New York, NY, July 30, 2010—Thirty million women will
benefit from the new health reform law over the next decade, either
through new or strengthened insurance coverage, according to a new
report from The Commonwealth Fund. In the first analysis of its
kind, the authors report that the law will stabilize and reverse
the growing exposure to health costs that women now experience by
subsidizing health insurance for up to 15 million currently
uninsured women, and strengthening existing coverage for 14.5
million women who are considered underinsured—those who have
health coverage that does not adequately protect them from high
medical expenses. Provisions important to women will expand
eligibility for Medicaid; provide subsidies to purchase insurance;
limit out-of-pocket spending; prevent insurers from charging higher
premiums or denying coverage based on health status or gender; and
require new plans to cover maternity and newborn care. These
provisions will also help uninsured women who earn too much to
qualify for Medicaid or premium subsidies gain comprehensive
coverage.
Although women are just as likely to be uninsured as men, their
health care needs leave them more vulnerable to high health care
costs and problems related to loss of health insurance. Because
insurance carriers consider women, particularly those of
reproductive age, higher risk than men, women report greater
difficulties gaining coverage in the individual insurance market
and are charged much higher premiums for the same benefits than men
of the same age. Further, most individual policies do not cover
pregnancy.
Another important provision that will help an estimated 100,000
uninsured women gain coverage is the Pre-Existing Condition
Insurance Plan (PCIP) to provide temporary coverage to adults with
pre-existing conditions who are uninsured during 2010 to 2013.
Seventeen states and the District of Columbia began enrollment in
PCIPs in July, and 12 will begin to enroll adults in August; in the
21 states without a PCIP the federal government began operation of
a PCIP July 1st.
"Historically, women have been more vulnerable to high health
care costs and have had greater difficulty paying medical bills
because of their lower incomes," said Commonwealth Fund President
Karen Davis. "This report provides good news to all women, who will
be more likely to get the care they need, with reduced risk of
incurring the unaffordable medical bills that have affected so many
Americans."
Realizing Health Reform's Potential: Women and the Affordable
Care Act of 2010 is the first in a series of Fund reports that will
focus on how health reform is expected to impact various
populations. It describes when provisions of the new law affecting
women take effect, and how many women will be affected by specific
provisions. Beginning in 2014, Medicaid coverage expansions and
subsidized coverage through state health insurance exchanges could
assist 15 million working-age women who currently lack insurance.
The majority of these gains come from Medicaid coverage expansions
that may affect up to 8 million currently insured women who earn up
to $14,000 or are in families with incomes up to $29,000.
Women living in states with higher than average uninsurance
rates stand to gain the most from the new law: New Mexico and Texas
(29% uninsured in 2008); Florida and Louisiana (24% uninsured); and
Alaska, Arizona, Arkansas, California, Georgia, Mississippi, West
Virginia, Idaho, Kentucky, Nevada and Oklahoma (at least 20%
uninsured).
Although women will have to wait until 2014 to begin to reap the
greatest benefits from expanded and improved insurance coverage,
several early provisions beginning in 2010 will also provide
important support, the study shows. These include:
- Strengthened and expanded insurance coverage for young adults,
through policies that allow adult children up to age 26 to come on,
or stay on, their parents' plans, and bans on pre-existing
condition exclusions;
- Bans on lifetime benefit limits and phase-out of annual
limits;
- Bans on rescissions of insurance policies;
- Coverage of recommended preventive services without
cost-sharing including mammograms;
- Eligibility for a new plan that covers uninsured people with
pre-existing conditions that currently make it difficult for them
to gain coverage; and
- Rebates to women enrolled in Medicare who reach the "doughnut
hole" in their prescription drug plans; women, along with people
with diabetes and Alzheimer's or other forms of dementia are most
likely to reach this gap in coverage.
Insurance Market Reforms
Nearly two in five women—an estimated 7.3
million—between the ages of 19 and 64 who tried to buy
individual insurance plans over a three-year period were turned
down, charged a higher price or had a pre-existing condition
excluded from their plan. Beginning in 2014, all insurers must
accept everyone who applies for coverage and cannot charge higher
premiums based on health status or gender.
In addition, all health plans sold through new state insurance
exchanges in both the individual and small group markets will have
to cover maternity and newborn care as part of the federally
determined benefit packages described below.
"Women who have an individual insurance market policy that
charges them higher premiums than men, who have been unable to
secure coverage for the cost of a pregnancy, or who have a
preexisting health condition excluded from their benefits will
ultimately find themselves on a level playing field with men, with
a full range of comprehensive benefits, including maternity
coverage," said lead study author Sara Collins, a vice president at
the Commonwealth Fund.
Insurance Exchanges and Subsidies
Uninsured women who earn too much to qualify for Medicaid will
be able to purchase policies through state-run exchanges that will
offer federally determined essential benefit plans with four levels
of cost-sharing with an annual cap on out-of-pocket costs of $5,950
for individuals and $11,900 for families, beginning in 2014. In
addition, women with incomes under 400 percent of poverty, or
$88,000 for a family of four, will be eligible for subsidies to
offset their premiums and out-of-pocket costs. Up to 7 million
currently uninsured women may gain subsidized coverage through the
exchanges.
"Today many health plans don't provide a comprehensive set of
affordable benefits, forcing women to choose between paying
out-of-pocket for necessary service or delaying or skipping care.
Better information and benefit plans that are easier to understand,
along with subsidies to offset their costs, will make a significant
difference for American families," said Collins.
Women who own businesses with fewer than 50 or 100 employees,
depending on the state, will also be able to purchase a health plan
through the exchanges.
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