|FEATURE | SPRING 2013
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.
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.
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
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
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.
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.
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.
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.
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 www.healthcare.gov.
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
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.
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.
The federal government has an all-purpose site with useful information about
the Affordable Care Act and what's happening when: www.healthcare.gov. 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
www.CountdowntoCoverage.org. 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 www.healthreform.kff.org.
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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