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This week we celebrate the twelfth anniversary of the passage of the Affordable Care Act (ACA) in 2010, and its importance to women in the United States. For more than a decade, the ACA has helped to improve the quality of and access to health care for millions of women across the country. In fact, a survey done by the Commonwealth Fund found that by 2016, the number of working-age women (ages 19-64) lacking health insurance had fallen by almost half since 2010. Women with lower income of all races and ethnicities have similar findings.
The ACA also ensured women are no longer charged higher premiums merely because of their gender. This discriminatory gender rating practice by insurance companies previously cost women approximately $1 billion per year. Since the ACA’s passage, our Women’s Health Program state-level advocacy partners, particularly those working in Black and brown communities, have worked tirelessly to educate their communities about health insurance coverage and assisted with providing information to local health insurance navigators. The ACA is crucial to women everywhere because it guarantees them access to preventive services such as birth control, annual well-women exams, cervical cancer screenings and other necessary care with no out-of-pocket costs. Most private insurance plans, including most employer-sponsored plans, are required to cover a wide variety of preventive services without cost sharing. These comprehensive services are vital for women who have a family history of certain diseases or would like to monitor their care.
Similarly, the ACA provides protection from being denied coverage merely based on a pre-existing condition. Before the ACA’s implementation, women could be denied coverage, have their insurance cancelled, or be charged more because of their pre-existing conditions. The ACA eliminated predatory practices that allowed insurers to turn away or exploit women who needed to receive care. It also ensured that insurers are prohibited from imposing lifetime dollar value caps on coverage and placing annual dollar value caps on essential health benefits. This is extremely substantial for women who need comprehensive care for their conditions and were not able to afford it prior.
Additionally, the ACA guarantees coverage for family planning and maternity care services. Prior to its enactment, most health plans in the individual market did not cover maternity care. Women with individual plans either had to go without maternity benefits and pay out-of-pocket for their care, or purchase costly maternal coverage ‘riders’. Access to maternity care coverage is especially important for marginalized women such as Black women, who are three to four times more likely to die from pregnancy-related complications than their white counterparts. It also allows more low-income women to have timely access to family planning services and makes it easier for state Medicaid programs to provide services to women who initially had to go through an inconvenient federal waiver process.
Although the ACA has created avenues for women, there are certain key areas we should build upon. According to a report done by the Center for American Progress, inequities remain in maternal health coverage and access. There has been increased recognition to move away from traditional payment models that pay providers per service to value-based care delivery. Although the ACA has tried models such as patient-centered medical homes and accountable care organizations (ACOs), some evidence suggests that BIPOC communities do not equally benefit from these reforms. A study published in Health Affairs even found that providers who serve a patient base with a higher concentration of BIPOC, low-income, uninsured, or disabled people were less likely to participate in these alternate models. It is also extremely important for the ACA to diversify the health plan provider networks to include community providers that serve low-income communities. This is vital to ensure that women residing in historically marginalized communities are able to see the providers they require.