If Mama Ain't Healthy...Lifesaving Benefits for Women in the Affordable Care Act

Women are key consumers of health care and often the primary decision maker when it comes to their families’ health. Women have unique health care needs and have high rates of chronic disease, such as diabetes, heart disease and stroke. 

Beginning August 1, 2012, women across the country gained access to preventive care services without a co-pay or out of pocket cost, including mammograms and cancer screenings. Many of the top risk factors leading to illness and premature death are preventable; making preventive care one of the most important steps women can take to manage their health and their families’ health.

Did you know that cardiovascular disease is the leading killer of women over age 25, according to the American Heart Association? It kills nearly twice as many women in the United States as all types of cancer, including breast cancer.

Women are more likely to have Alzheimer disease than men. The Alzheimer’s Association’s 2011 Alzheimer’s Disease Facts and Figures report indicates that 3.4 million of the 5.4 million Americans living with Alzheimer’s are female.

Approximately 11.5 million women, 10.2% of all women ages 20 or older, in the United States have diabetes.

In Texas heart disease and stroke account for 29.1% of all female deaths in the state. On average, nearly 64 women die from heart disease and stroke in Texas each day, while heart disease alone is the leading cause of women's deaths in Texas, accounting for 17,936 female deaths in 2009. Stroke is the number three cause of death for females in Texas, accounting for 5,289 female deaths in 2009. Nearly 59.3% of women in Texas are obese.

Studies show both stroke and heart disease are 80 percent preventable. The Affordable Care Act, or ACA, offers important new benefits for women and families in Texas. One of the major benefits introduced under the ACA is an increase in access to preventive care for women.

While women are more likely to need preventive health care services, they often have less ability to pay. In 2009, the Commonwealth Fund reported that more than half of women avoided/delayed preventive care because of its cost. Currently, the ACA requires all new private insurance plans to cover preventive health services at no cost, meaning no co-pays and no deductibles, therefore increasing women’s access to preventive services.

Also beginning in August 2012, insurance companies are under new mandates to include well-woman visits, well-baby visits, vaccinations, breastfeeding support, screening for gestational diabetes, HIV screening, and domestic violence resources among others. While benefits will come into effect at different times as health insurance plans renew, it’s important for the women of the Texas to know the changes in place and accessibility of new benefits. (Preventive services benefits are applicable if individuals joined a new health plan after March 23, 2010.)

In addition to coverage for preventive care, the ACA includes other important protections for women:

• Women cannot be denied coverage from insurance companies because of their gender. Before the ACA became law, insurance companies selling individual policies could deny coverage to women due to pre-existing conditions, such as cancer and pregnancy amongst others.

• Women will have access to lower health care costs. In 2014, insurers will not be able to charge women higher premiums than they charge men. Before the law, women could be charged more for individual insurance policies because of their gender. For example, previously a 24-year-old woman could be charged 150% the premium that a 24-year-old man paid.

• Women will have a choice of doctor. All individuals joining new insurance plans will have the freedom to choose from any primary care provider, OB-GYN, or pediatrician in their health plan’s network, or emergency care outside of the plan’s network, without a referral.

• Kids under the age of 26 can stay on their parents’ insurance plan. If the plan covers children, individuals can now add or keep their children on their policy until they turn 26 (except, in some cases, when your child’s employer offers health coverage). Regardless of whether your child is married, living with you, in school, or financially dependent on you.

• Individuals with pre-existing conditions have new coverage options. Health plans that cover children can no longer exclude, limit or deny coverage a based on a pre-existing condition. In addition, the law created a new program called the Pre-Existing Condition Insurance Plan (PCIP) to help provide coverage for uninsured people with pre existing conditions until new insurance market rules prohibiting discriminating against anyone with a pre-existing condition go into effect in 2014.

• Family members on Medicare will see new benefits. More than 20 percent of households are responsible for some or all of the care of elderly relatives (US Department of Labor) and according to a National Caregivers Alliance survey women constitute 66 percent of those family members providing elder care.

According to the Texas Department of Aging and Disability services, there are an estimated 2.7 million informal caregivers across the state of Texas and between 34 and 44 million informal caregivers throughout the United States. The roles that informal caregivers play are important not only to the individuals for whom they provide care, but also to the overall economy of the state and the nation. Informal caregivers are typically between the ages of 45 and 64 and the majority of caregivers are female.

•  If your parents or other loved ones are on Medicare, the ACA protects current benefits and offers new benefits aimed at cutting costs. The gap in drug coverage or the “donut hole” is being closed, reducing seniors’ out-of-pocket costs. Additionally, some individuals on Medicare may receive recommended preventive care free of costs, such as mammograms and colonoscopies.

• The Patient’s Bill of Rights provides consumers with new protections and rights. The ACA ensures consumers won’t lose their insurance, or have their insurance capped if someone is in an accident or becomes sick. It places precise restrictions on health insurance companies aimed at increasing insurance companies accountability to consumers.