I Am Woman, Hear Me Roar… About ObamaCare. Landmark Legislation Advances Women’s Health

ObamaCare was signed into law on March 23, 2010, and most of its provisions were upheld by the U.S. Supreme Court on June 28, 2012. ObamaCare, now a popular name for the Affordable Care Act (ACA), gives 47 million women access to free preventive health services. Over half the women in the United States have avoided or delayed preventive care due to cost. As of August 1, 2012, many of ObamaCare’s benefits for women went into effect and many more will be rolled out in years to come. More than 45 million women with private insurance and Medicare have already taken advantage of these services. In short, Obamacare will increase health insurance coverage for women, lower their health care costs, and end insurance industry abuses against them.

The Women’s Health Movement during the 1960s and 1970s made significant gains in improving health care for all women. In 1991, the Office on Women’s Health (OWH) in the Department of Health and Human Services was established to improve the health of women by advancing a comprehensive national women’s health agenda addressing health care prevention and delivery of care. The National Institutes of Health Advisory Committee on Research on Women’s Health meets twice a year to provide guidance on appropriate studies in women’s health to be undertaken by the national research institutes. In 2010, many hailed the passage of the ACA the greatest legislative advance in women’s health in a generation.

Thanks to the health care law, women in private plans and Medicare already have received potentially life-saving services, such as mammograms, cholesterol screenings, and flu shots at no extra cost. Health plans must now offer eight additional screenings and tests for adolescent and adult women at no extra charge. These include:

  • Annual well-woman visits.

  • Screening for gestational diabetes to help protect the mother and her child from one of the most serious pregnancy-related diseases.

  • Testing for the human papilloma-virus or HPV.

  • Counseling and screening for HIV.

  • Contraceptive methods and counseling

  • Breastfeeding support, supplies, and counseling.

  • Counseling for sexually transmitted infections.

  • Screening and counseling for domestic and interpersonal violence.

Health reform is a woman’s issue. There is no creature on the face of the earth as fragile yet powerful, as sensitive yet tolerant, as gentle yet resolute as a woman. Only a woman conceives life, is the first one to feel that life, the first one to feed that life from her own body, to give birth to that life, to love that life, to nurture that life, to fiercely protect that life. Women are the nation’s primary health care consumers. Women use health care services more than men. Women are more likely to choose providers, make appointments, and address health care needs for themselves and their families. Due to their reproductive needs, women get more frequent examinations and use more prescription drugs. Women are more likely to require ongoing treatment for chronic disease and more likely to experience anxiety, depression, and other mental health problems.

Before the Affordable Care Act became law, insurance companies selling individual policies could deny coverage to women due to pre-existing conditions. In 2014, it will be illegal for insurance companies to discriminate against anyone with a pre-existing condition. Pre-existing conditions for women could have included having had breast cancer, being pregnant, having a C-section, or having been a victim of domestic violence or sexual assault.

Before the law, under a practice called “gender rating”, insurers could charge women higher premiums than men. A 22-year-old woman could be charged 150% the premium that a 22-year-old man paid. In 2014, insurers will not be able to charge women higher premiums than they charge men because gender rating becomes illegal in all new individual and small group plans. Once the Affordable Care Act is fully implemented, about 8.7 million women will have guaranteed access to maternity and newborn care in all new individual and small group plans. Other benefits include the ability to see their Ob-Gyn without a referral, guaranteed breaks, a private space for nursing moms to pump breast milk while at work, and home visiting programs for at-risk new mothers.

The new health care law has eliminated lifetime caps on coverage and is phasing out annual caps. Thirty-nine-and-a-half million women, especially those with chronic conditions, have already benefited from the ban on lifetime limits. New health insurance plans will also have to cap co-pays and deductibles, which will help reduce the amount women pay in out-of-pocket expenses. Plans that do not spend at least 80 percent of their premiums on medical care, as opposed to administrative costs and CEO bonuses, will have to send their enrollees rebates.

