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Understanding the Affordable Care Act

What does the new Affordable Care Act mean for women’s healthcare and pregnancy? It’s a question we hear often at Arizona Associates for Women’s Health. We put together this resource to help explain the recent changes to health insurance laws. This resource doesn’t just apply to our patients here in Mesa or Tempe; this resource can be beneficial for all women in the United States who want to better understand their healthcare options.

Understanding the Affordable Care Act & Medicaid Expansion

The Affordable Care Act (a.k.a “ObamaCare”) was signed into law in March 2010 and became effective October 2013. The objective of the Affordable Care Act is to expand Medicaid coverage to more women, thereby increasing the percentage of insured U.S. women. As of the time of writing, Arizona supports the expansion of Medicaid, and legislation authorizing the Medicaid expansion has been signed into law. (Click here for up-to-date information on your state’s status.) This expansion is projected to open up Medicaid coverage to 300,000 additional state residents in Arizona.

The American College of Obstetricians and Gynecologists (ACOG) “fully supports the expansion of Medicaid as proposed in the ACA. States that proceed with expansion of their Medicaid programs will realize improvements in women’s health and the health of their communities.”

According to ACOG, uninsured women face adverse health outcomes that are less likely to be the case with insured women. Examples include:

  • “Uninsured women are 60% more likely than insured women to receive a diagnosis of late-stage cervical cancer.”
  • “Uninsured women with breast cancer are 30–50% more likely to die from cancer or cancer complications than insured women with breast cancer.”

The Medicaid expansion, states ACOG, would reduce the percentage of uninsured women (ages 19-64) from 20% to 8% if all states implemented the Medicaid expansion.

Other Goals of the Affordable Care Act

In addition to increasing coverage through Medicaid, the Affordable Care Act is supposed to reduce barriers to healthcare and help further women’s rights and protections. Here are a few general ways in which the Affordable Care Act makes obtaining healthcare easier:

  • Benefit summaries are now presented in a readable, easy-to-understand format.
  • Elementary paperwork mistakes are no longer grounds for an insurance provider to drop a customer.
  • Consumers now have access to services that provide answers to questions about health insurance coverage. (Currently Arizona does not offer a Consumer Assistance Program.)
  • Patients with preexisting conditions can now receive coverage.
  • Rate hikes of 10 percent or more must be evaluated by an impartial third-party.
  • Women may schedule an appointment with an OB-GYN without a physician referral.
  • Women have more options in choosing a physician.

Specific OB/GYN Healthcare Benefits Through Affordable Care Act

How does the Affordable Care Act affect your access to gynecologic care? Perhaps one of the biggest changes is the number of preventative services that women can now obtain without co-pays. These include:

  • One annual well-woman visit (multiple visits are covered if they are necessary for obtaining all preventative services)
  • Gestational diabetes screening (two screenings for women at high-risk for diabetes)
  • HPV testing (at least once every three years, beginning at age 30)
  • Annual counseling for sexually transmitted infections
  • Annual counseling and screening for HIV
  • Contraceptive methods and counseling, as prescribed
  • Breastfeeding support, supplies, and counseling in conjunction with each birth
  • Screening and counseling for interpersonal and domestic violence

(Source)

Other Ways the New Health Insurance Laws Affect Women

The following ten benefits, summarized by ThinkProgress, highlight the biggest changes women will notice under the Affordable Care Act:

  1. Insurers are now required to cover certain recommended preventative services (as outlined in the above section) without cost sharing.
  2. Maternity care will now be required in new individual and small group plans. (Prior to the ACA, only 12 percent of plans sold in the individual market offered maternity coverage.)
  3. Women can no longer be denied healthcare coverage because of gender-specific pre-existing conditions, such as having had a Caesarean section.
  4. “Gender rating,” a common practice in which insurers charge women a higher rate than men – despite offering the same benefits – is now illegal in all new plans.
  5. The new health insurance laws allow women to see an OB-GYN without physician referral. Women can also choose their own primary care provider, as well as their child’s pediatrician from a list of participating providers.
  6. Individuals who earn up to $43,000 per year and families of four with an annual income of $92,000 or less are now eligible for tax credits. This makes health insurance more affordable for women and their families.
  7. Under the Affordable Care Act, lifetime coverage caps have been eliminated and annual limits are being phased out. This means that women with chronic conditions or extremely high medical expenses will no longer be turned away by their insurer once they reach a certain dollar limit.
  8. Health insurers are required to spend at least 80 percent of premiums on providing healthcare (as opposed to their own administrative costs). This means unused healthcare dollars are returned to consumers in the form of a check rebate or credit. Additionally, providers can no longer take a consumer off a plan once the consumer becomes sick.
  9. Women in marginalized communities – who are less likely to receive quality coverage – will see reforms that provide better treatment and reduce discrimination.
  10. Lastly, under the Affordable Care Act, young adults can stay on their parents’ plan until the age of 26. This is a huge benefit for young women; it also provides peace of mind for their mothers!

Approximately 47 million women are now able to receive coverage of preventative services, wellness services, and better-priced insurance. The current deadline for Americans to enroll in Obamacare – without facing penalty – is March 31, 2014.

Have more questions about how the Affordable Care Act affects women’s healthcare? Contact your insurance provider. To schedule an appointment with a gynecologist in Tempe or Mesa, contact us. Or, schedule your next OB-GYN appointment online.

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