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Affordable Care Act, Culture, Gender, Government, Government Programs, Health Care, Health Care Reform, Health Disparities, Health Insurance, Health Reform, Healthcare, Obama, Obamacare, Politics, Public Health, Public Policy, Racial Disparities, Social Justice, Society, Uncategorized, Women's Health

The Affordable Care Act: Improving Health Care For Women Of Color

health-inequality

Women of color, many of whom have unique health issues or are disproportionately underserved by the current health care system, have much to gain under the Affordable Care Act (ACA). By making private insurance more affordable, expanding Medicaid, creating partnerships with communities of color, and supporting important care-delivery and system reforms, the ACA will improve access to more affordable health coverage for all women and decrease health disparities that disproportionately impact women of color.

Expanding and Improving Medicaid

About one in three American women are women of color, yet women of color are more than half of the country’s uninsured women (1). Latinas are most likely to be uninsured, with 38 percent lacking health insurance (2). Thanks to the ACA, more than 10 million women will become eligible for Medicaid coverage this year (3).

Medicaid provides essential health care for women of color, who represent one of the largest populations of Medicaid beneficiaries. Women are more than 70 percent of the Medicaid population and women of color disproportionately qualify for and receive Medicaid benefits, as compared to white women (4).

In 2014, states will enlarge the nation’s safety net by expanding Medicaid.

This year, Medicaid eligibility was expanded to individuals with incomes up to 138 percent (5) of the Federal Poverty Level (FPL). With this change, millions more women, many of whom are women of color, will qualify for Medicaid’s comprehensive health coverage with strong out-of-pocket cost (cost-sharing) protections (6).

Within Medicaid, coordinated care and family-centered care models will better address the needs of low-income women of color. For example, a woman with HIV who receives Medicaid benefits could access combined housing, childcare, and nutrition support with treatment or prevention services (7).

Making Coverage More Affordable

Health insurance marketplaces will allow women of color to make apples-to-apples comparisons of health insurance plans and find the one that best meets their needs. While almost two-thirds of Americans have employer-sponsored health insurance, only 52 percent of African Americans, 51 percent of Southeast Asians, and 41 percent of Latinos have health insurance through their employers (8). Since women are more likely to work part time and less likely to be a part of the work force, being able to purchase health insurance without employer sponsorship is crucial to women (9). With the new insurance exchange, women can compare plans and purchase private health insurance in state or federal health insurance marketplaces (10).

Premium and cost-sharing subsidies will make coverage for women of color more affordable. For women and families who don’t qualify for Medicaid, but still struggle to make payments on their health plans, premium subsidies and cost-sharing assistance may be available to assist with buying private insurance coverage in state marketplaces. Women and families earning between 100 and 400 percent of the federal poverty level ($94,200 for a family of four or $45,960 for an individual) are eligible for subsidies that will help reduce the cost of their monthly health-insurance premiums (11,12).

Women and men will now be charged the same amount for health insurance. Before the ACA, insurance companies could charge women higher premiums simply because they were women—a practice known as “gender rating.” Under the ACA, gender rating has been banned, meaning women will pay the same amount as men for their health insurance. This represents an important victory for women of color, who tend to have lower incomes, as compared not only to men, but to white women as well (13).

The ACA protects access to coverage for people with pre-existing conditions and/or chronic illnesses. Under the ACA, insurance companies may not discriminate against people with pre-existing conditions, nor can they take away coverage from people who get sick while enrolled in health plans (14). Insurance companies can no longer turn women away because of certain experiences, such as pregnancy (15) or being a victim of domestic violence (16), that have previously been categorized as “pre-existing conditions.” This provision is of particular importance to groups that face higher rates of chronic illness (17). For example, Asian and Pacific Islander women experience higher rates of breast, cervical, liver and stomach cancers (18). Thanks to the ACA, women with chronic illnesses will no longer face annual or lifetime caps on essential health benefits, enabling them to receive the care they need when they need it (19).

Working with Communities of Color

The ACA takes steps to improve health outcomes not just for individuals of color, but for entire communities.

Community health centers (CHCs) will receive $11 billion in increased funding (20). Community health centers disproportionately serve people of color; more than a third of the patients they serve are Latino and a quarter are African American (21). The ACA’s funding for CHCs will go to projects such as adding services in medically underserved areas and creating patient centered medical homes that coordinate preventive and primary care to help reduce health disparities affecting people of color (22).