Starting in 2014, families and small businesses will receive tax credits on an income-based sliding scale to help purchase insurance coverage. This will help individuals who earn up to $43,000 per year and up to $92,000 for families of four. In 2014, up to 10.3 million women will gain insurance coverage when Medicaid expands its income eligibility to include people with incomes below the poverty level – less than $15,000 for individuals and about $31,809 for a family of four in 2011.

A baby girl born in the U.S. in 1900 had a life expectancy of 48.3 years. Her great-great-granddaughter born in 2008 can expect to live to 80.3 years. In 2009, women, an extremely diverse group, represented 50.7 percent of the 307 million people living in the United States.  In most age groups, women represented approximately half of the population. Within the 65 years or older age group, women represented 57.5 percent of the population. While white women account for the majority of the female population, there is an increasingly large group of women of color – Latina, African American, Asian/Pacific Islander, and other mixed race groups. Black and Hispanic women account for 8.9 and 6.9 percent of the female population aged 65 years and older, but they represent 13.8 and 22.4 percent respectively of females under 18 years of age. Their health needs, their insurance options, and how they use health care services are shaped by their age, income, race, ethnicity, level of education, family structure, and employment status among other factors.  As beneficial as ObamaCare is for women overall, two groups of women in particular were left out of the law—undocumented and recent immigrant women and women who need abortion services.

While women continue to live longer than men, they are more likely to report physical and social activity limitations across all age groups. A woman is usually so busy taking care of her man, her partner, her children, her friends, her relatives, and her neighbors that she forgets about herself and puts off her own health care needs. A demanding schedule and the cost of health care may place many women at risk for delays in receiving their own health care. Too often, women worry about what their medical expenses will mean to the family budget and choose to pay for groceries or rent instead.

As the major coordinators of care, women are the link to the health care system for their families. They play the key role in coordinating and ensuring access to health care for the family with health care of their children a priority. Studies show that the overwhelming majority of U.S. adult women – 90 percent – are responsible for the vast majority of routine health care decisions for themselves and their families. Day in and day out, a woman is in the health care trenches – a chronic caregiver, especially of relatives and extended family who are often sick, disabled, or elderly.

Although women can expect to live five years longer than men on average, women experience more physical and mental unhealthy days than men. In 2007-2008, 58.1 percent of white women reported themselves in excellent or very good health, compared to only 40 percent or less of American Indian, Black, and Hispanic women. Women and men have many of the same health problems, but they affect women differently. Women may have different symptoms of heart disease. Some diseases or conditions are more common in women, such as osteoarthritis, obesity, depression, anxiety, and other mental health problems. Some conditions are unique to women, such as menopause and pregnancy.  Women of color are disproportionately affected and have higher rates of a number of diseases and health conditions, including HIV/AIDS, diabetes, asthma, heart disease, high blood pressure, and sexually transmitted infections.

As we celebrate women during Women’s History Month, in many ways, women are better off today than their foremothers. Yet in spite of earning more money, commanding more respect, and gaining political voice and stature, women still experience chronic health problems, endure more stress, and suffer more from more chronic health conditions than men. ObamaCare is not a perfect bill, but it’s a good start with significant positive implications for women. It has ushered in a new day for women’s health to ensure that women don’t have to rely on a spouse for their health coverage or worry about losing that coverage after a change in their marital status. Thanks to Obamacare, women who choose to remain unmarried, women who seek a divorce, and LGBT women who live in states where they cannot legally marry will have the benefits and services of health coverage.

The Affordable Care Act puts women in control of their health and enables them to catch potentially serious conditions at an earlier and more treatable stage. ObamaCare empowers women to take charge of their health and care enough about themselves and their loved ones to share in the responsibility of their own health.

About Sheila Thorne: Born in the South Bronx and a former New York City high school teacher of foreign languages, Sheila Thorne, president & CEO of Multicultural Healthcare Marketing Group, has worked for health care organizations throughout North America,  Western Europe and Latin America. Associate Clinical Professor at Stony Brook University School of Social Welfare, Ms. Thorne has spent over two decades as a cross-cultural educator, health marketer and advocate for quality health care for all, especially for communities of color, and the health care professionals who treat them.

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