#NWHW: Women and the Affordable Care Act

CPPP's Stacey Pogue

Last week during National Women’s Health Week (#NWHW), the Kaiser Family Foundation released findings from the 2013 Kaiser Women’s Health Survey.  The survey looks at a range of women’s health issues and helps establish a baseline for changes that women may experience as a result of the Affordable Care Act .  The ACA makes significant improvements in women’s access to care like preventing insurers from charging women more than men and requiring coverage of maternity and coverage of contraception with no copays in many policies.

A few items that jumped out at me from the survey include:

Women are more likely to face burdens due to health care costs than men, in part because women earn less on average and have fewer financial assets.  Women were more likely than men to delay or forego health care due to cost (26% of women and 20% of men) and more likely to have trouble paying off medical bills (28 percent of women and 19 percent of men).

The ACA’s mandate for insurance coverage of FDA-approved, prescription contraceptives with no copays or deductibles first took effect in 2012; yet at the end of 2013, only 35 percent of women with private health insurance reported having contraceptives covered with no added cost.  More women (41 percent) say insurance covered some of the cost, while 13 percent report lacking contraceptive benefits in their insurance policy.

Kaiser ACA women's health survey

One reason that women with private insurance report having to still pay for contraceptives is because insurers are given discretion over which birth control pills to cover with no copay.  We’ve heard from a few Texas women whose insurance appears to not cover all generic birth control pills with no copay, much less cover all brand-name pills that do not have a generic equivalent.  If you have insurance and are being charged for contraceptives, this National Women’s Law Center tool kit can help you figure out why and appeal your health insurer’s decision, if needed.

A sizable minority (32 percent) of sexually active women using contraceptives are using highly effective long acting reversible contraceptives (LARCs).   LARCs include IUDs, contraceptive implants, and injections.  The rate of LARC use may rise with the ACA’s requirement that insurance cover contraceptives with no co-pays.  LARCs are more effective at preventing unintended pregnancy than more common contraceptives like birth control pills and condoms.  However, LARCs have a much higher up-front cost, which can create a cost barrier for some women.

What’s going on with LARCs in Texas? LARCs were one of the topics discussed at February’s state Senate Health and Human Services Committee interim hearing on women’s health.  Researchers from the University of Texas recommended ways to increase the availability of LARCs through Texas’ subsidized family planning programs to further decrease unintended pregnancy rates.  Their research documents substantial demand for LARCs by low-income women in Texas, as well as barrier to access.  For example, our states’ newest family planning program, the Expanded Primary Health Care program, does not require providers to offer LARCs and providers report that they had to decrease access to more expensive LARCs in response to drastic budget cuts to the state’s family planning programs in 2012-13.

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