Amid the political noise surrounding implementation of the Affordable Care Act (ACA), one profound detail is often overlooked: this is the first time that the U.S. government is requiring coverage of preventive health services for women. In a recent online overview of the ACA by Alina Salganicoff, vice president and director of women's health policy at the Kaiser Family Foundation (KFF), and Laurie Sobel, senior policy analyst at the KFF, the presenters covered the benefits and restrictions of the ACA for women, including expanded coverage and the upcoming U.S. Supreme Court decision that could undermine it.
The benefits. Before the ACA took effect, insurance companies could deny coverage based on preexisting conditions, including pregnancy, domestic violence, or depression, and most plans didn't include maternity services-now they cannot deny coverage for such services. Prenatal visits, lactation consultation, and the costs of breast pump rental must also be covered, without copayments. In addition, "gender rating," taking sex into consideration when setting premiums (usually charging women more than men for the same services), is banned under the ACA. One of the most important new benefits for women, says Salganicoff, is the coverage of mental health services, particularly because women experience anxiety, depression, and panic disorders at almost twice the rates of men. And the extension of preventive services for older women covered under Medicare Part B is "really important," Salganicoff emphasized, because more than half of older women earn less than $20,000 annually.
The limitations. The 19th century notion that women's health revolves primarily around reproduction and maternity still clouds current policy, particularly that regarding contraception and abortion. This month, for example, a decision by the Supreme Court is expected regarding whether corporations have a right to refuse contraception coverage based on the owner's religious beliefs.
And the picture gets more complicated for uninsured women-about 18 to 19 million, according to a KFF analysis. Although the ACA expands who's eligible for Medicaid and requires access to preventive health services in that context, about half of the states haven't yet expanded Medicaid services. This leaves many without access to the new benefits. So despite the advances in women's services, the United States will still need a "robust health care safety net," says Salganicoff, which currently comprises charity hospitals, community health clinics, and family planning providers, although legislators in some states are passing laws that are forcing many of the latter to close.
The KFF Webinar, with complete references and resources, can be viewed at http://bit.ly/P70ti6. Also, the National Women's Law Center provides several resources, including fact sheets about the ACA and information on what to do if you're charged a fee for a preventive service or are eligible for Medicaid, at http://bit.ly/1fVBQAX.-Gail M. Pfeifer, MA, RN, news director