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Women made great strides in equal treatment under the Affordable Care Act (ACA), though it seems this is one of the best-kept secrets about the health care law. A recent report showed 40% of women today are a household’s primary income earner, but they are more likely to not be insured through their own employer than men, and 20% of women between 18 and 64 go uninsured. That is 1 in 5 women who could benefit from the Marketplace’s health insurance plans.
The ACA changes have a direct impact on women’s healthcare in 10 significant ways:
1. Gender-rating is no longer permitted.
Before the ACA, women paid more for health insurance premiums than men of the same age. Not anymore.
2. Pre-existing conditions have changed.
Even a past pregnancy could have been considered a pre-existing condition before the ACA. Since pre-existing conditions are no longer a way to deny coverage, women can get insurance more readily. Diabetic women, cancer survivors, and domestic abuse victims (all things previously taken into account in denying or charging more to women) will also benefit from this change.
3. Preventative services are expanded.
Services deemed highly effective are now covered, usually without cost-sharing, including mammography, pap smears, HPV vaccines, STI screening, and annual well-woman visits.
4. Contraceptives are more affordable.
The ACA requires most private plans to cover all forms of prescription birth control (but not all brands) without any co-pay. Medicaid also covers birth control without cost-sharing. It is estimated this will save $600 a year for some women.
5. Maternity care is expanded.
Most employer plans are required to cover maternity care (usually childbirth and well-baby care), but now this includes prenatal visits and screenings, breast pump rentals, and breastfeeding counseling, because they are considered preventative under the ACA.
6. Nursing mothers gain access.
Women who work for a large employer (50 or more full time employees, generally) are now entitled to a private room for expressing milk for the baby, and break times to do so.
7. Women can choose an OB-GYN.
Most plans must allow a woman to choose an OB-GYN as a primary provider or see one without a referral.
8. Abortion is included in plans.
Not surprisingly, there is a heated debate about insurance covering abortion. Each Marketplace depends on the state and insurance carriers. Group Health, Kaiser, and BridgeSpan initially proposed plans without abortion coverage in Washington. This was met with resistance from the Washington Legislature. While a bill was not passed, Kaiser and Group Health decided to ensure an abortion benefit in their plans for Washington Marketplace enrollees.
9. More access to insurance.
If a woman loses coverage through death, divorce, or because an employer cancels family benefits (because she is a dependent on her spouse’s plan), the Marketplace offers another option that could save her and her family money.
10. Family benefits for the children.
Women are often the healthcare decision makers for the family. The ACA considers pediatric dental and pediatric vision to be essential benefits, so all Marketplace plans will include these which were not standard in most plans prior. Finally, preventative care for children is expanded as well.
ACA clearly has affects on you and your practice, particularly our solo and small firm practitioners. Watch each week for WSBA’s weekly blog series to help you navigate the ACA.
Navigating the Affordable Care Act is an ongoing series from the WSBA Law Office Management Assistance Program designed to help solo and small practitioners understand the Affordable Care Act and how it affects them.
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