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Health Care Reform – For Women

Jun 3rd 2011 at 3:03 PM

A 25 year old woman is charged more than a 25 year old man, and at age 40 it’s up to 50% more.” As outlined below, the ‘before’ and ‘after’ reveal the significant benefits women and children will enjoy as the Affordable Care Act is implemented over the next decade.


Before: Higher Costs, Less Coverage

For years, gender bias has been commonplace in the health care industry. Women have routinely been charged more for their insurance premiums solely because of gender. Insurance companies have treated pregnancy, c-sections, and even domestic abuse as ‘pre-existing conditions.’ This practice enabled them to deny women coverage.


Before: Negative Impact on Women

The burden of not being able to afford care has had a greater impact on women than men. In one study, over 50% of women delayed seeking medical care because they couldn’t afford it (compared to 39% of men); and a third faced difficult decisions to pay for needed care, such as giving up basic necessities.

In both two-parent and single-parent families, women frequently make health care decisions for themselves and their children. The complexities of existing health care plans have created an additional challenge for women.


After: Exchanges for the Better

Signed into law on March 23, 2010, by President Obama, the Affordable Care Act establishes state-based health insurance Exchanges that will provide women (and men) with private insurance choices and multi-state plans that will encourage competition and offer additional options.


After: Maternity Care Coverage

Under the current system, maternity benefits are not typically provided by health insurance plans in the individual insurance market. The new Exchanges not only offer coverage of prevention and basic health services, but maternity benefits as well.

Currently, less than half of women can obtain health insurance through an employer.The Exchanges ensure that women will always have access to quality, affordable health insurance despite job loss or changes in employment, illness, or relocation.

Through these Exchanges, women can obtain standardized and straightforward details on the various health insurance plans available in the areas in which they live; this will enable them to easily compare prices and benefits and choose the plan best suited to them.


After: Timeline for Changes

Starting in 2010 the Affordable Care Act will:

  • End rescission, the term used to describe an insurance company’s decision to drop coverage for a previously insured customer the first time she/he becomes seriously ill, even if that individual has paid insurance premiums for years. Insurance companies will be banned from dropping coverage for those who become sick.
  • Eliminate lifetime coverage limits on how much insurance companies will cover if a woman/man become ill.
  • Restrict the use of annual limits in all new plans and existing employer plans through a gradual phaseout through 2014.
  • Prohibit insurance companies from denying children coverage based on pre-existing conditions.
  • Provide access to affordable insurance for uninsured Americans with pre-existing conditions through a temporary subsidized high-risk pool to help prevent medical bankruptcy.
  • Provide a $250 rebate to Medicare beneficiaries who hit the Medicare Part D prescription-drug coverage gap known as the ‘donut hole’ this year.
  • Restrict the use of annual limits in all new insurance plans and existing employer plans this year until 2014 when annual limits for these plans are prohibited.
  • Require new plans to exempt prevention and wellness benefits from deductibles and other cost-sharing requirements, thus covering these benefits at no charge.

Starting in 2011, the Affordable Care Act will:

  • Institute a 50% discount on brand name drugs in the ‘donut hole’ and will eventually close this hole by 2020.
  • End co-payments for preventive services and exempt preventive services from deductibles under the Medicare program.
  • Support States in requiring health insurance companies to submit justification for requested premium increases; those with excessive or unjustified premiums may be prevented from participating in the new Exchanges.
  • Require insurance companies to prove they are spending at least 80% of customer’s premium payments on medical services and not on on non-medical costs (executive salaries, marketing, bureaucracy). Those companies that spend more on non-medical services must provide consumer rebates if those costs are too high.

Starting in 2014, the Affordable Care Act will:

  • Prohibit insurance companies from
    - denying women coverage due to a pre-existing condition
    - excluding coverage of that condition
    - charging more because of gender or health status
  • Place a cap on what insurance companies can require women to pay in out-of-pocket expenses such as co-pays and deductibles.
  • Provide tax credits for women who cannot afford health insurance.
  • Prohibit all annual limits in new plans and existing employer plans.
  • Require coverage of basic pediatric services as well as dental and eye care services under all new health care plans.
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