Written in Collaboration with Jessica Ho and Anita Mathews
Writing A National Prescription to Improve Women's Health
Historically, women have experienced discrimination in terms of their health despite making 80 percent of health care decisions for their families, using more medical services than men, and suffering greater disability from chronic disease. Many women even pay more for their health insurance than do men because of the possibility of pregnancy and other female conditions. Furthermore, until just 18 years ago, women were excluded as subjects from much of medical research, and the data from studies were not analyzed for sex differences. Men were considered the "generic" humans, and the results were then generalized to guide the diagnosis, treatment, and prevention of disease in women. In the past, preventive interventions to reduce tobacco use, to encourage healthy diets and physical activity or to lower cholesterol levels often did not include women. Additionally, inequalities in health care limited women's access to certain diagnostic procedures and therapies proven to be effective for specific conditions. This omission of women as research subjects and as the focus of prevention campaigns, as well as limitations on access to health care services had put women's health at risk -- with rising rates of heart disease, lung cancer, autoimmune illnesses, mental and addictive disorders, and the epidemic of AIDS.
I am proud to have played a leadership role in the 1990s to write a new national prescription to improve women's health in the federal government working with a broad range of partners in the public and private sectors in the United States and globally. The guiding principle of this prescription was that our country's research, prevention and service delivery programs must target all of the nation's women -- of all socioeconomic statuses, of all ages, and of all ethnic backgrounds-- addressing the health needs of the whole woman, in body and in mind.
Some of the milestones achieved during my tenure as the country's first Deputy Assistant Secretary of Women's Health in the U.S. Department of Health and Human Services (HHS) included developing a coordinated national approach and building infrastructure in the United States to improve women's health. A women's health focus was woven into the fabric of all HHS agencies, and many new initiatives were established on a broad range of health issues. Scientific and public awareness was significantly increased, as were collaborations across agencies of the government and the private sector using a health-in-all-policies approach. In addition to women's health offices established in all HHS Agencies, I appointed regional women's health coordinators to work at the state level and envisioned and implemented the National Centers of Excellence in Women's Health program to help change the way research is conducted, physicians are trained, and health care is provided to women. Another initiative that I established was the National Women's Health Information Center (NWHIC), accessible through a toll-free telephone number (800-944-WOMAN) and on the Internet at www.womenshealth.gov, that provides consumers, health professionals, and researchers with free, state-of-the-art information on a broad range of women's health issues, linking them to thousands of cutting-edge resources in the federal government as well as the private sector. These federal initiatives have helped to improve the health of millions of women in America and around the world.
The bottom line: Just 20 years ago, women's health was neglected in the halls of public policy, at the research bench, and in clinical settings in America. Thanks to our new national prescription, this has changed. However, while there have been significant advances for women's health in recent years, one key component of the national prescription that had been missing until now was women's access to comprehensive, quality health care. In fact, 19 million women in America do not have health insurance. Women are more likely to lose their insurance if divorced or widowed, and often paid more for premiums than did men. Thanks to the recent passage of the Patient Protection and Affordable Care Act of 2010 (recently upheld by the Supreme Court), all of this will change.
How Health Care Reform Helps Women
Why is the health care reform legislation crucial for improving women's health? The United States spends $2.6 trillion on health care -- 18 percent of the gross domestic product (GDP) -- but has functioned as a "sick care" system. Only 3-5 percent of our national health budget has been spent on prevention while 75 percent of the $2.6 trillion has been for the treatment of preventable lifestyle-related diseases. This is like waiting for your car to break down before taking it in for maintenance! Furthermore, the U.S. ranks 50th on life expectancy and 37th on its health system worldwide. A RAND study found that patients in the United States get the right treatment for a disease only 55 percent of the time. The result: Americans were simply not getting what they paid for when it comes to their health care.
