WASHINGTON -- Although the requirement that contraception be covered by employers' health care plans was not an issue addressed by the Supreme Court on Thursday, the measure has become one of the most controversial aspects of the Affordable Care Act. But Thursday's decision upholding the law will have a profound effect on millions of women that extends far beyond free birth control.
Beginning in August, woman of all income brackets will be able to obtain contraception, annual well-woman visits, screenings for sexually transmitted infections and gestational diabetes, breastfeeding support and supplies, and domestic violence screenings without any co-pays or deductibles. Currently, 62 percent of women buying health insurance in the individual market do not have maternity coverage, but under the health care law, 8.7 million more women will gain that coverage starting in 2014.
The Affordable Care Act also prohibits insurance companies from charging women higher premiums than men for the same insurance coverage and from denying women health coverage for such "preexisting conditions" as breast cancer, pregnancy and domestic violence.
"Being a woman, i.e., being able to give birth, is one of the primary issues for gender rating, and that is no longer allowed under the Affordable Care Act," said Dr. Paula Johnson, chief of the women's health division at Brigham Women's Hospital and a member of the Institute of Medicine panel that recommended preventative care coverage for women under the health care legislation. "The fact that insurers are no longer able to discriminate with regard to pre-existing illness is a major victory."
One often-overlooked benefit of the law for senior women, who make up the majority of Medicare beneficiaries, is the fact that it closes the "donut hole" for prescription drugs. Medicare Part D covers prescription medicines up to a certain total amount; then seniors must pay for medicine out of their own pocket until their costs reach a much higher amount and the coverage kicks in again. The Affordable Care Act narrows this gap to help seniors afford their medications.
"A greater proportion of seniors are women, and of those seniors, women tend to be more at risk financially and have more chronic illnesses and out-of-pocket costs," Johnson said. "We have to look at these policies through the lens of women's health to understand that many of these issues are critically important to women and why that is."
Some religious organizations, anti-abortion advocates and conservative women's groups remain opposed to the health care reform, arguing that it politicizes women's health by forcing religious employers to provide contraception coverage to their employees and allows certain state health insurance exchanges to charge members for abortion coverage (albeit through a separate fee). Charmaine Yoest, president of Americans United for Life, has called the Affordable Care Act "the largest expansion of abortion since Roe v. Wade," and Penny Nance, president of Concerned Women for America, said Thursday's decision would "especially hurt" women.
"As we have seen with the contraception mandate, the politicization of so-called women issues by the left leaves the majority of women extremely vulnerable to the exploitation of a few radical groups that exert much political influence in Congress and the White House," Nance said in a statement.
Planned Parenthood, on the other hand, released a statement Thursday calling the Affordable Care Act "the greatest advance in women’s health in a generation."
CLARIFICATION: Language in an earlier version of this article suggested that all religious organizations are opposed to the Affordable Care Act. In fact, while the U.S. Conference of Catholic Bishops has been an outspoken faith-based opponent, many religious groups support the law.