health services. Having this coverage will make a tremendous difference in women’s ability to access the care they need during pregnancy, protecting their own health and the health of their children.
While many accomplishments have been made in the area of women’s health since the Affordable Care Act was enacted, there is still plenty of work to be done to ensure that women have the coverage and care that they need. The following are three items that must be on our health care reform agenda in order to continue the progress that we have made for women’s health.
Low-income Americans, and women in particular, face significant health disparities relative to more affluent Americans in large part because of inequitable access to insurance coverage and health care.
To ensure that low-income Americans can gain access to the health insurance coverage that they need, the Affordable Care Act expanded Medicaid eligibility to all people with incomes up to 138 percent of the poverty line—$14,856 a year for individuals—regardless of whether they are pregnant or parenting. Of the 17 million uninsured Americans who could become newly eligible for coverage under the Medicaid expansion, at least 7 million are women. But at least 4 million of those women live in states that have rejected the expansion or have not yet decided whether to expand coverage.
Without access to Medicaid coverage, low-income women in these states will have nowhere to turn to for health insurance and will continue to be at greater risk for poor health outcomes. We must continue pushing for all states to expand their Medicaid programs to ensure that these women’s health needs are not ignored.
The Affordable Care Act includes language that allows states to pass legislation prohibiting private insurance plans in their exchanges from offering abortion coverage. In at least 21 states already, women will be prohibited from buying a private insurance plan that covers abortion in their health insurance exchange, and some of these states have gone so far as to ban abortion coverage in all private insurance plans in their state, including those remaining outside of the exchanges.
Creating this additional barrier to abortion coverage will hinder access to abortion for all women, but it will especially work
to further increase disparities for lower-income women. We must keep fighting for abortion coverage to be included in the exchanges.
There have been almost constant efforts by lawmakers on Capitol Hill to repeal some or all of the health care law. Some Republican lawmakers have also worked to replace guaranteed federal funding for Medicaid with block grants to the states, which would dramatically reduce federal spending on Medicaid and force states to cut back on coverage and benefits.
Both of these proposals would harm women around the country by turning back the clock on the gains made to improve access to quality health care. We cannot allow these erosions to occur.
After just three short years, women have already benefited significantly from the Affordable Care Act, and there is a great deal more to which we can look forward. But there is still a lot to be done to ensure that women have access to affordable and high-quality health care as we continue with the implementation of this historic law.
Lindsay Rosenthal is a Research Assistant with the Health Policy program and the Women’s Health and Rights program at the Center for American Progress.
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