We hope to clear up the confusion by explaining the top five ways the Affordable Care Act is already helping women. This list is followed by three important issues that need attention as we move forward with implementing the law.
Top five ways health reform is helping women
Stopping the worst practices of the insurance industry
Insurance companies are prohibited from canceling the policies of people who get sick. Rescission, or the practice of dropping coverage when people develop illnesses, is now prohibited. That means women who develop heart disease or other serious illnesses are protected from losing their coverage at a time when they need health care the most. Insurers also can’t cancel a policy because someone makes an unintentional mistake on his or her paperwork. The only way a policy can be canceled now is if the insurance company can prove intentional fraud.
Insurance companies can no longer set lifetime limits or “unreasonable” annual limits on the amount of medical care they will cover under existing policies. The Affordable Care Act prevents insurance companies from setting lifetime limits on the dollar amount of health care they will cover and then ending coverage when someone hits that limit. These limits left women facing treatment for serious illnesses, such as ovarian cancer, with the added burden of major medical debt from paying the cost of treatment beyond the insurer’s limits.
Insurers must spend more of the money they collect on your medical care and less on CEO salaries, marketing, and overhead. The Affordable Care Act requires insurance companies to send consumers rebates if they don’t spend at least 80 percent to 85 percent of the premium dollars they collect for policies on providing medical care. This went into effect on January 1, 2011, and the rebates will begin in 2012. The law also requires insurance companies to make information about how they spend premiums available to the public. This will make it easier for women shopping for health insurance for their families to choose the plan with the best value.
Keeping kids and young adults covered
The Affordable Care Act allows young adults to stay on their family policies until their 26th birthday. Young adults who cannot get insurance through an employer are eligible to stay on family policies even if they are no longer students, no longer live at home, are financially independent, or are married (though their spouse cannot be covered). This provision is especially important for young women who need affordable coverage for contraception, maternity care, abortions, and screening for or treatment of sexually transmitted infections, or STIs.
Children with pre-existing conditions cannot be denied coverage. Employer-based health plans and new individual plans are no longer allowed to deny or exclude coverage for children who are under age 19 and have a pre-existing condition and/or a disability.
Focusing on prevention
All new insurance plans are required to cover preventive health care without any cost-sharing such as co-payments or deductibles. The Department of Health and Human Services, or HHS, released a list of covered preventive services including many important services for women, such as cervical cancer screenings, mammograms, and STI screenings.
Medicare now provides better access to primary and preventive care. Older women enrolled in Medicare can now get many preventive health services—such as vaccinations, colorectal cancer screenings, and mammograms—without paying charges such as co-payments or deductibles. They also can get a free annual wellness exam where their health provider will help them create a personalized prevention plan.
Keeping health care affordable
Adults with pre-existing conditions have new, more affordable coverage options through “high-risk” pools. HHS has worked with individual states to establish temporary high-risk pools, known as pre-existing condition insurance plans, or PCIPs, that provide health coverage to people who have been uninsured for at least six months, have been unable to get health coverage because of a health condition, and are U.S. citizens or are residing in the United States legally. Women face higher rates of chronic conditions and are more likely to be uninsured and underinsured than men. Access to PCIPs is thus very important for women. Unfortunately these plans do not include abortion coverage except in cases of rape, incest, or a threat to the woman’s life, even though women in PCIPs are more likely to need an abortion for health reasons.
The Medicare “donut hole” is being phased out. Women with high prescription drug expenses who are on Medicare Part D are getting discounts and rebates to decrease how much they have to pay out-of-pocket for previously unreimbursed drug expenses.
Helping small businesses do the right thing
Small employers with low-wage workers (under $50,000) are eligible for tax credits to help them buy health coverage for employees. If an employer has fewer than 25 employees it may qualify for a tax credit of up to 35 percent for small businesses and up to 25 percent for nonprofits to help with the costs of providing employee health insurance. This provision is especially important for women, many of whom work for small businesses or nonprofits.
Three areas in health reform that need attention
Despite these advances work remains to be done to make sure that health reform’s promise is realized for women, our families, and our communities. There are three important issues on which advocates and legislators need to work together as we move forward with implementation of the law at both the federal and state levels.
- Contraception should be categorized as preventive care. The government is still deciding whether contraception will be included in the list of preventive care that will be available without cost-sharing. Ensuring that every woman has access to the contraceptive method that works best for her is crucial to reducing the number of unintended pregnancies and keeping women and children healthy.
- Abortion should be included in health insurance plans without legal or administrative hurdles. Denying access to abortion coverage in health insurance affects women’s health and restricts their ability to plan and raise healthy families. Yet the Affordable Care Act imposes special rules on the purchase of plans that include abortion coverage. And many states have already moved to ban abortion coverage in private insurance policies to be sold in their insurance exchanges. These policies unfairly target women who receive federal subsidies for their health care and prevent them from having access to safe abortion care.
- Immigrants should benefit from health reform. Immigrants—specifically undocumented immigrants, including women of reproductive health age—have been excluded from health reform. They are not eligible for Medicaid or federal subsidies to help them buy insurance, and they are even prohibited from using their own money to buy health insurance through the exchanges. Community health centers, where many low-income women and undocumented immigrant women receive primary and reproductive health care, were slated to receive $11 billion in new funding through the Affordable Care Act. But that funding has come under attack.
The Affordable Care Act’s many benefits are undeniable. But so are the upcoming challenges to make sure that health reform fulfills its promise to women. We must continue to raise our voices and take action in the next months and years to ensure that the health care needs of our families and communities are met.
This column is adapted from the Raising Women’s Voice’s publication, “What Women Are Getting from Health Reform: The Top Ten List.”
Eesha Pandit is the Director of Advocacy for Raising Women’s Voices and a member of the Center for American Progress’s Women’s Health Leadership Network. For more information and action steps, visit www.raisingwomensvoices.net.