How health care reform affects coverage for women

Amy Higgins

Women have unique concerns when it comes to their health, but with rising health care costs and limited coverage under many insurance plans, many aren’t getting the care they need. A recent report from The Commonwealth Fund analyzes how that could change under health care reform.

How health care reform affects coverage for women
How health care reform affects coverage for women

A health care discrepancy

In 2010, roughly 27 million women were uninsured, according to the report, called”Women at Risk: Why Increasing Numbers of Women Are Failing to Get the Health Care They Need and How the Affordable Care Act Will Help.” The Commonwealth Fund also found that 45 million women, both with and without health insurance, delayed or avoided health care because of cost in 2010.

Health insurance coverage helps alleviate some financial burden, but obtaining coverage can be challenging for women because of their medical needs. The Commonwealth Fund survey found that few plans in the individual insurance market offer maternity coverage. Also, young women many times can pay premiums as much as 84 percent higher than those for men for identical coverage.

Other key findings in the report include:

  • Women working for small businesses are more likely to be uninsured than those who work for large ones. Many small companies won’t offer health benefits because they pay higher health insurance premiums than large companies do on average — and maternity benefits often are something that small employers just can’t afford.
  • In 2010, an estimated 26 million working-age women spent 10 percent or more of their income on premiums and out-of-pocket costs.
  • In 2010, an estimated 45 million women did not fill a prescription or skipped recommended health care because of the cost.
  • More than a third of the women suffered from hypertension or high blood pressure, heart disease, diabetes, asthma, emphysema or lung disease. Thirty-one percent of these women reported skipping medicine or not filling a prescription because of cost.
  • Fewer than half (46 percent) of the women surveyed said they were up to date on recommended preventive screening tests for things like blood pressure, cholesterol, cervical cancer, colon cancer (for ages 50 to 64) and breast cancer (50 to 64).
  • Adult women younger than 65 are more likely than men to suffer from a set of chronic conditions, including arthritis, depression and asthma.

Change on the horizon?

When the health care reform law’s insurance mandate provision goes into effect in 2014, all individuals in the United States will have access to and be required to get health insurance. According to the Kaiser Family Foundation, health care reform has the following implications for women’s access to health care:

  • Health insurance companies must issue and renew policies, regardless of health status, once the mandate goes into effect. In other words, an individual health plan won’t be able drop a woman if she becomes pregnant.
  • Insurers won’t be allowed to charge higher premiums based on gender or health status once the mandate is in effect.
  • Pre-existing condition exclusions no longer will be allowed under the mandate. Currently, pregnancy often is considered a pre-existing condition under many plans.
  • Annual and lifetime coverage limits were abolished in 2010. That means that women no longer have to worry that a complicated pregnancy or birth will cause them to exceed their policy’s limits.

But is there a guarantee that plans will include maternity coverage when the health insurance mandate goes into effect? Currently, yes. Insurance plans will be required to include certain “essential benefits” in all health plans, according to the Kaiser Family Foundation. These include maternity and newborn care, as well as things like ambulatory care, emergency services, rehabilitation and chronic disease management.

Women have health care concerns besides pregnancy. And other provisions of the health care reform law take them into account. Plans that began Sept. 23, 2010, no longer can charge co-pays or co-insurance for certain types of preventive care, including mammograms, pap smears and bone density screenings. Women receiving Medicare and Medicaid have the same benefits. In other words, women with insurance, Medicare or Medicaid no longer will have to pay out of pocket for some vital services.

The affordability of coverage once the mandate takes hold is yet to be determined. But women who have had trouble obtaining health insurance or coverage for maternity expenses may find it easier to get insurance and keep it.

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