Obamacare: six truths that matter to women

Obamacare: six truths that matter to women

What voters need to know: ACA insures more than 14 million women, bans discrimination, adds maternity coverage, preventive services

October 31, 2012

Extreme statements of a few Senate candidates have brought the abortion issue center-stage in this electoral campaign. Abortion certainly deserves attention. (I wrote about it in The Nation here.) Yet it should not overshadow other women’s health issues, which were a major focus of health reform. These parts of the Affordable Care Act (ACA) get less attention than they should.

1. Most obviously, ACA will insure more than 14 million women, who would otherwise go uninsured. About one million of these women are young adults, age 19-26, insured on a parent’s employer-based insurance. The remaining 13 million women will be insured through ACA’s Medicaid expansion or the new health insurance exchanges.

2. ACA bans discrimination against women within the individual and small-group insurance market. Women have historically paid higher premiums – not because insurers are evil, but because women have higher expected costs. In effect, women have been treated as if possession of two X chromosomes were a pre-existing condition. Researchers at the National Women’s Law Center examined policies in states that permitted gender-rated individual and small-group policies. They found: “Even with maternity coverage excluded, nearly a third of plans examined charge 25- and 40-year-old women at least 30% more than men for the same coverage.”

The differences can be striking. For example, women nonsmokers are sometimes charged higher premiums than male smokers of the same age. ACA bans gender rating. Its combination of an individual mandate, regulatory protections, and subsidies alters the fundamental conditions of insurance markets that made such gender discrimination the likely outcome.

3. ACA will provide maternity coverage to 8.7 million women who otherwise go without these benefits. For obvious economic reasons, women’s insurance policies within the individual market often exclude maternity coverage. ACA requires insurers to offer maternity coverage as an essential health benefit. This will be a major relief for millions of women who do not work for large employers, and who now would face significant financial and logistical challenges in the event they become pregnant.

4. ACA requires coverage of preventive services, including contraceptive and other reproductive health services without copayment.  ACA covers evidence-based clinical preventive services for women without patient copayments or deductibles. These include many key services and diagnostic screening such as mammography, pap smears, screening for sexually-transmitted infections, breastfeeding supplies, and smoking cessation services for pregnant women.

From a public health perspective, generous contraceptive coverage is one of the most important aspects of health reform. It is likely to reduce both unintended pregnancies and the number of abortions. Surveys indicate that one-third of US women who use reversible contraception would switch to more reliable methods if they did not have to worry about cost. Just this month, a major study reported that provision of no-cost contraceptives, with an emphasis on long-acting methods such as IUDs, was associated with large reductions in abortion rates, repeat abortions, and teen births.

5. ACA does not cover abortions.  Federal funds under ACA do not finance abortion care, through either Medicaid or through the new insurance exchanges. Under long-standing policy known as the Hyde Amendment, federal funds may not pay for abortions except in cases of life endangerment, rape, or incest. (Seventeen states use their own Medicaid funds to pay for abortions.)  ACA effectively extended the Hyde Amendment to millions more women. Health plans cannot be required to cover abortions as part of their essential health benefits package. This aspect of health reform disappoints many liberals and feminists. It disappoints me, too. But this reflects the uneasy historic compromise whereby abortion remains legal, yet the federal government effectively chooses not to pay for it.

6. ACA expands and strengthens Medicaid – and this is a women’s issue, too. You might not think of Medicaid as a women’s issue. It is. Single mothers with children comprise a huge subgroup of Medicaid recipients. Two-thirds of Medicaid dollars finance care for the elderly and the disabled. Women comprise about two-thirds of nursing home residents in America. Care for many of these women is financed through Medicaid. Women are the dominant majority of caregivers for disabled parents, siblings, and children who rely on Medicaid, too.

ACA expands Medicaid eligibility and services – with the federal government paying virtually all of the additional costs. This financing piece is important for many reasons – not least that it preserves the long-term viability of this state-federal program. And here, as Henry Aaron and I have written at this site, the contrast between the two parties is especially stark. Governor Romney and House Republicans have pledged to cut federal contributions to Medicaid by an estimated 38 percent over the next decade. That’s a much deeper cut than anything contemplated in Medicare or other areas of the federal health budget. This may be the most worrisome women’s health issue in the 2012 election.

Federal researchers have summarized a broad array of ACA’s benefits for women’s health:

All and all, ACA is an important accomplishment for women’s health, more than most people realize.

Tags: abortion, ACA, Affordable Care Act, gender rating, mammogram, maternity coverage, Medicaid, Obamacare, preventive services, women’s health insurance

About Harold Pollack

Harold Pollack

Harold Pollack is the Helen Ross Professor at the School of Social Service Administration. He is also Co-Director of The University of Chicago Crime Lab. He has published widely at the interface between poverty policy and public health. Pollack serves as a Fellow at the…

All authors

Visit the authors page and find out who is behind all of the great content at healthinsurance.org™.

Latest Obamacare news & opinion

Health Wonk Review June 5 2014

Health Wonk Review for June 5, 2014

If you haven’t gotten your health policy fix, head over to Health Wonk Review –…


Looking beyond the botched ACA rollout

"People have given up on the repeal. There are very few people who want Congress to…

price responsive consumers

Figuring out how to put ‘skin in the game’

The studies indicate that people are very responsive to healthcare prices when they see…

Curbside Consult David Cutler

Can we ‘do the right thing’ profitably?

David Cutler was the author of a prescient and scathing 2010 analysis warning of the need…


Dem ad slays Obamacare-hating Republican

Of the nearly half a billion dollars that has been spent on political ads mentioning the…


Health Wonk Review for May 22, 2014

Summer's here (at least it is where I am) and with it comes a summer-y edition of Health…

Sabrina Corlette health reform

Obamacare: Just what the doctor ordered?

In Part 2 of my conversation with Sabrina Corlette, we talk about whether the Affordable…

Health Wonk Review May - 2014

Health Wonk Review for May 8, 2014

Just a reminder that if you're still looking for some compelling health policy reading…


‘Bros’ on board – and other promising signs

With 8 million Americans enrolled in Obamacare's exchanges – 28 percent of them young…

all posts

See all 379 blog posts.

Browse by date

Search within posts

Related terms

Affordable Care Act (ACA)

The Patient Protection and Affordable Care Act (PPACA) – also known as the Affordable Care Act or ACA, and generally…


Medicaid is a health insurance program for low-income individuals and those with disabilities. Elderly low-income people are eligible…

Recent tweets @EyeOnInsurance

Mon Aug 18 18:44 2014 • reply • retweet • favorite

Mon Aug 18 18:41 2014 • reply • retweet • favorite

Wed Aug 13 01:34 2014 • reply • retweet • favorite