Women’s Preventive Health & the ACA
Oh man. Compared to men, women have been coming up short in receiving proper preventative health care services. Despite women making up 51% of the population (Representation2020.com, 2020) and literally making and bearing 100% of the population, U.S healthcare saw nothing wrong in being slow and reluctant to meet the needs of women. Thanks to the Affordable Care Act (ACA), in 2010 America started making big changes to live up to the promise that a “health care delivery system should have two primary objectives: (1) enable all citizens to obtain needed health care services; and (2) ensure that services are cost-effective and meet certain established standards of quality” (Shi & Singh, 2019, p. 4). This is a look at the U.S healthcare system’s journey towards equality through a woman’s eyes before the ACA, since the ACA and possibly seeing the future without the ACA.
Before The ACA
It was just so hard to get insured. Women were being denied healthcare coverage due to pre-existing conditions like pregnancy, depression, non-skin cancer and/or having a BMI>40 (Long & Salganicoff, 2020). If they weren’t denied healthcare coverage, they were taken advantage of by health insurers through a practice called gender rating. “Women buying insurance on the individual market were routinely charged up to 50 percent more for monthly premiums than men. In some cases the gap was as high as 81 percent” (Rimler, 2016) for receiving the same coverage as a man- these are “plans that typically did not include maternity care” (Usha, 2020). Insurers thought this to be fair as women “tend to visit the doctor more frequently, live longer, and have babies” (Rimler, 2016). This is arguably true but so is the fact that “men are nearly 10 times more likely to get inguinal hernias than women, and five times more likely to have aortic aneurysms” (Mars Vs. Venus: The Gender Gap In Health 2019). Harvard Men's Health Watch also reports that men are more likely to be hit by gout, develop kidney stones, become alcoholics, have bladder cancer, and suffer from emphysema or a duodenal ulcer (Mars Vs. Venus: The Gender Gap In Health 2019). Yet men were never penalized with gender rating. “In 2007, more than three of five adult women under age 65 reported a problem paying medical bills, a cost-related problem getting needed health care, or both, compared with about half of men” (Rustgi, Doty, & Sara, 2009). These women were unable to obtain or afford the necessary resources to see a provider meaning they were also unable to receive preventative services that included:
Contraceptives
Mammograms
Pap tests
Talking to clinicians about diet, exercise, nutrition, or the risks of smoking
Mental health services
(Ranji, Salganicoff, & Rousseau, 2019)
These are services that could have helped with preventing the same pre-existing conditions that kept women from getting health coverage in the first place.
Since The ACA
The ACA “has improved health care for women and their families through the law’s insurance market reforms, mandatory coverage of free preventive care, and subsidized, comprehensive insurance options for people lacking access to affordable employer coverage” (Gunja, Collins, Doty, & Beutel, 2017). The Commonwealth Fund Biennial Health Insurance Surveys shows the drastic decrease of uninsured women starting in 2010 when the ACA was introduced:
Percent Of Women Ages 19–64 Who Are Uninsured
This was a game changer and opened the sliding doors of hospitals to millions of women in the U.S. “The law did away with longstanding policies that insurance plans used to discriminate against women” (Long, Ramaswamy, & Salganicoff, 2020). No one with pre-existing health conditions, like pregnancy, can be “denied or charged more for individual insurance” (Long, Ramaswamy, & Salganicoff, 2020). Medicaid was expanded, allowing more women to become eligible, and plans that were purchased in the AMA Marketplace were subsidized, causing health insurers to be competitive with pricing and quality (Long, Ramaswamy, & Salganicoff, 2020). Finally, preventative care is accessible, covered without cost sharing (no deductibles to pay) and include services specifically for women:
Maternal Health
Gestational diabetes screening
Breastfeeding support, supplies, and counseling
Sexual Health
STI counseling
HPV DNA testing
HIV screening and counseling
Contraception and contraceptive counseling
Intimate Partner Violence
Interpersonal and domestic violence screening and counseling
Coverage of Mental Health & Substance Abuse Disorder Treatment
Benefiting survivors of domestic abuse
(The Affordable Care Act & Women’s Health 2013)
“Almost 90 percent of women in this country now have health insurance coverage. This includes over 33 million women of color, who historically have been more likely to be uninsured, be poor, and go without health care because of cost” (Borchelt, 2018). In 2010, 48% of women were not getting the care they needed but after 6 years, that dropped to 38% (Gunja, Collins, Doty, & Beutel, 2017). More women are receiving preventative care and are having fewer reported problems with medical bills (Gunja, Collins, Doty, & Beutel, 2017). Not only is this a win for women but also a win for children, who now get healthcare services tailored to their distinctive needs.
