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

New Survey Shows Many Women Still Unaware Of How The Affordable Care Act Helps Them


Historically, women have not had equal access to essential health coverage and care. Women have been charged higher insurance premiums than men simply because they are women. And they’ve had no guarantee that the health coverage they purchase will cover the women’s health services that they need.

The Affordable Care Act is one of the greatest victories for women’s rights in recent decades because it puts an end to this discrimination. The law improves access to care that is essential to women’s health, and it makes coverage more affordable. Already, millions of women are benefiting from the health care law — but many are still unaware of the benefits already in effect, according to a new survey.

The Kaiser Family Foundation (KFF) polled more than 3,000 women between the ages of 15 and 64 in September and October 2013 to take inventory of women’s experiences in accessing health care during a period of transition — key portions of the Affordable Care Act (ACA) took effect in 2013 and 2014.

For example, the ACA calls for mandatory maternity care to be offered in insurance coverage, and it bars insurers from charging women more than men for the same services. It also ensures that women will have access to contraceptive methods and counseling — as well as a number of other preventive services including cancer screenings, breastfeeding support and supplies, testing and counseling for sexually transmitted diseases, family planning, and domestic violence counseling — with no cost sharing (which means that you won’t be charged a co-pay and the costs of the services won’t be applied to your deductible).

KFF’s new survey is the first in a series and is intended as a baseline measure which will be used to assess the future impact of the law. KFF also polled 700 men between the ages of 18 and 64 in order to compare their experiences to the women’s.

The findings identified several key issues, including disparate rates of uninsured and an overall lack of awareness of many of the law’s important provisions for women.

Overall, 18 percent of women aged 18 to 64 were uninsured, but low-income and minority women disproportionately lacked health insurance coverage — nearly a quarter (22%) of black women and 36 percent of Hispanic women were uninsured, compared to just 13 percent of white women. Among low-income women, 40 percent were uninsured at the end of 2013, compared to just 5 percent of higher-income women.

“Over time, as the ACA’s coverage expansion takes full effect, we expect that this profile will change, particularly as a result of the Medicaid expansion that is happening in at least half of the states,” Usha Ranji, KFF’s associate director of women’s health, said on Thursday.

Ranji added that many of the women who were uninsured when the survey was administered should have been able to gain insurance access with the launch of the state- and federally-run insurance exchanges, which offer tax credits based on a user’s income.

However, the report pointed out, “some of the poorest women do not qualify for assistance because they reside in a state that is not expanding Medicaid or are undocumented immigrants who are explicitly excluded” from Medicaid, as well as individual health insurance plans sold through the exchanges.

In March, Rep. Michelle Lujan Grisham (D-NM) introduced the Health Equity and Access Under the Law (HEAL) for Immigrant Women and Families Act of 2014, a piece of legislation that would open access to affordable health insurance coverage for legal immigrants and undocumented immigrants granted temporary deportation reprieve and work authorization under the Deferred Action for Childhood Arrivals (DACA) program. Almost 600,000 tax-paying legal permanent residents and about 600,000 DACA recipients would likely qualify. Since 2009, “the federal government gave states the option to provide immediate coverage to lawfully residing immigrant children,” according to the Miami Herald. Twenty six states and Washington, D.C. have eliminated that waiting period for children.

Some states already allow immigrant children and pregnant women to qualify for limited health coverage — California’s Medi-Cal program authorizes coverage for “citizens and certain lawfully present immigrants” like low-income DACA recipients. And studies show that people who receive quality health care and preventative services early on in life have greater health benefits and will likely pay lower health care costs in their twilight years. What’s more, states that don’t participate in the Affordable Care Act’s Medicaid expansion could cost public safety net hospitals more than $50 billion by 2019, since “uninsured and under-insured Americans cannot afford to compensate hospitals for the care they receive — and that shortfall is ultimately shifted onto the American taxpayer.”

Unfortunately, 24 GOP-led states are still refusing to expand Medicaid to cover more low-income residents. As a result, between 5 and 7 million low-income Americans who would otherwise qualify for Medicaid will remain uninsured, including over 3 million low-income women.

Without health insurance coverage, low-income women face significant barriers to accessing health care. A staggering 65 percent of uninsured women reported that they had delayed care or gone without care in the past year due to costs, compared to 35 percent if women with Medicaid and 16 percent of women with private insurance. Additionally, 42 percent of uninsured women reported that they had skipped recommended medical tests or treatments within the last year due to costs, compared to 18 percent of Medicaid-covered women and 12 percent of women with private health plans.

Not surprisingly, uninsured and low-income women reported significantly more problems paying their medical bills than insured and higher-income women. Overall, 28 percent of women said they had trouble paying medical bills in the past year, but the percentage was far higher among uninsured (52%) and low-income women (44%).

Regardless of insurance status, the cost of health care was more of a barrier to care for women than men. More women than men reported skipping recommended tests or treatments, not filling a prescription or skipping a dose of medicine, and having problems paying off medical bills. This may be because women on average earn lower wages, have fewer financial assets, accumulate less wealth and have higher rates of poverty, according to the KFF report.

Amy Allina, deputy director at the National Women’s Health Network, spoke at a briefing on the survey about the hard choices women make. “Postponing or skipping care when you can’t afford costs isn’t a crazy decision — the findings show that a significant number of women that have medical debt reported that they have to use most of their savings [to pay off debt], they have trouble paying for housing, they’re contacted by collection agencies. These are experiences that have lifelong consequences.”

The report also revealed significant barriers to care that were present even women with health insurance. Notably, many women were unaware of the important provisions of the health care law that are already in effect.

In terms of preventive care, 60 percent of women did not know that insurers must cover at least one preventive visit a year. Fifty-seven percent of women knew that services like mammograms have to be covered, but only 34 percent of women between 18 and 44 were aware that insurers help pay for breast pump rentals, and 33 percent of women were not aware that insurers now cannot charge higher premiums for women than men.

Cara James, director of the Office of Minority Health at the Centers for Medicare and Medicaid Services, which does outreach and data collection on health, said that her office will in June launch a national campaign to reach women and families on what having insurance means and how to use benefits.

Several professional groups and government agencies, including the USPSTF, the Institute of Medicine, and the Centers for Disease Control and Prevention, recommend that women in their reproductive years be tested for sexually transmitted infections such as chlamydia, gonorrhea and HIV. Knowing one’s status is important to receive early treatment and prevent transmission to sexual partners. As with provider counseling, these tests are now covered without cost sharing in new private plans under the ACA’s preventive services coverage requirements. They are also commonly included as part of family planning services under Medicaid.

Approximately four in ten women of reproductive age reported that they have had an HIV or STI test in the past two years; however,  half of these women assumed these tests were included in routine gynecological visits—which they’re not. And despite the high rates of STIs and unintended pregnancy, and the recommendations of professional groups, counseling on many of these topics is not routine among women of reproductive age — even though such counseling is covered by insurance plans under the ACA’s new guidelines. Sixty percent of women between 15 and 44 had recently had a conversation about contraception with a provider, but only 50 percent had talked about sexual history, 34 percent about HIV, and just 30 percent about STIs.

This particular finding is troubling because providers have clinical guidelines to discuss sexual health during visits, said Vanessa Cullins, vice president of external medical affairs at the Planned Parenthood Federation of America.

“If you pair that with data that many providers don’t do the test that they’re supposed to do such as annual Chlamydia under the age of 25, or determining whether or not baby boomers have Hepatitis C, means we have a lot of work to do in terms of provider and consumer knowledge,” she said.


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