6 Things We Should Demand From Healthcare Coverage
Illustration: Ana Yael
The Affordable Care Act of 2010 (ACA, a.k.a. Obamacare), while imperfect, was a boon for women's healthcare coverage. "Many people don't realize that it's because of the ACA that they can get mammograms or well checkups at no cost," says Alina Salganicoff, director of women's health policy at the Henry J. Kaiser Family Foundation. "The ACA stopped insurers from charging women higher premiums on the individual market or denying them coverage."
Of course, change is now afoot. Yet healthcare should be a nonpartisan issue. That's why we need to let decision-makers know that no matter what new or revamped health plan they support, there are certain demands from which we cannot back down.
1. Must Have: Coverage without consideration for genderBefore the ACA, insurers in some states could reject previously uninsured women for having preexisting health "conditions," including a current pregnancy, a previous C-section, and—unbelievably—treatment for rape and a history of domestic abuse.
Even without so-called preexisting issues, women got a raw deal. A 2012 study by the National Women's Law Center in Washington, D.C., found that nearly one-third of individual insurance plans charged women at least 30 percent more than men for coverage—"even when their plans didn't include maternity coverage," says NWLC's Gretchen Borchelt.
Liberation from discriminatory insurance policies isn't just good for our physical health; it helps us get ahead. "When women know they can afford a quality individual plan, they are no longer locked into a job just for the insurance. They're freer to go back to school or start their own business," says Borchelt.
And lest you assume this doesn't matter if you don't want kids, already have them, or are part of a plan that provides great benefits for women, keep in mind that other people's health issues eventually take a financial toll on everyone in the community. "Poor prenatal care raises the risk of kids being born preterm and with health issues. This can affect parents' ability to work and to support their family," says Michael Miller, MD, senior policy adviser to HealthyWomen, a national health education group based in New Jersey. Families that lose their economic footing may need to rely on public assistance to stay afloat, Miller says. Healthcare is expensive, but not providing healthcare still has significant costs to society.
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Spending caps hit women particularly hard. Treating long-term illnesses that predominantly affect women, like multiple sclerosis, can run upwards of $100,000 a year in the most severe cases, eventually outpacing lifetime spending caps.
Even if lawmakers don't go back to explicitly permitting spending caps, insurers may be allowed to limit their costs nonetheless: Federal legislators could change the preexisting condition rules so that states may let insurers effectively price people with serious health conditions out of the individual market. Those with a chronic illness would then apply for admission to new state-run high-risk pools, which are currently banned by the ACA. "In the past, these pools had waiting lists and high premiums," says Miller. "Their return would drive up premiums for many people who would be least able to afford them because they have serious chronic illnesses."
The ACA currently requires all new individual and small-group plans to provide coverage for mental health services. Yes, there's plenty of room for improvement—for instance, many clinicians don't accept insurance, partly because reimbursements are low relative to the time it takes to provide therapy. But from the ACA's perspective, seeking therapy for depression is as valid as seeing an ENT for an ear infection. Families struggling with substance abuse no longer have to choose between receiving inpatient treatment and, say, keeping their homes. Services for those who suffer from PTSD or sexual abuse are more affordable for more women. These protections have become increasingly vulnerable in the current debate.
Under ACA regulations, the majority of plans are required to cover all 18 forms of contraception approved by the FDA when prescribed by a doctor. If coverage goes away, women may be unable to afford methods like IUDs, which range from $500 to $1,000, and implants, which can cost up to $800. Even brand-name versions of the pill can run $600 or more a year without insurance. Contraception works only if women can obtain and use it consistently. Yet a 2010 Planned Parenthood survey found that one-third of female voters struggled to afford prescription birth control at some point in their lives.
Research has shown that birth control helps more women advance their education and participate in the workforce. Planned pregnancies also tend to have better health outcomes for mother and child. That means fewer bills for insurers to cover, which helps control everyone's premiums. It also means a healthier and happier existence for women—and we should consider that our right.
Read more: 7 Ways to Fight for Better Healthcare Coverage