The Affordable Care Act (ACA), also known as ObamaCare, impacted health care for all Americans. There were specific provisions in the law that impacted women’s health care in particular. Prior to the ACA, women were often charged more for insurance and sometimes struggled to gain access to birth control and other health services. The ACA gave women broader access to health care while ensuring that they would not pay more than a man for coverage.
Changes to Women’s Healthcare Due to the ACA
In the past, women were generally charged more for health insurance plans due to their gender. The insurance companies reasoned that because women can get pregnant and have children, they were likely to cost the company more than men. As a result, they were charged a higher premium. ObamaCare put an end to that practice, requiring insurance companies to charge the same premiums for men and women. The only rating factors insurers can use are geographic area, age, tobacco use, and individual vs. family enrollment.
Another change that the ACA made to health insurance for women involved free access to preventive screenings. All new individual and small group plans must include coverage for a large variety of preventive benefits for women, including breast cancer mammography for women over 40, cervical cancer screening, domestic and interpersonal violence screening, and annual well-woman visits, and more. These preventive services must be provided without charging any cost-sharing or a deductible. For more information, visit the women’s preventive benefits page on Healthcare.gov.
The ACA also includes requirements that health insurance plans provide maternity care. In the past, maternity care could be excluded from a health plan, especially if the woman was pregnant when she applied for coverage. With the ACA, health insurance plans must include maternity care.
With the passage of ObamaCare, women have increased access to health insurance. Prior to the law, 18 percent of women ages 18-64 were uninsured. With the creation of state marketplaces and the expansion of Medicaid in many states, millions of women stand to gain coverage as a result of the ACA.
Controversies in Women’s Health Care
The additional coverages included in the ACA have not been without controversy. Some aspects of women’s health care, especially contraception and abortion, have been the source of a moral debate among many Americans. As a result, federal support of these services have met with strong criticism from those who oppose abortion and use of contraceptives.
Since 1977, the Hyde Amendment has been passed every year as an attachment to Congressional appropriation bills. This amendment stipulates that federal funds cannot be used to pay for abortion except in case of incest, rape, or endangerment of the woman’s life. A state can choose to use its own funds to cover abortion on a wider basis and 17 states currently use state funds to pay for abortions for women on Medicaid in additional circumstances beyond the Hyde Amendment. The ACA reinforces the Hyde Amendment, continuing to limit federal funds to paying only for abortions in cases of rape, incest, and life endangerment of the woman. It also explicitly does not preempt individual state requirements surrounding abortion.
On the issue of contraception, the Institute of Medicine determined that health insurance plans must provide all FDA approved contraceptives free of charge as part of a woman’s preventive health benefits, unless the company notifies the government about an objection to contraception. In this case, women still have access to contraceptives, but the insurer or plan administrator pays for the coverage rather than the employer.
If a woman works for a non-profit house of worship or a closely-held for-profit corporation that has a religious objection to contraception, then she may have insurance that provides limited or no coverage for the contraception. The government is currently looking into how to expand contraceptive coverage for women who fall into these exceptions.
Overall, the ACA has helped women gain increased access to health care and services while keeping them from being charged more than men for this access. Women have a number of free preventive services available. On more controversial health services, especially the issue of contraception, the details of how to ensure women’s access to care without impeding upon the free practice of religious beliefs are still being worked out.