*Note: Numbers might not add to 100% because people are allowed to report more than one source of insurance.
Challenge: Smooth Eligibility 100% Federal Money Exchange which State will set up- will it be passive? Active? 2. Insurance Reforms: -No pre-existing conditions refusals. -Gender. -Health Status. -No lifetime or annual limits. -No dropping your insurance coverage when you get sick. Selling the plan -40 – 53 Won’t drop me when I get sick Mammograms Able to stay on parents coverage until 26. 3. Personal Responsibility -Approps: No funds can be used for: Cesareans DV- 7 States - Workforce - Scholarships - Max. Residency slots -primary care -general surgery -Tax Relief -Low Interest Loans -CHC’s
Why The Affordable Care Act Matters: The Women's View
Why the Affordable Care Act Matters: The Women’s View Judy Waxman National Women’s Law Center November 2012
Where Do Women Get Their Health Coverage? Women’s Health Insurance Coverage in 2011 Other Public = Biggest impact of ACA coverage provisions Insurance, 6.00% Individual Market, 7.70% Employer Medicaid, 12.30% Sponsored Insurance (ESI), 59.80% Uninsured, 19.60%Source: National Women’s Law Center analysis of 2011 health insurance data from the U.S. Census Bureau CurrentPopulation Survey’s (CPS) 2011 Annual Social and Economic (ASEC) Supplements
What’s At Stake for Women• Women make 80% of health care decisions for their families• More than half of women reported going without necessary health care because they couldn’t afford it. (52% women vs. 39% men)• Close to half of women reported going without preventive care and dental care because of cost (45% vs. 36%)
Turning to Fairness• Annually, gender rating could cost women approximately $1 billion• Gender rating is prevalent throughout the country – In states that allow the practice, 92% of plans gender rate – Only 14 states have banned or limited gender rating on the individual market – 25-year-old women were charged as much as 85% more for coverage• Wide variations across and within states raise questions about the arbitrariness of gender rating, undercutting insurance industry defense• Maternity coverage does not explain the difference
Maternity Coverage• Out of 3,331 plans available to 30 year old women on the individual market, only 12% cover maternity care• Only 226 plans even offer the option of purchasing maternity coverage for an additional monthly premium• The maternity riders available cost between $15 to $1,615 extra a month.
AFFORDABLE CARE ACT A Three Legged Stool1. Coverage • Exchange and Tax Credits • Medicaid1. Insurance Reforms2. Personal Responsibility • Exceptions
Essential Health Benefits• Ambulatory patient services.• Emergency services.• Hospitalization.• Laboratory services.• Maternity and newborn care.• Mental health and substance use disorder services, including behavioral health treatment.• Pediatric services, including oral and vision care.• Prescription drugs.• Preventive and wellness services and chronic disease management.• Rehabilitative and habilitative services and devices.• Special rules for abortion.
Women’s Preventive Services• Well-woman visits• Screening for gestational diabetes• Human papillomavirus (HPV) DNA testing for women 30 years andolder•Sexually-transmitted infection counseling•Human immunodeficiency virus (HIV) screening and counseling•FDA-approved contraception methods and contraceptive counseling•Breastfeeding support, supplies, and counseling•Domestic violence screening and counseling
Challenges Ahead• Medicaid/Exchanges• Educating consumers, providers, and insurance companies• Evaluating where the cracks are such as • Need for more providers • Improving coordination of care • Holding down costs
The Promise of the ACA• Change the assumptions of the American healthcare system• Become a country where everyone has access to health insurance• Become a healthier, more productive nation