However, with the passage of the Patient Protection and Affordable Care Act of 2010 (ACA), there will be several significant improvements to ensure an efficient, effective, and equitable health care system for women -- and men -- over the life cycle. Currently, only 50 percent of women have employer-sponsored insurance compared to 57 percent of men. One of the victories of the legislation is the elimination of the gender rating on premiums, which will prevent insurance companies from charging women higher rates than men for coverage. Additionally, the legislation allows youth up until the age of 26 to be insured on their parents' plans. As a result of this provision in the new law, 1 million young women now have health insurance. Thanks to the ACA, an estimated 13 million more women will have coverage by 2016. Furthermore, women can no longer be denied coverage for pre-existing conditions like cancer, asthma, or depression. Additionally, the ACA's "Patient's Bill of Rights" prevents insurance companies from instituting lifetime benefit caps, dropping patients who file reimbursement claims, and spending more than 20 percent of premium payments on administrative costs.
Eligibility for the Medicaid program, which insures low-income individuals, is being expanded under the ACA to cover all Americans with incomes at or below 138 percent of poverty level (FPL). Currently, two-thirds of Medicaid beneficiaries are women, and the majority of the 55 percent of uninsured women who have incomes below 138 percent of FPL will now qualify for Medicaid coverage in 2014. Women whose incomes are between 139 percent and 399 percent of the FPL will be eligible for tax-credits towards the purchase of insurance plans.
With greater access to health care, women can benefit from the free preventive services provided by the legislation that no longer requires cost-sharing or paying deductibles. These services include well-woman visits, pap smears, mammography, cervical cancer and colon cancer screenings. Monitoring of cardiovascular health, another preventive service that is now covered under the law, is a particular benefit for women, who die in higher numbers than men from heart disease every year. In fact, heart disease is the leading cause of death among women, and regular screenings can help improve their chances of early detection, avoiding chronic disease or heart attacks.
Importantly, women's mental health services will be treated on parity with their physical health as a result of the legislation. Women are four times more likely to attempt suicide than men, and experience depression and anxiety disorders at twice the rate of men. They are also more likely to be victims of domestic violence, and the ACA covers screenings and counseling for these public health concerns as well.
Enhanced reproductive health services and perinatal care is another important component of the ACA. Contraceptives are included as part of the basic package of free preventive services that insurers are required to cover, with some exceptions given for religiously-affiliated organizations. The ACA also includes funding for a new education program that aims to inform teens about safe sexual practices and ensures that screenings for sexually-transmitted infections including HIV are readily available, especially for high-risk youth. The legislation also helps pregnant women receive the care that they need. Despite being one of the most advanced countries in the world, the United States ranks 50th in maternal health. Astonishingly, the maternal mortality rate in America has increased over the last two decades and is among the highest in the industrialized world. The ACA will help to reduce America's alarmingly high maternal mortality rate through the provisions in the law that improve pregnancy related health care. Preventive services that will be covered under the ACA with no cost-sharing include screenings for gestational diabetes, Hepatitis B, Rh incompatibility, HIV, and iron deficiency. Interventions to prevent complications due to alcohol consumption and tobacco use during pregnancy are also covered, as are folic acid supplements to prevent birth defects. Medicaid program services, which currently cover 41 percent of all births in the United States, will be extended beyond delivery for women into the post-partum period. Women will also have more options for delivery of their babies with higher reimbursement rates for nurse midwives and birth attendants. Moreover, the ACA includes additional provisions to improve maternal and child health after delivery by requiring coverage of breastfeeding support services and workplace protections for nursing women. Postpartum depression (PPD) detection and support services as well as PPD research and treatment are also covered by the new law. All of these interventions will have important protective effects on a mother and infant's health.
Women also have special needs as they age, and constitute 57 percent of the population over the age of 65, and 65 percent of the population over age 85. In addition to being more likely than men to live longer and to experience chronic illness, women are less likely than men to have the financial resources to maintain their good health later in life. The ACA expands Medicare benefits, covering prescription drugs as well as osteoporosis and other screenings for recipients, 59 percent of whom are women.
