Women’s Health Care Is Changing
It used to be that simply by being female, you paid more for health insurance coverage. That is, if you had coverage at all — one in five women under 65 don’t. The Affordable Care Act (ACA), aka Obamacare, aims to right those wrongs by banning gender pricing and providing cheaper-than-ever health insurance plans that will make coverage accessible to millions.
“The big picture here is that 20 percent of working-age women do not have insurance right now, and we expect that the majority of them will qualify for some sort of assistance to get coverage,” says Usha Ranji, associate director for women’s health policy at the Kaiser Family Foundation. “And that is a big change.”
Some people chafe at the idea of being required to buy health insurance coverage. Others don’t agree with the cost the federal government is taking on to help provide care to those who otherwise can’t afford it. There are currently 48 million uninsured people in America, and cost is a huge factor affecting why people aren’t covered.
But no matter where you stand on the political issues of Obamacare, the fact is that the law has many provisions that will make it easier for women to stay healthy. From breastfeeding to birth control to out-of-pocket costs, here are the ways Obamacare is impacting the lives of women.
There’s Increased Access to Insurance
As of Oct. 1, if you are uninsured, you will be able to shop for coverage in the new Health Insurance Marketplace. According to the U.S. Department of Health and Human Services, most uninsured people will be able to find coverage for less than $100 a month thanks to tax credits and subsidies.
The ACA caps how much people who earn up to four times the poverty level (about $46,000 for a single person or $94,000 for a family of four) will have to pay for insurance. Depending on your income you could pay between 2 to 9.5 percent of your earnings for coverage, and the extra cost will be covered by federal tax credits. If you earn more than four times the poverty level, you can still purchase through the exchange, but will not be eligible for the tax credits that help reduce cost.
For example, if you’re a couple in your forties with two kids and a household income of $80,000, your annual health insurance premium would be just under $12,000, on average, according to the Kaiser Family Foundation’s Subsidy Calculator. But because you earn less than 400 percent of the poverty level, you will pay no more than 9.5 percent of your earnings for health insurance — or $7,600 annually. The difference is covered by a federal tax credit. (This example is for a silver plan, one of the four plans offered. You could opt for a lower-cost bronze plan that has higher deductibles but lower premiums.)
Those who earn less than 138 percent of poverty ($15,856 for a single person or $32,499 for a family of four) can enroll in Medicaid, the federal program that provides health care for the low-income and disabled. As part of the ACA, Medicaid was expanded to include everyone earning below that income level. In the past, the program was reserved for pregnant women, the disabled and elderly.
However, as part of the Supreme Court’s 2012 ruling on the constitutionality of the law, states cannot be required to expand their Medicaid programs. So far only 26 states have chosen to expand. Those who now qualify for Medicaid under the new rules but live in a state that didn’t expand the program are not required to obtain health insurance. Visit the Kaiser Family Foundation to see where your state stands.
Preventive Care Is Covered
Need a mammogram? Pap smear? By law, your insurance company must now cover it in full without charging a co-pay or applying the care to your deductible, as long as your doctor is in network. Preventive care screenings are also covered, including blood pressure, cholesterol, depression, diabetes, HIV and BRCA genetic testing (for women at high risk of breast cancer). Annual well-woman visits are also paid for. Covered services specific to pregnant women include screening for anemia, bacteriuria (urinary tract infection), Rh incompatibility and gestational diabetes, as well as folic acid supplements.
Most, but not all, employer-sponsored plans have to abide by this law. Grandfathered plans, which were in place before the law was passed in 2010 and have not changed their pricing or coverage since then, do not have to comply with this or any other ACA-mandated changes. However, once a plan undergoes any significant changes, it has to fall in line with ACA rules. According to the Kaiser Family Foundation, 36 percent of workers are still covered by grandfathered plans. But that percentage is falling quickly: In 2012, the number was 48 percent. The National Women’s Law Center expects that by 2014, 90 percent of all large U.S. companies will lose their grandfather status.
Contraceptives Are Paid For
Are you on the pill? As of Jan. 1, 2013, all non-grandfathered private insurance plans were required to cover in full the cost of your monthly prescription. In fact, all Food and Drug Administration (FDA) approved contraception methods must be covered, including IUDs and Depo-Provera, and permanent contraception such as tubal ligation must be covered as well.
If you work for a house of worship that has objections to contraceptive coverage, you might not get this benefit, says Ranji. But the exemption only applies to churches themselves, not religiously affiliated institutions such as hospitals.
Breastfeeding Support Is Available
Breastfeeding supplies, support and counseling must now be covered by your insurance company at no charge to you. And at work, employers must provide employees a private space that is not the bathroom in which they may pump. “Insurance must cover the cost of renting a breast pump and the cost of a lactation consultant,” says Ranji. “This issue is not getting as much attention, but it is a huge public health goal.” (That can net potentially big savings: electric breast pumps can range from $100 to more than $350--and lactation consultants can charge anywhere from $20-$100 an hour.)
The Female Surcharge Disappears
Insurance companies will no longer be able to charge women higher premiums just because they’re women. Insurance plans made available through the marketplace will only be able to use four factors in determining cost: geography, family size, age and smoking status.
“Prior to the ACA, individual plans or small group plans would do gender rating, where they would charge a higher rate for women than men for the same insurance plan,” says Lauren Birchfield Kennedy, senior health policy counsel at the National Partnership for Women and Families. “If you were a small business that employed a majority of women, you paid a higher rate. But now you can no longer rate a plan based on gender.”
Pre-existing Conditions No Longer Preclude Coverage
Insurance companies used to be able to deny coverage based on your medical history. So if you had a history of cancer, a C-section or a chronic condition such as diabetes, insurers used to be able to refuse to sell you a plan. But such discriminatory tactics are now illegal. A plan also cannot drop your coverage when you get sick nor can it impose an annual limit on how much care it will cover.
Maternity Care Must be Covered
In order to be considered a “qualified medical plan” and therefore satisfy the individual mandate that all Americans have coverage, a health care plan must cover maternity care and prenatal visits. “Prior to the ACA most individual plans did not offer maternity coverage,” says Kennedy. “This is really a game changer. If you buy a plan in the state marketplace you're also guaranteed comprehensive care.”
Abortion Might be Covered
Employer-sponsored plans can choose whether or not to cover abortions, and many private insurance plans do cover abortion care. Some states, however, have enacted laws restricting coverage. As of early September, 23 states had enacted laws prohibiting insurance coverage of abortion in state exchanges; eight of them also banned abortion coverage in all private health plans.
In addition, because the exchange plan is accepting federal dollars in the form of subsidies and tax credits, it is subject to the Hyde amendment, which bans the use of federal money for abortion services with exceptions allowed in cases of rape, incest and danger to the mother's life. The Medicaid program, however, allows the states the option of using their own funds to pay for abortions, thus leaving state legislatures to deal with the pro-life vs. pro-choice debate.
“If the plan decides to include abortion in its package they have to come up with an accounting methodology that ensures no federal funds go toward covering abortions,” says Ranji. The insured won’t have to opt in for abortion coverage, but a portion of their payment might be segregated in order to ensure that portion of the coverage is only paid for with private funds.