By Sara R. Collins, Sheila D. Rustgi, and Michelle M. Doty
The Affordable Care Act (ACA) is likely to stabilize and reverse women's growing exposure to health care costs over the next decade. Up to 15 million women who now are uninsured could gain subsidized coverage under the law. And 14.5 million "underinsured" women will benefit from provisions that improve coverage.
While women are as likely as men to be without health insurance, their role as caregivers and their own unique health care needs leave them more exposed to the rapidly rising costs of care and to the problems resulting from loss of health coverage. Because insurance carriers consider women, particularly young women, a higher risk than men, women experience more difficulty obtaining coverage from the individual market and are charged much higher premiums for the same benefits than men of the same age. Most policies sold in the individual market, moreover, will not cover the costs of a pregnancy. Women's higher health care costs mean that they are more likely than men to experience problems paying medical bills—their own and those of family members. And women, both insured and uninsured, are more likely than men to delay health care to avoid the associated costs.
While women and their families will realize the greatest benefits from the expansion and improvement of insurance coverage beginning in 2014, several ACA provisions that are to be implemented during 2010—or have already been implemented—will provide important transitional support. The provisions that will benefit women, and their expected impact, are summarized below.
Requirement that employers and insurers allow adult children up to age 26 to join or remain on a parent's health plan (Sept. 2010). Nearly 1 million uninsured adult children are expected to gain coverage through their parents' policies over the next three years, while another 600,000 currently enrolled in individual market plans will gain more-affordable coverage by joining their parents' plans.
Ban on lifetime coverage limits (Sept. 2010). About 102 million people have health plans with lifetime benefit limits, and each year up to 20,400 people exceed their plan limits and lose coverage. Assuming that women make up half the population, about 10,000 women would gain coverage as a result of the ban.
Phased-in restrictions on annual benefit limits (Sept. 2010). An estimated 18 million people have health plans with annual benefit limits. The Affordable Care Act increases the cap on annual limits over 2010–2013, before banning them completely in 2014. By 2013, up to 3,500 people will gain coverage as a result of the ban, about 1,750 of them women.
Bans on rescissions of coverage (Sept. 2010). About 15 million people who have coverage through the individual insurance market, where rescissions, or cancellations, of health policies are most common, will benefit from this ban. About 10,700 people, including 5,350 women, are estimated to have their coverage rescinded each year.
Preexisting condition insurance plans (July–Aug. 2010). An estimated 200,000 people, including approximately 100,000 women, who have serious health problems and have had difficulty obtaining insurance coverage will gain coverage through these plans over the next three years.
Rebates to Medicare beneficiaries in the drug coverage doughnut hole (2010). Each year, about 16 percent of Medicare beneficiaries—a disproportionate number of them women—will hit the "doughnut hole" in their prescription drug coverage. Starting this year, beneficiaries will receive $250 rebates when they reach the hole, which will be phased out completely by 2020.
2014 and Beyond
Expansion in Medicaid eligibility to cover adults with incomes below 133 percent of the federal poverty level ($29,000 for a family of four) (Jan. 2014). The expansion in Medicaid has the potential to cover up to 8.2 million currently uninsured adult women under age 65.
New state health insurance exchanges, with premium and cost-sharing subsidies for people with low and moderate incomes (Jan. 2014). Uninsured women who earn too much to qualify for Medicaid will be able to purchase policies through state-run exchanges with those earning less than 400 percent of poverty ($88,000 for a family of four) eligible for subsidies to offset premiums and out-of-pocket costs. Up to 7 million uninsured adult women under age 65 may gain subsidized coverage through the exchanges.
Essential health benefit standards that include maternity care, as well as limits on cost-sharing, for plans sold in insurance exchanges and in the individual and small-group markets (Jan. 2014). This provision will ensure that all women have health plans that cover the cost of a pregnancy, a major gap in the individual insurance market, where only 13 percent of health plans now include maternity benefits. The new benefit standard and out-of-pocket spending limits will help uninsured women who earn too much to qualify for Medicaid or premium subsidies gain comprehensive coverage and also promise to significantly reduce the estimated 14.5 million women who are considered underinsured because of their high out-of-pocket costs relative to income.
Prohibitions on insurance carriers from denying coverage or charging higher premiums on the basis of health or gender (Jan. 2014). An estimated 7.3 million women—38 percent—who tried to buy health insurance in the individual market over a recent three-year period were turned down, charged a higher premium, or had a condition excluded from coverage because it was preexisting. Moreover, rating on the basis of gender is currently permitted in the individual market in 42 states, while 38 states allow insurance carriers to take into account gender in pricing health insurance policies for small businesses, a blow to women in companies with predominantly female workforces. Millions of women will benefit from the new rules prohibiting denial of coverage or higher premiums based on health or gender.
Together, these provisions will ensure that women and their families can get the health care they need without the risk of incurring catastrophic medical bills.