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10 Things Women Need To Know About Health Reform

By CINDY PEARSONThink Like a Man

Have you noticed some changes in your health insurance lately? All of a sudden you don't need to come up with a co-pay when you pick up your birth-control pills or schedule a mammogram? Maybe your grandmother doesn't have to pay so much for her prescriptions, or you were able to keep your post-collegiate kid on your insurance even if she's as old as 25? Or maybe you know someone with an expensive medical condition who doesn't have to worry anymore about reaching a lifetime coverage limit? And did you get a refund check last year because your insurance provider wasn't spending at least 80 cents of your premium dollar on health care?

These are just a few of the changes the Affordable Care Act (ACA) has made in health-care coverage in the three years since it was signed into law. Now, having just celebrated the third anniversary of ACA, it's time to look ahead at what it will do for you as additional provisions go into effect—especially when the state health-insurance exchanges go into action this fall.

1 . Everyone Gets Insured.

If you're like a lot of women, you've worried about losing your health insurance if you change jobs, get divorced, take early retirement or switch to part-time work. Maybe you've worried whether you'll ever be able to get, or afford, health insurance. If so, you're not alone: Nineteen million women are currently uninsured, and many more report that they feel trapped in a job or marriage because it's their ticket to health insurance.

The Affordable Care Act is about to change all that. Oct. 1 marks the launch of virtual health marketplaces across the country, where women will be able to shop and compare the health-insurance options available in their state. The marketplaces will offer online shopping for health insurance, the same way Expedia or Travelocity offer online shopping for airplane flights. You'll be able to compare prices and look for features you like, secure in the knowledge that all of the plans offered in the health marketplace are fully vetted and legitimate. Coverage will then go into effect on Jan. 1, 2014.

And no one will be denied coverage. Some of the plans might seem expensive, but lower-cost alternatives will also be offered, and if you make less than $42,000 as an individual (400 percent of the federal poverty level), you'll get tax subsidies to help you cover the cost of insurance. If you're below the poverty line, Medicaid (which was dramatically expanded by ACA) will cover you. Whatever your income or family size, there's an option for you—and the insurers can't say no. If the insurance company offers a policy and you're willing to pay, you're covered.

2. Women pay no more than men.

What a concept—insurance companies have to treat women fairly! No charging women more than men for identical health-insurance plans. No selling policies that exclude maternity care. No treating cesarean birth as a preexisting condition.

The ACA is making insurance better for men and children, too. Insurance companies have to spend a reasonable amount of the premium you pay on actual health care. (Remember those refund checks you get if more than 80 percent of your premium isn't spent on health care—85 percent if you're covered by a large group plan? Insurance companies had to pay out more than $1 billion last year!)

All policies have to be comprehensive (which means some of those employer-provided policies are going to get better, too.) The new requirements for "essential health benefits" move insurance a long way from "just in case of an emergency" to actually supporting good health, including mental-health services.

3. No co-pays for preventive care.

This was one of the fights that made people pay attention to health reform. If health insurance is supposed to help us stay healthy, then it should cover the cost of preventive services with no extra fees. No co-pays. No deductibles.

No one complained when preventive coverage started first for kids and adults in 2010. But when it was time to offer preventive coverage specifically for women's health, the U.S. Conference of Catholic Bishops and conservative politicians realized that prevention also means contraception— and they tried to stop health reform in its tracks. The Obama administration stood strong, however, and the women's coverage has started to take effect.

All insurers now have to cover well-woman exams (thanks to the lobbying efforts of women senators such as Barbara Mikulski), contraception and breastfeeding (even the expensive stuff such as IUDs and breast pumps), cancer screening such as mammograms and Pap smears, domestic-violence screening and STI counseling. If you're working for Catholic Charities or a religiously affiliated hospital, however, don't bother asking your HR department about any of this: The Department of Health and Human Services (HHS) has created a work-around so that the bishops don't have anything to do with your contraceptive coverage. According to Mayra Alvarez, director of public health policy in the Office of Health Reform at HHS, "We've really worked hard to find the best compromise between respecting religious concerns and women's access to contraceptive services. …The important compromise is that the religious employer itself is not going to be connected to the policy but the woman will continue to receive the information and the benefit directly from the insurer."

In other words, every insured woman's contraceptive needs will be covered—at no extra cost to her.

4. Midwives and birth centers are covered.

It's about time! We've known for a long time that the midwife model can be superior in many ways to an overly medicalized, ob-gyn-based approach to childbirth. But unlike many other countries that integrate midwives into their health-care systems, U.S. midwives and their supporters have had to fight for inclusion. The Affordable Care Act did away with a misguided policy that prohibited Medicaid coverage of birth centers staffed by certified nurse midwives (CNMs). It also requires Medicaid to start paying CNMs the same amount M.D.s receive for vaginal deliveries.

