March 23, 2020
Women’s history month takes on special significance this month ― March 2020 is the 10th anniversary of the enactment of the Affordable Care Act (ACA), popularly known as Obamacare. Women have much to celebrate because of all the ways that the ACA has improved women’s access to health care. A recent article in Health Affairs that reviews academic articles, reports, and policy documents published from 2005 to 2015 makes clear how important the ACA has been for women.
Before the ACA, women (and men) often found access to health insurance blocked. Insurance companies denied coverage to about 14 percent of people who applied to get it. In 2012, the uninsured rate was 22 percent for men and 19 percent for women. The lack of health insurance was higher for women of color and low-income women whose uninsured rates were 22 percent, 36 percent, and 40 percent, respectively. Insurance companies could use preexisting conditions as a reason to reject a person’s insurance application. Women faced uniquely female types of such conditions. Depending on where a woman lived, a history of pregnancy, a history of infertility treatment, or a sexual assault could be considered a preexisting condition by insurers in her state.
Even women who were not denied health insurance faced disadvantages. Pregnancy might be excluded from their insurance coverage, and women routinely were required to pay higher premiums than men of the same age for the same health insurance coverage. The Health Affairs article reports that “gender rating,” which allowed insurance companies to set separate rates for men and women, meant women paid an estimated $1 billion more per year than men for insurance coverage.
The ACA helped eliminate health insurance practices that discriminated against women and unfair practices that blocked many others from accessing benefits. Under the ACA, insurance companies were prohibited from charging women more than men for the same coverage and were barred from using preexisting conditions to deny health insurance or exclude pregnancy and maternity benefits from insurance coverage.
And insurers were required to provide essential health services, including maternity care, mental health care, and prescription drugs that are especially important to women. Insurance companies were also required to provide preventive services such as mammograms, screening for conditions such as cervical cancer, osteoporosis, depression, and well-woman visits to doctors’ offices.
Medicaid was also required to provide these benefits, improving access to these benefits for women in this government health care program — including women in so-called Medicaid expansion states that came on board with financial assistance from the ACA. The list of required health services was expanded in 2014 to include blood pressure and cholesterol screening and flu vaccines.
The Health Affairs report found that by 2017 the uninsured rate for working-age women 16 to 64 had fallen to 11 percent. Lower-income women experienced larger drops in their uninsured rates than higher-income women, and women in Medicaid expansion states had lower uninsured rates than their counterparts in non-expansion states. Women’s use of preventive services increased, with low-income women experiencing the greatest gains. Enhanced access to screening led to earlier diagnosis and improved treatment of cervical cancer, and improved mental health care and outcomes.
Despite these impressive gains for women as a result of the Affordable Care Act, challenges remain. In 2017, there were still more than 10 million working-age women who lacked health insurance, with low-income, immigrant, or women of color most likely to be affected. Even women who have insurance may have large deductibles that discourage them from seeking care when they need it and burden them with unaffordable medical debt when they do get care. The result has been significant, but uneven improvements in women’s health, but sharp disparities in health outcomes for low-income and women of color, remain.
The novel coronavirus has revealed the weaknesses in the ACA that jeopardize the health of all Americans. It is now clearer than ever that the US needs to move beyond the ACA to provide universal, affordable coverage to ensure no one lacks health care when they need it.