The ACA improves access to culturally appropriate care. Language or literacy barriers— particularly for recent immigrants—can make it more difficult for women of color to receive the care they need. Under the ACA, insurers must increase access to health care information (including providing language services at no cost) for people with low literacy levels or limited English proficiency (23). Health care providers will receive additional training on providing culturally competent care (24). Employers may take advantage of incentives built in to the ACA to hire more people of color in the health care sector (25).

Decreasing Health Disparities

Women of color have unique health issues and often suffer from higher rates of certain illnesses and diseases, including diabetes, heart disease, obesity, some forms of cancer, and hypertension (26). The ACA attempts to reduce these health disparities among people of color.

Increased access to preventive care can help stop health disparities before they happen.

Greater access to preventive care for communities of color could decrease health disparities. For example, African American women have the highest mortality rates from breast cancer (27); receiving earlier and more preventive care could allow African American women to be diagnosed and begin receiving treatment sooner. Under the ACA, many preventive services—including mammograms—are covered with no out-of-pocket costs (28). Furthermore, because African American and Latina women account for 80 percent of women living with HIV (29), women of color will benefit from no-copay screening and counseling for HIV and other sexually transmitted diseases (30).

No-cost family planning care gives women of color the opportunity to decide for themselves if and when to have children. Timely access to contraceptive services can improve maternal and child health by providing women with essential services to plan their pregnancies. With no copay for FDA-approved contraceptives, insured women will be able to access many forms of contraception without cost sharing.

Better tracking of health disparities will help improve health outcomes. With the demographics of the country rapidly changing, data collection systems that measure health disparities need to keep pace. The ACA orders the U.S. Department of Health and Human Services (HHS) to define data collection categories by race, ethnicity, sex, disability and primary languages (31). With this change and others, HHS will better be able to determine what health disparities exist across populations and to decide how to allocate resources to improve access and health outcomes.

*See below for references.

 

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References

1 Ridley-Kerr, A. & Wilf, R. (2012, May 2). The top 10 benefits women of color are seeing under Obamacare. Retrieved from http://www.americanprogress.org/issues/race/news/2012/05/02/11570/the-top-10-benefits-women-of-color-are-seeing-under-obamacare/

2 Countdown to Coverage. (n.d.). The Affordable Care Act is helping women of color get the health care we need. Retrieved from http://countdowntocoverage.org/storage/countdown-resources/CtC%20checklist%20-%20WOC%20%20Final%20updated%200829.pdf

3 Ridley-Kerr, A. & Wilf, R. (2012, May 2). The top 10 benefits women of color are seeing under Obamacare. Retrieved from

http://www.americanprogress.org/issues/race/news/2012/05/02/11570/the-top-10-benefits-women-of-color-are-seeing-under-obamacare/

4 Reid, D. (2013, July 23). Using the Affordable Care Act and other opportunities to address maternal mortality. Retrieved from http://www.healthlaw.org/images/stories/2013_07_22_NHeLP_Issue_Brief_Maternal_Mortality.pdf

5 In 2014, Medicaid eligibility will be expanded to individuals and families with household family income at or below 133% FPL. However, a standard 5% income disregard used when determining eligibility effectively raises the limit to 138% of FPL.

6 Kaiser Family Foundation. (2012, January). Medicaid’s role for women across the lifespan: Current issues and the impact of the Affordable Care Act. Retrieved from http://www.kff.org/womenshealth/upload/7213-03.pdf

7 The 30 for 30 Campaign. (2012, July). Affordable Care Act priorities and opportunities for addressing the critical health care needs of women living with and at risk for HIV. Retrieved from http://www.taepusa.org/Portals/0/30-for-30-ACA-Exec-Summary.pdf

8 Women of Color United for Health Reform. (n.d.). Facts. Retrieved from http://www.womenofcolorunited.net/learn-more-facts/

9 U.S. Bureau of Labor Statistics. (2013, February). Women in the labor force: A databook. Retrieved from http://www.bls.gov/cps/wlf-databook-2012.pdf

10 U.S. Centers for Medicare & Medicaid Services. (n.d.). What is the health insurance marketplace? Retrieved from https://www.healthcare.gov/what-is-the-health-insurance- marketplace/

11 Countdown to Coverage. (n.d.). The Affordable Care Act is helping women of color get the health care we need. Retrieved from http://countdowntocoverage.org/storage/countdown-resources/CtC%20checklist%20-%20WOC%20-%20Final%20updated%200829.pdf

