Health-Care Reform's Supreme Court Showdown

06.28.12

A Supreme Win for Women: The Crucial Benefits of Obamacare

Thanks to Obamacare, women can’t be charged 150 percent more than men for insurance, can’t be penalized for having had a C-section—and can count birth control as preventive care.

Women have much to celebrate in today’s historic Supreme Court ruling upholding the Affordable Care Act—starting with the fact that it means an end to gender discrimination in the health-insurance market. In other words, women will no longer pay up to 150 percent more than men for the exact same health benefits.

Under a current practice known as “gender rating,” insurers can charge women higher premiums than men—in fact, women now pay $1 billion more than men each year for identical health plans in the individual market. As of 2014, gender rating becomes illegal in all new individual and small group plans.

Also in the current individual insurance market, coverage for maternity care is routinely excluded. Only 12 percent of plans sold in the individual market offer maternity coverage, which is frequently inadequate because of long waiting periods and deductibles that can be as high as the cost of the birth itself. Once the Affordable Care Act—otherwise known as Obamacare—is fully implemented, about 8.7 million women will have guaranteed access to maternity and newborn care in all new individual and small group plans.

It’s also common in today’s market for insurers to refuse to cover women because of gender-based “preexisting conditions.” These conditions can include issues such as having had breast cancer or a Caesarean section or having been a victim of domestic violence or sexual assault. This practice, too, will be outlawed under Obamacare in 2014. In the meantime, adults with preexisting conditions who have been uninsured for at least six months can purchase affordable coverage through temporary Pre-existing Condition Insurance Plans.

Another big way in which women benefit from Obamacare is in its guarantee of recommended preventive-health services with no cost sharing, such as copays, deductibles, or coinsurance. More than 50 percent of women have delayed seeking medical care due to cost, and one third of women report forgoing basic necessities to pay for health care. Under Obamacare, insurers are now required to cover critical preventive services such as mammograms, Pap smears, and well-baby care without cost sharing. More than 45 million women with private insurance and with Medicare have already taken advantage of these services.

In addition, starting this August, more services specifically for women will be added to the list of preventive care that must be covered at no additional cost. That list includes contraception, gestational diabetes screening, breastfeeding counseling and equipment, annual well-woman care (in other words, a visit to the OB-GYN), and screening and counseling for domestic violence and sexually transmitted infections, including HIV and the human papillomavirus.

Other benefits for women include the ability to see their OB-GYN without a referral, guaranteed breaks and a private space for nursing moms to pump breast milk while at work, and home visiting programs for at-risk new mothers.

“Preexisting conditions” can include having had breast cancer or a C-section, or having been a victim of domestic violence or sexual assault.

Finally, there are a number of general provisions in the Affordable Care Act, many already in place, that benefit women especially, due to their high health-care utilization rates on behalf of themselves and their family members. To begin with, as its name implies, the law makes health insurance more affordable. Starting in 2014, families and small businesses will receive tax credits on an income-based sliding scale to help purchase insurance coverage. This will help individuals who earn up to $43,000 per year and up to $92,200 for families of four.

Also in 2014, up to 10.3 million women will gain insurance coverage when Medicaid expands its income eligibility to include people with incomes below 138 percent of the federal poverty level—less than $15,000 for individuals and about $31,809 for a family of four in 2011. The health law also eliminates Medicaid’s categorical requirements, so that low-income women who meet the income requirements can be enrolled even if they have no children and are not pregnant.

Further, the health-care law has eliminated lifetime caps on coverage and is phasing out annual caps. Thirty-nine-and-a-half million women, especially those with chronic conditions, have already benefited from the ban on lifetime limits. New health-insurance plans also will have to cap copays and deductibles, which will help reduce the amount women pay in out-of-pocket expenses. And plans that do not spend at least 80 percent of their premiums on medical care, as opposed to administrative costs and CEO bonuses, will have to send their enrollees rebates.

Mothers will also have peace of mind knowing that their children will be covered.  Insurers can no longer deny coverage to the 17 million children with preexisting conditions. And Obamacare requires insurance companies to allow young adults to stay on their parents' health-insurance plans until their 26th birthday. Already, 6.6 million people have gotten insurance under this provision.

In short, Obamacare will increase health-insurance coverage for women, lower their health-care costs—and end the worst insurance-industry abuses against them.