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Affordable Care Act: What Women Gain

Health Insurance Reform & Women

Insurance Coverage Expanded

Some 32 million more individuals will gain access to health care coverage. It is estimated that the vast majority of people in the United States, some 95% of the population, will gain access to coverage once the Affordable Care Act is fully implemented. Undocumented immigrants, however, will still not have access.

Bans Discrimination

The ACA provides a major advance for women – a Title IX for health care. The law bans discriminatory practices based on sex, race, national origin, ethnicity, age or disability by any health program or activity which receives federal financial assistance. It states that, with a few exceptions specified in the law, an individual cannot "be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any health program or activity, any part of which is receiving federal financial assistance." It explicitly cites Title IX of the Education Amendments of 1972 which prohibits sex discrimination in federally funded education programs; Title VI of the Civil Rights Act which prohibits race discrimination; the Age Discrimination in Employment Act of 1975 and the Rehabilitation Act of 1973.

Gender Discrimination in Pricing will be Prohibited

By 2014 at the latest, insurers will be banned from "gender rating," or charging women higher premiums than men for the same coverage, both for individual policies and for employer group plans with fewer than 100 employees. Typically, in most states, women with plans, pay on the average some 48% higher premiums than men for the same health insurance coverage.

No Charge for Preventive Care

Every new insurance policy is required to include the basic preventive health care package without any co-pays or deductibles. As recommended by the Institutes of Medicine, this includes pap smears, mammograms, birth control, STI/STD testing, well woman checkups, immunizations and other preventive care.

Caps on Benefits Eliminated

Lifetime caps on the dollar amount of insurance benefits were eliminated immediately (on Sept. 23, 2010) and annual limits on benefits will be fully eliminated on January 1, 2014. In the interim until 2014, there are limits placed on annual caps. For example, for plans or policies issued after Sept. 23, 2011 the annual cap must be at least $1.25 million.

Discrimination Based on Pre-Existing Conditions Eliminated

Exclusions for pre-existing conditions were immediately eliminated for children in 2010, and will be eliminated in 2014 for adults. This will prevent the exclusion of coverage for women who have "pre-existing conditions" such as pregnancy, prior injuries caused by domestic violence, the second or subsequent Caesarian delivery, re-occurrence of breast cancer, etc. A temporary high risk insurance pool program is available to cover eligible adults with pre-existing conditions until 2014.

Bans Insurers from Dropping Coverage Because of Illness

Insurers are not allowed to drop (rescind) your insurance coverage because an illness has been diagnosed or a claim made, except in case of fraud or misrepresentation.

Mandatory Coverage of Maternity Care and Specific Health Services

Beginning January 1, 2014, individual and small employer plans must cover at a minimum a comprehensive package of "essential health benefits" including, for example, pre-natal and maternity care, prescription drug coverage, mental health care, and pediatric care (including oral and vision care). Currently 87 percent of individual health insurance plans exclude maternity coverage.

Extended Coverage for Adult Daughters and Sons

Beginning this year, this year, young people can remain on a parent's family coverage until age 26 regardless of marital status or employment status.

Mental Health Parity

Plans in the health insurance exchange will be required to provide mental health coverage beginning in 2014.

Benefits for Older People

  • Medicare guaranteed benefits are not reduced.
  • Beginning in 2011, Medicare now covers the full cost of preventive care, including cancer screenings, annual physical examinations and immunizations.
  • The Medicare prescription drug "Donut Hole" will be gradually eliminated, starting with a $250 payment to beneficiaries in 2010 and a 50% discount on Medicare Part D prescription drug costs. By 2020, payments by beneficiaries will be reduced to 25% of drug costs in the gap.

Ban on Discrimination against Lower Paid Employees

Employers will not be allowed to provide inferior plans with less coverage to their lower-paid workers, who are more likely to be women and people of color.

Addresses National Nursing and Primary Care Physicians Shortage

The law increases the numbers of nursing education slots, providing loan repayments and retention grants and offering grants for employment and training of family nurse practitioners. It provides scholarships, loan programs and bonus payments to private care physicians and general surgeons. It also expands health accessibility by doubly the capacity of community health centers. New programs will increase support for school-based and nurse-managed health centers.

For Uninsured or Underinsured Women

Expands Medicaid

Beginning in 2014, an estimated 16 million people (including 10.3 million women) will gain access to health care coverage through expansion of Medicaid and the State Children's Health Insurance Programs (SCHIP). Currently, Medicaid only assures coverage of the following groups where family income is below the poverty line: pregnant women, children ages 6-18 and their parent/caretaker, the elderly, disabled and blind (the 2012 poverty line is $11,130 for an individual and $19,090 for a family of three). Children under age 6 are covered if family income is below 133 percent of poverty.

The new act will dramatically broaden coverage to individuals under 65 who are not currently entitled to or enrolled in Medicare, and have incomes at or below 133% of the poverty level.

Makes Health Insurance More Accessible and Affordable

Beginning in 2014, individuals and small businesses will be able to purchase health insurance at group rates through state exchanges. When fully implemented, the insurance exchanges are expected to cover 24 million people.

Most citizens and legal residents will be required to purchase health insurance, but federal subsidies will be provided for some 75% of these individuals -- those whose incomes are between 133% and 400% of the federal poverty level – particularly benefiting women, whose incomes are lower.

Employers with more than 50 employees will be required to offer health insurance coverage or pay a penalty of $2,000 per employee. Small businesses with fewer than 25 employees will receive tax credits for providing coverage.

Updated June 27, 2012

Sources

  1. Full text of the Patient Protection and Affordable Care Act of 2010 PDF
  2. National Women's Law Center
  3. United States Census Bureau PDF
  4. 2012 HHS Poverty guidelines
  5. White House Blog 3/23/10
  6. DPC Section-by-Section Analysis of Changes PDF