12 Calculations by the National Partnership based on data from the U.S. Department of Health and Human Services. Retrieved at http://aspe.hhs.gov/poverty/13poverty.cfm

13 U.S. Bureau of Labor Statistics. (2013, February). Women in the labor force: A databook. Retrieved from http://www.bls.gov/cps/wlf-databook-2012.pdf

14 The White House. (n.d.). Affordable Care Act: The new health care law at two years. Retrieved from http://www.whitehouse.gov/sites/default/files/uploads/careact.pdf

15 The White House. (n.d.). The Affordable Care Act helps women. Retrieved from http://www.whitehouse.gov/sites/default/files/docs/the_aca_helps_women.pdf

16 Futures Without Violence. (2012, June). How the Affordable Care Act (ACA) affects victims of domestic, sexual, and dating violence. Retrieved from http://www.futureswithoutviolence.org/userfiles/file/HealthCare/ACA%20and%20DV%20final.pdf

17 National Asian Pacific American Women’s Forum. (﴾n.d.)﴿. Affordable health care under attack – What’s at stake? Retrieved from http://napawf.org/wp- content/uploads/2011/04/WhatisatStake.pdf

18 National Asian Pacific American Women’s Forum. (﴾n.d.)﴿. Affordable health care under attack – What’s at stake? Retrieved from http://napawf.org/wp- content/uploads/2011/04/WhatisatStake.pdf

19 The White House. (n.d.). Affordable Care Act: The new health care law at two years. Retrieved from http://www.whitehouse.gov/sites/default/files/uploads/careact.pdf

20 Ridley-Kerr, A. & Wilf, R. (2012, May 2). The top 10 benefits women of color are seeing under Obamacare. Retrieved from http://www.americanprogress.org/issues/race/news/2012/05/02/11570/the-top-10-benefits-women-of-color-are-seeing-under-obamacare/

21 Countdown to Coverage. (n.d.). The Affordable Care Act is helping women of color get the health care we need. Retrieved from http://countdowntocoverage.org/storage/countdown-resources/CtC%20checklist%20-%20WOC%20-%20Final%20updated%200829.pdf

22 Health Resources and Services Administration, U.S. Department of Health and Human Services. (n.d.). The Affordable Care Act and health centers. Retrieved from http://bphc.hrsa.gov/about/healthcenterfactsheet.pdf

23 Kaiser Commission on Medicaid and the Uninsured, Kaiser Family Foundation. (2012, August). Overview of health coverage for individuals with limited English proficiency. Retrieved from http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8343.pdf

24 Ridley-Kerr, A. & Wilf, R. (2012, May 2). The top 10 benefits women of color are seeing under Obamacare. Retrieved from http://www.americanprogress.org/issues/race/news/2012/05/02/11570/the-top-10-benefits-women-of-color-are-seeing-under-obamacare/

25 Andrulis, D., Jahnke, L., Siddiqui, N., & Cooper, M. (2013, March). Report no. 1: Implementing cultural and linguistic requirements in health insurance exchanges. Retrieved from http://www.texashealthinstitute.org/uploads/1/3/5/3/13535548/implementing_cultural_and_linguistic_requirements_in_health_insurance_exchanges_march_2013.pdf

26 Ridley-Kerr, A. & Wilf, R. (2012, May 2). The top 10 benefits women of color are seeing under Obamacare. Retrieved from http://www.americanprogress.org/issues/race/news/2012/05/02/11570/the-top-10-benefits-women-of-color-are-seeing-under-obamacare/

27 Women of Color United for Health Reform. (n.d.). Facts. Retrieved from http://www.womenofcolorunited.net/learn-more-facts/

28 Health Resources and Services Administration, U.S. Department of Health and Human Services. (n.d.). Women’s preventive services guidelines. Retrieved from http://www.hrsa.gov/womensguidelines/

29 The 30 for 30 Campaign. (2012, July). Affordable Care Act priorities and opportunities for addressing the critical health care needs of women living with and at risk for HIV. Retrieved from http://www.taepusa.org/Portals/0/30-for-30-ACA-Exec-Summary.pdf

30 Health Resources and Services Administration, U.S. Department of Health and Human Services. (n.d.). Women’s preventive services guidelines. Retrieved from http://www.hrsa.gov/womensguidelines/

31 U.S. Department of Health and Human Services. (2011, June 29). Affordable Care Act to improve data collection, reduce health disparities. Retrieved from http://www.hhs.gov/news/press/2011pres/06/20110629a.html

 

 

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