The Affordable Care Act and Women

By:
Alison Cuellar, Adelle Simmons, and Kenneth Finegold, ASPE

Abstract

The Affordable Care Act includes several provisions that are expected to significantly improve women’s health.  The Affordable Care Act improves coverage for important preventive services and maternity care, promotes higher quality care for older women, and ends the gender discrimination that requires women to pay more for the same insurance coverage as men.  Over one million young adult women have already gained health insurance coverage because of the Affordable Care Act and 13 million more women will gain coverage by 2016.

Maternity Coverage

Starting in 2014, 8.7 million more women who currently buy coverage in the individual market will gain maternity coverage, as part of the Affordable Care Act’s requirement for plans to cover essential health benefits.²  Currently, 62 percent of individual market enrollees do not have maternity coverage.

Preventive Health Services

The Affordable Care Act helps to make prevention affordable by requiring most private health insurance plans to cover recommended prevention and wellness benefits without cost-sharing.³  Insurers must now cover mammograms, screenings for cervical cancer, prenatal care, flu and pneumonia shots, and regular well-baby and well-child visits with no cost-sharing.  An estimated 20.4 million women are currently receiving expanded preventive services without cost-sharing because of the Affordable Care Act.⁴  Starting in August 2012, additional recommended preventive services including well-woman visits, screening for gestational diabetes, domestic violence screening, breastfeeding supplies, and contraceptive services will be covered by health plans with no cost-sharing.⁵  Eliminating such barriers as copayments, co-insurance, and deductibles will increase access to services that improve the health of women and their children.⁶  For example, prenatal care helps improve maternal health and birth outcomes.⁷

Improved Medicare Coverage

Women represent 56.9 percent of Americans aged 65 years and over, almost all of whom participate in Medicare.⁸  The 24.7 million women who have coverage through Medicare can now receive additional preventive services without cost-sharing, including an annual wellness visit, a personalized prevention plan, mammograms, and bone mass measurement for women at risk of osteoporosis.⁹

The Affordable Care Act expands prescription drug coverage under Medicare by closing the Medicare prescription drug coverage gap, often called the “donut hole.”¹⁰  More than 2 million women are already benefitting from this provision, saving $1.2 billion on their prescription drugs.¹¹  This number is projected to grow to 3 million women, saving $4.9 billion in 2021, as the donut hole is fully closed over the coming decade.¹²

Ending Gender Discrimination in Premiums

Today, many insurance companies in the individual market charge women higher premiums than men.  A 25-year-old woman enrolled in a health plan — one that does not cover maternity care — may pay as much as 81 percent more than a 25-year-old man enrolled in the same plan.¹³  Similarly, a 40-year-old non-smoking woman pays up to 57 percent more than a 40-year-old male smoker in the same plan.  Beginning in 2014 insurance companies in the individual and small-group health insurance market may no longer charge higher rates due to gender or health status.  Premiums can vary based on age, tobacco use, family size and geographic location, within limits set by the Affordable Care Act.

Expanded Insurance Coverage

Today, most nonelderly women are covered by health insurance offered by employers.  However, women are more likely than men to be covered as family members through their spouse’s employer.¹⁴  That means that women’s coverage is often dependent on their spouse’s circumstances.  Depending on their coverage, women can lose their health insurance coverage if they lose their job, or if they become widowed, divorced, or if their husbands lose their jobs.  The Affordable Care Act expands the availability of insurance options, outside of employer-sponsored insurance, for all Americans, providing a larger range of insurance options and improving the security of insurance for women.

Already, young adults ages 19-25 can be covered under their parents’ employer-sponsored or individually purchased health insurance.¹⁵  In the first nine months after this provision took effect, the proportion of young adults in this age group with health insurance increased by 8.3 percent.¹⁶  Today, an estimated 1.1 million young women have health insurance coverage because of this provision of the Affordable Care Act.¹⁷

By 2016, an additional 13.5 million women are expected to gain health insurance through other provisions of the Affordable Care Act (Figure 1).¹⁸  Starting in 2014, new Affordable Insurance Exchanges will provide women without access to employer-based coverage with one-stop marketplaces where they can choose the coverage that best fits their needs and have the same kinds of insurance choices as members of Congress.¹⁹  Women with incomes up to 400 percent of federal poverty guidelines (currently $89,400 for a family of four) will be eligible to purchase coverage using tax credits.  In addition, the Affordable Care Act expands Medicaid coverage to include almost all Americans with family incomes at or below 133 percent of federal poverty guidelines (currently $30,657 for a family of four); the expansion includes adults without dependent children who have not historically been eligible for Medicaid in most states.²⁰

The Affordable Care Act benefits women in many other ways, including:

• Coverage for Women with Preexisting Conditions.  Under the Affordable Care Act insurers cannot deny coverage to adult women or men because of a pre-existing health condition, starting in 2014.  (The Affordable Care Act banned insurers from such discrimination for children in 2010.) Until then, a new program called the Pre-Existing Condition Insurance Plan (PCIP) makes health coverage available and more affordable for individuals who are uninsured and have been denied health insurance by insurance companies because of a pre-existing condition.  Fifty-four percent of today’s PCIP enrollees are women, making a total of 27,000 previously uninsured women with serious health conditions who were shut out of the private insurance market, but now covered by health insurance.²¹
• Chronic Disease Management.  Older women are more likely to have chronic conditions than men,²² and certain chronic conditions, including hypertension, arthritis, osteoporosis, and asthma, are more prevalent among older women than older men.²³  The Affordable Care Act invests in community-based strategies such as Community Transformation Grants to improve chronic disease prevention.²⁴
• Small-Business Health Care Tax Credit.  In 2011 an estimated 360,000 small businesses will receive tax credits to help toward the cost of health insurance coverage.²⁵  Women own 35 percent of small businesses with fewer than 25 employees.²⁶  The Affordable Care Act provides small-business tax credits to encourage employers to offer health insurance coverage for the first time or maintain coverage they already have.  Small businesses with average employee incomes of $50,000 or less qualify for a tax credit of up to 35 percent of premiums.²⁷  The credit will increase to 50 percent in 2014.
• Long-Term Care.  More than two-thirds (67.4 percent) of Americans aged 85 years or older are women.²⁸  Women in this age range are more likely than men to live in nursing homes, or to live alone and require help with personal care needs such as eating, bathing, dressing, or getting around inside their home.  One in five women over age 85 living in the community need assistance with personal care needs and rely on adult children, family members, friends, and paid caregivers.²⁹  Under the Affordable Care Act, additional resources are available to help state Medicaid programs offer additional services for those who wish to stay at home and in the community, rather than entering nursing homes.³⁰  The Affordable Care Act also protects the families of Medicaid enrollees receiving home- and community-based services in the same way that Medicaid now protects the families of those who enter nursing homes.  It also provides better information about the choices available to those who need nursing home care.³¹
• Office of Women’s Health.  The Affordable Care Act gives new authorities to the Office on Women’s Health to establish short-range and long-range goals and objectives within the Department of Health and Human Services and to coordinate with other appropriate offices on activities within HHS relating to disease prevention, health promotion, service delivery, research, and public and health care professional education, for issues of particular concern to women throughout their lives.³²

The Affordable Care Act strengthens health care for women in all age groups.  Women with private insurance coverage are already benefiting from expanded coverage of preventive services, and will soon be paying fairer premiums as well.  Millions more have benefitted from improvements in the Medicare program.  And many women who would otherwise remain uninsured will gain coverage beginning in 2014.

Table 1. Key Benefits of the Affordable Care Act for Women