March is Women's History Month, a time to celebrate the struggles and achievements of American women who have reshaped our nation's history and advanced the cause of equal rights for all people. One of the more recent historic accomplishments for women was the enactment of the Affordable Care Act (ACA). While the law is groundbreaking, we know that in reality, laws are not always implemented in the way that they were intended. As we mark Women's History Month and approach the third anniversary of the ACA, we need to redouble our efforts to assure that it delivers on its promises to women.
The ACA ushers in a new era for American women who have faced discrimination in health coverage by guaranteeing that women are not denied insurance because of preexisting conditions such as breast cancer, by eliminating gender rating for health insurance, and by covering preventive services such as contraception and well woman visits without co-pays. These policies and their future impact on women are being shaped today as the law is being implemented; and while policymakers hold hearings and commission reports on ACA implementation, there has been a notable lack of interest in how reform can improve women's health.
In fact, early signs raise some red flags regarding whether the law will meet its potential in serving women. Take the law's no-cost coverage for preventive services. The ACA policy was intended to promote access to evidence-based services that are good for women's health. You've probably heard a lot about contraception, but there are many other services that have not received as much attention, such as breastfeeding. The ACA policy is meant to provide women with access to lactation consultations and pumps, which can make the difference in the initiation and duration of breastfeeding. However, there are reports that some women have had limited options in the types of pumps they can obtain and some are being charged out-of-pocket costs up front, the exact barriers the policy was meant to remove.
To ensure that women's health concerns are prioritized in new policies, we have designed a "checklist" that policymakers and advocates can use in developing the Exchanges, online marketplaces where the uninsured can obtain insurance beginning next year. Ensuring the "Health Care Needs of Women: A Checklist for Health Exchanges" raises important questions and provides critical resources for integrating the needs of women into exchange design and implementation. Developed through a unique partnership between the Connors Center at Brigham and Women's Hospital, the Jacobs Institute of Women's Health at George Washington University, and the Kaiser Family Foundation, it is informed by years of women's health research including lessons learned from Massachusetts reform, the model for national reform.
Questions raised include:
- Will benefit packages and provider networks offered by Exchange plans include the range and scope of health services needed by women? Coverage for services important to women such as treatments for eating disorders, interpersonal violence counseling, and abortion services will need to be addressed. Will providers with expertise in women's health such as family planning clinics be included in plan networks?
- How will Exchanges oversee the new benefits for no-cost preventive services for women to maximize access? For example, some women may not be covered for their current contraceptive if it is a name brand. If generic alternatives are not good options for them, will they get coverage for their contraceptive of choice and what will be the process for obtaining coverage?
- How will the Exchanges measure and report the impact and outcomes of health reform on women's health and access to care? In Massachusetts, the largest health reform initiative to date, state systems still do not routinely collect or report data by sex on important measures, such as how many of the remaining uninsured are women.
The passage of the ACA was groundbreaking, but the hard work and vigilance must continue during this critical stage of ACA implementation. How women fare under the ACA will be an important measure of its success. So as we celebrate Women's History Month, we must assure that the passage of the ACA is used to advance the achievements made by our mothers and grandmothers. Our choices today about the ACA will define the women's health accomplishments our daughters will celebrate in the future.
Co-authored with Alina Salganicoff, Ph.D. and Susan F. Wood, Ph.D.
Susan Wood is an Associate Professor of Health Policy at the George Washington University School of Public Health and Health Services, and Director of the Jacobs Institute of Women's Health Services where her work and public advocacy focuses on the use of scientific knowledge in public policy.
Alina Salganicoff is Vice President and Director of Women's Health Policy for the Kaiser Family Foundation. She directs the foundation's work on health coverage and access to care for women, with an emphasis on challenges facing underserved populations, including low-income and uninsured women, women on Medicaid as well as women of color. Widely regarded as an expert on women's health policy, Dr. Salganicoff has written and lectured extensively on health care access and financing for low-income women and children. Dr. Salganicoff was also an Associate Director of the Kaiser Commission on Medicaid and the Uninsured and specialized on coverage and access issues facing low-income women and children, Medicaid managed care, and state health reform. She also worked on the program staff of the Pew Charitable Trusts.