The Affordable Care Act: What’s in it for women?

There is lots of good news for women in the new health reform law.  On this 1-year anniversary of its inception, here is a brief reminder of some of the benefits of particular concern to women.
The Good News

  1. Preventive care: Paying for life-saving preventive care services has often been challenging for women.  Now new insurance plans are required to provide many screening services at no cost to all members.    This means that tests that are recommended by the United States Preventive Services Task Force are now free, including screenings for cervical cancer (Pap smears), colon cancer (colonoscopies), and tests for sexually transmitted infections.  Mammograms are also covered for all women age 40 and up.  This benefit started in September 2010, and by 2018 nearly all insurance plans will cover these preventive services for free.
  2. Expanded access to Medicaid: By 2014, everyone with an income up to 133% of the federal poverty level will be eligible for Medicaid regardless of family status.  Women systematically earn less money than their male counterparts for equal work, putting them at higher risk for living below the poverty line.  Medicaid provides vital coverage for basic health care for young women, including testing for sexually transmitted infections, prenatal care, and contraception.
  3. No more gender rating: Discrimination against women on insurance premiums is being phased out.  Because insurance premiums are based on anticipated costs of providing care to individuals, women have generally had to pay higher premiums because they tend to use medical services more often than men.  This has led to insurance rates up to 50% higher for women than for men in some states.  This practice is no longer legal in new insurance plans.
  4. OB/GYN care without a referral: Women no longer need to take extra time away from work to get a referral from their primary care provider to see an obstetrician/ gynecologist.
  5. Maternity care coverage: In the past, women were often surprised to find that when they got pregnant, their insurance was no longer valid.  This situation can be catastrophic, as prenatal care even for a routine pregnancy costs thousands of dollars.  All insurers must provide coverage for prenatal care.
  6. Improved access to midwifery care: Although midwifery care for low-risk obstetric patients costs less than care from an OB/GYN and offers excellent outcomes, many low-income women are shut out from such care because they can’t afford it.  Now midwives will be reimbursed at a higher rate for Medicaid patients, making it more likely they will accept Medicaid patients, and Medicaid will also pay for deliveries at birth centers.  All women, regardless of their income, should be able to choose among a variety of qualified providers and sites for their maternity care.
  7. Home visiting programs for new mothers: The ACA allocated $1.5 billion for extra nursing support to new teen mothers.  Teen mothers are more likely to have inadequate prenatal care, to have lower birth-weight babies, and are less likely to breastfeed.  They need and deserve extra support to help make sure they and their babies are healthy.  Visiting nurse programs for teen mothers have strong evidence behind them for better outcomes for both moms and babies.
  8. Support for breastfeeding mothers at work: Mothers who want to continue breastfeeding while working outside the home face an uphill battle, especially when they work in blue collar jobs.  Employers are now required to provide women with time to use a breast pump, as well as a clean, private place that is not a bathroom.

The Not-So-Good News
There is a lot to be lauded in health reform.  However, women took a lot of losses in the battle to pass the ACA.  The law brought added restrictions on funding for abortion.  While there has been a long-standing ban on the use of federal money for abortion provisions in most cases, private employers and insurers have been free to offer benefits for abortion coverage.  The ACA opens the door to make it difficult or impossible for many private insurers to offer abortion coverage as an option for their subscribers, even for those paying for the coverage entirely out of pocket.  While it remains unclear exactly how this will play out, it is likely that more women will need to pay out of pocket for this particular medical procedure.  Since approximately one in three women will have an abortion at some point in her lifetime, tens of millions of women will find themselves paying hundreds or thousands of dollars for their health care out of pocket.
In addition, undocumented immigrants are completely excluded from all forms of health insurance, even if they choose to pay entirely with their own money.  Documented immigrants will similarly be excluded from purchasing insurance for the first 5 years they reside in the United States, even if they use their own money.
What can you do?
First of all, keep reminding your elected officials that you support health reform, and that this is a needed first step on a long journey to fix a system we have allowed to become incredibly broken over the past several decades.  They need to hear from doctors who see how patients struggle day-to-day to remind them of how much good the ACA has done already, and how much good it will do in the future.
Second, advocate for “contraception as prevention.”  Contraception is the number one medical need for many young women, and it is a vital preventive health benefit.  Despite this, it has not been designated as a preventive health service that should be provided with no cost-sharing in all new insurance plans.  Read about a campaign by our partner Raising Women’s Voices called “Contraception is Prevention” here (pdf), and contact HHS Secretary Kathleen Sebelius to show your support.