The new rules don't apply to every private insurance policy, but these are big steps in the right direction. Forty percent of all births are paid for by Medicaid, and health reform is making midwives an option for many more pregnant women.

5. You have to enroll

We wish health-care coverage started the day you were born and lasted a lifetime, but we're not there yet. Until then, if you need coverage and don't already have it either as an individual or from your employer, you need to enroll. You might not even get an official notice telling you about your state's health marketplace. But count on it—starting Oct. 1 you can go to the online marketplace and sign up for health insurance. Your new coverage can then begin on Jan. 1, 2014.

Intimidated by online shopping? There will also be call centers staffed with people who can help you figure out what's right for you. And in many states there will be a network of inperson assisters to help people who don't have access to the Internet or prefer to communicate in a language other than English or Spanish.

6. Everyone should enroll - even the young and healthy.

You may feel like it's not worth the bother of going online to enroll in the health marketplace. And if you're on a tight budget, even a subsidized insurance plan might not seem like a good use of your money. If you don't sign up, you'll pay only a $95 penalty at tax time.

That might seem like a good deal compared to paying $200 a month for health insurance—but it's absolutely not. Insurance is vitally important to your well-being and that of your family. Under the ACA, the no-co-pay contraception alone can save a woman who needs it as much as $1,200 a year, which includes doctor visits. Even if you can handle the cost of occasional colds and checkups without insurance coverage, bad things happen unexpectedly. And that's what insurance is for.

If you're already covered, start talking to others about the importance of enrolling. As the Office of Health Reform's Alvarez reminds us, "Women are often the decision makers when it comes to health care in a family. Women are usually who we depend on when we have health-care questions. We go to our mom; we go to our sister."

So use your power! Make sure your friends and relatives know that health insurance is important. Young men are the most likely to believe that they don't need health insurance, but we need lots of young healthy people to sign up to make the new system work.

7. LGBT families aren't left out.

No state health marketplace can discriminate against consumers on the basis of sexual orientation or gender identity. In fact, same-sex couples can search for plans that offer coverage for both domestic partners and same-sex spouses through the health-plan finder tool at

Advocates are continuing efforts to ensure that all health plans understand the health-care needs of transmen and transwomen. Also, some states are making it easier for lesbian and gay parents who are legally married to get family coverage through health marketplaces, even though they can't yet file federal tax returns.

8. Read the fine print and be a smart shopper.

Even though the Affordable Care Act is doing a lot to protect consumers, we still have to be smart shoppers when it comes to our health insurance. You can count on any plan you buy through the health marketplace to cover essential benefits, but you may have to do some research on your own to make sure that the plan has enough of the kind of providers that are important to you. Are there enough ob-gyns? Does the plan include nurse practitioners? You'll have to read the fine print to know if your new health insurance puts tight limits on seeing clinicians who are outside the plan's network.

Being a smart shopper is especially important if you need a plan with excellent access to family planning and abortion. By law, all insurance plans sold through the exchange have to cover contraceptive counseling and services. But where do you get those services now, and will those providers be able to bill your new insurance company? Some insurance plans are sponsored by Catholic health-care systems: Watch out for them! State regulators are supposed to make Catholic insurance plans comply with the law, but coverage might not be smooth at the beginning.

And some insurance companies don't like paying for care received at familyplanning clinics, because they're used to dealing with individual physicians. Advocates are trying to address this by asking states to require insurance companies to work with any willing provider, especially those providing essential community services. If you love going to your local women's clinic, give them a call and ask which plans they're already working with.

9. So what about abortion?

The answer depends on the state you live in. As of April 2013, 20 states have prohibited companies selling insurance in the health marketplace from covering abortion care. Eight states prohibit private-insurance coverage of abortion altogether. But if it's not prohibited by state law, many insurance companies cover abortion care.

Again, read the fine print, and if you don't see the answer, don't be afraid to ask. Access to safe abortion helps women maintain their good health and take care of the children they already have. All of us should try to buy plans that include coverage for abortion care, even if we think we'll never need it.

10. There's help in figuring this all out.

The federal government has an all-purpose site with useful information about the Affordable Care Act and what's happening when: And for helpful fact sheets about what women get from health reform and how things will work once the health marketplaces are up and running, visit To find out how much a new insurance policy is likely to cost, try the insurance subsidy calculator designed by the Kaiser Family Foundation at

CINDY PEARSON is executive director of the National Women's Health Network and a cofounder of Raising Women's Voices for the Health Care We Need.

Reprinted from the Spring 2013 issue of Ms. To have this issue delivered straight to your door, Apple, or Android device, join the Ms. Community.

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