The Affordable Care Act includes several provisions that are expected to significantly improve women’s health. The Affordable Care Act improves coverage for important preventive services and maternity care, promotes higher quality care for older women, and ends the gender discrimination that requires women to pay more for the same insurance coverage as men. Over one million young adult women have already gained health insurance coverage because of the Affordable Care Act and 13 million more women will gain coverage by 2016.
Starting in 2014, 8.7 million more women who currently buy coverage in the individual market will gain maternity coverage, as part of the Affordable Care Act’s requirement for plans to cover essential health benefits. 2 Currently, 62 percent of individual market enrollees do not have maternity coverage.
The Affordable Care Act helps to make prevention affordable by requiring most private health insurance plans to cover recommended prevention and wellness benefits without cost-sharing. 3 Insurers must now cover mammograms, screenings for cervical cancer, prenatal care, flu and pneumonia shots, and regular well-baby and well-child visits with no cost-sharing. An estimated 20.4 million women are currently receiving expanded preventive services without cost-sharing because of the Affordable Care Act. 4 Starting in August 2012, additional recommended preventive services including well-woman visits, screening for gestational diabetes, domestic violence screening, breastfeeding supplies, and contraceptive services will be covered by health plans with no cost-sharing. 5 Eliminating such barriers as copayments, co-insurance, and deductibles will increase access to services that improve the health of women and their children. 6 For example, prenatal care helps improve maternal health and birth outcomes. 7
Women represent 56.9 percent of Americans aged 65 years and over, almost all of whom participate in Medicare. 8 The 24.7 million women who have coverage through Medicare can now receive additional preventive services without cost-sharing, including an annual wellness visit, a personalized prevention plan, mammograms, and bone mass measurement for women at risk of osteoporosis. 9
The Affordable Care Act expands prescription drug coverage under Medicare by closing the Medicare prescription drug coverage gap, often called the “donut hole.” 10 More than 2 million women are already benefitting from this provision, saving $1.2 billion on their prescription drugs. 11 This number is projected to grow to 3 million women, saving $4.9 billion in 2021, as the donut hole is fully closed over the coming decade. 12
Today, many insurance companies in the individual market charge women higher premiums than men. A 25-year-old woman enrolled in a health plan — one that does not cover maternity care — may pay as much as 81 percent more than a 25-year-old man enrolled in the same plan. 13 Similarly, a 40-year-old non-smoking woman pays up to 57 percent more than a 40-year-old male smoker in the same plan. Beginning in 2014 insurance companies in the individual and small-group health insurance market may no longer charge higher rates due to gender or health status. Premiums can vary based on age, tobacco use, family size and geographic location, within limits set by the Affordable Care Act.
Today, most nonelderly women are covered by health insurance offered by employers. However, women are more likely than men to be covered as family members through their spouse’s employer. 14 That means that women’s coverage is often dependent on their spouse’s circumstances. Depending on their coverage, women can lose their health insurance coverage if they lose their job, or if they become widowed, divorced, or if their husbands lose their jobs. The Affordable Care Act expands the availability of insurance options, outside of employer-sponsored insurance, for all Americans, providing a larger range of insurance options and improving the security of insurance for women.
Already, young adults ages 19-25 can be covered under their parents’ employer-sponsored or individually purchased health insurance. 15 In the first nine months after this provision took effect, the proportion of young adults in this age group with health insurance increased by 8.3 percent. 16 Today, an estimated 1.1 million young women have health insurance coverage because of this provision of the Affordable Care Act. 17
By 2016, an additional 13.5 million women are expected to gain health insurance through other provisions of the Affordable Care Act (Figure 1). 18 Starting in 2014, new Affordable Insurance Exchanges will provide women without access to employer-based coverage with one-stop marketplaces where they can choose the coverage that best fits their needs and have the same kinds of insurance choices as members of Congress. 19 Women with incomes up to 400 percent of federal poverty guidelines (currently $89,400 for a family of four) will be eligible to purchase coverage using tax credits. In addition, the Affordable Care Act expands Medicaid coverage to include almost all Americans with family incomes at or below 133 percent of federal poverty guidelines (currently $30,657 for a family of four); the expansion includes adults without dependent children who have not historically been eligible for Medicaid in most states. 20
The Affordable Care Act benefits women in many other ways, including:
The Affordable Care Act strengthens health care for women in all age groups. Women with private insurance coverage are already benefiting from expanded coverage of preventive services, and will soon be paying fairer premiums as well. Millions more have benefitted from improvements in the Medicare program. And many women who would otherwise remain uninsured will gain coverage beginning in 2014.
Table 1. Key Benefits of the Affordable Care Act for Women