Over the past 20 years, much progress has been made to advance women's health. As a result of the passage of the ACA, a critical ingredient has been added to the national prescription to improve women's health that had been missing until now -- access to comprehensive, quality health care. The ACA focuses on the unique needs of women, from infancy through childhood, adolescence, and adulthood, and into later life. The results of this legislation should ensure a healthier future for all American women in the years ahead.
Rear Admiral Susan Blumenthal, M.D., M.P.A. (ret.) is the Public Health Editor of the Huffington Post. She is also the Director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress in Washington, D.C., a Clinical Professor at Georgetown and Tufts University Schools of Medicine, and Chair of the Global Health Program at the Meridian International Center. Dr. Blumenthal served for more than 20 years in senior health leadership positions in the Federal government in the Administrations of four U.S. Presidents, including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women's Health, and as Senior Global Health Advisor in the US Department of Health and Human Services. She also served as a White House Advisor on Health. Prior to these positions, Dr. Blumenthal was Chief of the Behavioral Medicine and Basic Prevention Research Branch and Head of the Suicide Research Unit at the National Institutes of Mental Health and Chair of the Health and Behavior Coordinating Committee at the National Institute of Health. Admiral Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the US Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. She is the author of many scientific publications and is the editor of the book, Suicide Across the Life Cycle. Named by the New York Times, the National Library of Medicine and the Medical Herald as one of the most influential women in medicine, Dr. Blumenthal is the recipient of the 2009 Health Leader of the Year Award from the Commissioned Officers Association and was named a Rock Star of Science by the Geoffrey Beene Foundation.
To learn more about Susan Blumenthal, M.D., visit 4globalhealth.org.
Jessica J. Ho is a second year at Johns Hopkins School of Public Health pursuing her Masters in Health Policy with a certificate in Public Health Informatics. She is also a Registered Dietitian and received her B.S. in Dietetics from UC Berkeley. Jessica served as a health policy fellow at the Center for the Study of Presidency and Congress in Washington, D.C.
Anita Mathews is a recent graduate of Brown University with a major in neuroscience. She is currently a Health Policy Fellow at the Center for the Study of the Presidency and Congress in Washington, D.C and will attend medical school next year.
 U.S. Department of Labor. "Fact Sheet - General Facts on Women and Job Based Health." Fact Sheet - General Facts on Women and Job Based Health. N.p., n.d. Web. 10 Oct. 2012.
 Cuellar, Alison, Adelle Simmons, and Kenneth Finegold. "ASPE RESEARCH BRIEF The Affordable Care Act and Women." The Affordable Care Act and Women: ASPE Research Brief. U.S. Department of Health and Human Services, 20 Mar. 2012. Web. 10 Oct. 2012.
 The Henry J. Kaiser Family Foundation. "Focus on Health Reform; Impact of Health Reform on Women's Access to Coverage and Care." N.p., Apr. 2012. Web. 10 Oct. 2012.
 "Women & Heart Disease Fact Sheet." WomenHeart: Women & Heart Disease Fact Sheet. WomenHeart: The National Coalition for Women with Heart Disease, 2012. Web. 10 Oct. 2012.
 Amnesty International. "Maternal Health in the U.S. - The Maternal Health Accountability Act of 2011." Maternal Health in the U.S. N.p., 2012. Web. 10 Oct. 2012.
 Blumenthal, S.J. and Maliha, G. & Mathews, A., Stopping the Surge in Military Suicides: How to Win this Preventable War, Huffington Post, September 14, 2012
 Blumenthal, S.J., Women's Health: Decades Later, What's Still Neglected, Huffington Post, March 8, 2011
 Blumenthal, Susan J. and Jenny Shelby. "Healing America's Health Care System." Huffington Post. 3 August 2012.
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