By Cindy Goff, VP, Policy, EmblemHealth
When Congress crafted the Affordable Care Act (ACA), they carefully considered how some of the unique health care needs of women could be better met under a reformed insurance system. Before the ACA, things like gender-rating and lack of maternity coverage in the individual market made health care insurance inadequate or unaffordable for some women. In addition to the many ACA provisions that reformed health insurance for all — including prohibitions on denying or applying pre-existing conditions restrictions and elimination of annual and lifetime limits on coverage — the legislation included several changes specifically designed to improve access to health care services for women.
For women, one of the most important and far-reaching benefits of the ACA was elimination of “gender rating,” which allowed insurers to charge higher premiums to women than men. The ACA recognizes that in an insurance system where all are required to have coverage, it is no longer necessary or desirable to distinguish the costs of men’s and women’s health care.
Another important benefit of the ACA is the inclusion of maternity and newborn coverage in individual coverage. Before the ACA, when the purchase of health insurance was voluntary, most individual health products did not cover maternity care. The ACA requires that maternity and newborn care be part of a set of “essential health benefits” that must be included in all ACA-compliant insurance products.
There are several other essential health benefits identified in the ACA that are meant to specifically acknowledge women’s health care needs. These include mammograms and cervical cancer screenings with no copays or deductibles, screening and counseling for domestic violence, access to network OB/GYNs without referral, and coverage of reproductive education and FDA-approved birth control methods with no cost-sharing. As part of the required coverage for maternity and newborn care, insurance now covers screening for gestational diabetes and postpartum depression, as well as breastfeeding equipment and counseling.
The benefits to women enacted by the ACA are not limited to insurance coverage. The Act creates new grants for states to build programs that help teenage mothers complete school, and to provide at-risk parents with home visits from social workers and nurses. It also requires employers to offer accommodation for women to express breast milk during the workday. And the ACA establishes Geriatric Education Centers to support the training of family caregivers (who are often women) at minimal or no charge to better understand how to assist family members with chronic care, dementia, mental health and long-term care management.
In its early stages, the ACA has already had a positive impact. According to the Department of Health and Human Services (HHS), in its first open enrollment period, more than 7.7 million women signed up for health insurance. And, 1.1 million women between the ages of 19 and 25 who would have otherwise likely been uninsured now have coverage under their parents’ plans.
Dr. Nancy Lee, Deputy Assistant Secretary of Health — Women’s Health, and Director of the Office on Women’s Health at HHS, said, “In my opinion, the Affordable Care Act has been the most important advance in women’s health in my lifetime. [It] provides a larger range of insurance options and more security for women.”
For more information on the ACA and its benefits, visit EmblemHealth’s website.