The Possible Future Of The ACA
The Trump Administration has been sabotaging the ACA at every turn:
Getting the Supreme Court to possibly repeal the ACA on the grounds that “the ACA’s mandate for all Americans to obtain insurance became unconstitutional after Congress reduced the penalty for not having such insurance to zero” (Boyle, 2020)
Cutting off the cost-sharing reduction payments to insurers, which are vital to helping low-income women afford health insurance
Issuing rules (currently blocked by courts) allowing virtually any employer to refuse to cover birth control without out-of-pocket costs as required by the ACA
Proposing rules to expand the sale of junk plans that discriminate against women
(Borchelt, 2018)
If the ACA is repealed, women across the U.S will no longer be able to receive care for their needs and also their children’s needs. Not providing women’s preventive health care services will increase unintended pregnancies and high-risk pregnancies which will lead to further complications that could endanger the health of mother and child (Yazdkhasti, Pourreza, Pirak, & Abdi, 2015). It will also cost the government more as providing care for pregnancies is more expensive than preventive care. Thankfully the Biden Administration is ready to restore, revise and rescind the doings of Trump. JoeBiden.com states he will “pursue an aggressive and comprehensive plan to further women’s economic and physical security and ensure that women can fully exercise their civil rights.” Other opportunities that could help Biden accomplish his plan:
Expand Medicaid to the 12 states that haven't adopted the expansion
Include undocumented immigrants by reducing restrictions/ immigration reform
Give out tax credits to make premiums more affordable
Including more women in medical research trials to properly represent how the findings effect females
The U.S has finally opened its eyes to see that America is made up of both men and women that require different things to live an equally healthy life.
References
The Affordable Care Act & Women’s Health. (2013, December). Retrieved December 09, 2020, from https://www.acf.hhs.gov/sites/default/files/fysb/aca_fvpsa_20131211.pdf
The Biden Agenda for Women. (2020, September 22). Retrieved December 10, 2020, from https://joebiden.com/womens-agenda/
Borchelt, G. (2018). The Impact Poverty Has on Women's Health. Retrieved December 10, 2020, from https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/poverty-on-womens-health/
Boyle, P. (2020, November 19). That's enough: Supreme Court appears poised to resolve validity of ACA and 'move on'. Retrieved from https://www.aamc.org/news-insights/s-enough-supreme-court-appears-poised-resolve-validity-aca-and-move
Gunja, M. Z., Collins, S. R., Doty, M. M., & Beutel, S. (2017, August 10). How the Affordable Care Act Has Helped Women Gain Insurance and Improved Their Ability to Get Health Care: Commonwealth Fund. Retrieved December 10, 2020, from https://www.commonwealthfund.org/publications/issue-briefs/2017/aug/how-affordable-care-act-has-helped-women-gain-insurance-and
Long, M., & Salganicoff, A. (2020, November 04). Pre-Existing Condition Prevalence Among Women Under Age 65. Retrieved December 09, 2020, from
Long, M., Ramaswamy, A., & Salganicoff, A. (2020, November 13). The 2020 Presidential Election: Implications for Women's Health. Retrieved December 09, 2020, from https://www.kff.org/womens-health-policy/issue-brief/the-2020-presidential-election-implications-for-womens-health/
Mars Vs. Venus: The Gender Gap In Health. (2019, August 26). Retrieved December 09, 2020, from https://www.health.harvard.edu/newsletter_article/mars-vs-venus-the-gender-gap-in-health
Ranji, U., MS, Salganicoff, A., PhD, & Rousseau, D., MPH. (2019, June 11). Barriers to Care Experienced by Women in the United States. Retrieved December 09, 2020, from https://pubmed.ncbi.nlm.nih.gov/31184724/
Representation2020.com. (2020, November 03). Women's Representation. Retrieved December 09, 2020, from https://www.representwomen.org/current-women-representation
Rimler, R. (2016, June 25). Should Women Pay More for Healthcare Services? Retrieved December 09, 2020, from https://www.healthline.com/health-news/should-women-pay-more-healthcare-services
Rustgi, S. D., Doty, M. M., & Sara, C. R. (2009, May 11). Women at Risk: Why Many Women Are Forgoing Needed Health Care. Retrieved December 09, 2020, from https://www.commonwealthfund.org/publications/issue-briefs/2009/may/women-risk-why-many-women-are-forgoing-needed-health-care
Shi, L., & Singh, D. A. (2019). Delivering Healthcare In America: A Systems Approach (7th ed.). Burlington, MA: Jones & Bartlett Learning.
Usha Ranji, L. (2020, October 29). Loss of the ACA Could Greatly Erode Health Coverage and Benefits for Women. Retrieved December 09, 2020, from https://www.kff.org/womens-health-policy/issue-brief/loss-of-the-aca-could-greatly-erode-health-coverage-and-benefits-for-women/
Yazdkhasti, M., Pourreza, A., Pirak, A., & Abdi, F. (2015, January). Unintended Pregnancy and Its Adverse Social and Economic Consequences on Health System: A Narrative Review Article. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4449999/
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