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On March 23, 2010, the Affordable Care Act (ACA) was signed into law.  Two years later, we are days away from oral arguments in the case before the U.S. Supreme Court that will decide its fate.  These two occasions have prompted us at the National Health Law Program (NHeLP) to pause and take stock of all that the ACA has done, or will soon do, to improve the health and well-being of low-income and underserved individuals.

In honor of the ACA’s second birthday, and acknowledging all that is at stake in the Supreme Court, NHeLP is pleased to present our “Top 5” list of the ways the ACA addresses women’s health needs.  In truth, it was difficult to whittle the list down to only five.  But here are our personal favorites:

1) Medicaid expansion.  Medicaid already does so much for women.  In fact, women make up three-quarters of the current adult Medicaid population.  However, only women who are pregnant, parenting or living with a disability have historically qualified for enrollment.  The ACA changes that by expanding eligibility in 2014 to all individuals with incomes below 138 percent of the federal poverty level. For the first time, low-income women who do not meet previous eligibility criteria - 55% of currently uninsured women - will qualify for Medicaid coverage.  On top of that, the ACA ensures that the new Medicaid enrollees will receive family planning benefits with the freedom to choose a provider and without cost-sharing.  These are major wins for uninsured low-income women, easily earning the Medicaid expansion the number one spot in our Top 5.

2) Access to preventive care.  The ACA requires all new insurance plans to cover certain preventive health care services without cost-sharing.  This is particularly important for women who, when compared to men, have more preventive health needs, lower incomes, and are more likely to forgo necessary preventive care due to cost.  The list of required benefits includes critical women’s health services such as:  mammograms; screenings for cancer, gestational diabetes, domestic violence, HIV and sexually transmitted diseases; lactation and breastfeeding support and equipment; well-woman visits; and all FDA-approved contraceptive options, ensuring that each woman can obtain the method that is most appropriate for her life and medical condition. Those opposed to contraception are attempting to undermine these guarantees with a broad exemption that would allow any employer to refuse to provide coverage of any health service for any reason.  NHeLP and others are fighting to protect these Top 5-worthy women’s preventive health care gains against attacks on quality health care coverage.

3) The end of discriminatory insurance practices that harm women.  Several provisions in the ACA work together to prevent harmful insurance practices. No longer will insurers be permitted to deny women coverage based on “preexisting conditions” such as pregnancy, cesarean sections or domestic violence.  The ACA requires insurers to sell insurance to any woman no matter her medical history, current condition or health factors.  No longer will insurers in the individual and small group markets be permitted to charge women higher premiums than their male counterparts; this practice of “gender-rating” is prohibited for new plans beginning in 2014.  And for the first time, the ACA prohibits sex-based discrimination by all health programs and insurers that receive federal funding (or are administered by an executive agency like the federal Department of Health and Human Services).  We celebrate these important ACA victories for women and only wish they had happened sooner.

4) A new option for state family planning coverage.  The ACA also created the new Family Planning State Option which allows states to expand access to family planning services and supplies by electing to cover a new Medicaid eligibility category for individuals who need family planning services, but who do not qualify for full-scope Medicaid.  Before the ACA, states had to request permission from the Federal government through a “waiver” to provide this kind of coverage.  Waivers must be budget neutral, are temporary and allow states to limit enrollment or services to stay within specified caps on spending.  In contrast, the new Family Planning State Option allows states to incorporate this coverage into their permanent state Medicaid program and creates an entitlement (without enrollment caps) for all those who qualify, including men.  Better family planning coverage leads to better overall health outcomes for women and children and improves women’s educational and economic opportunities. Thank you, ACA, for creating another pathway to family planning access for these populations.

5) Required coverage of maternity care.  Not surprisingly, pregnancy is one of the most common and significant medical events experienced by women. And yet, according to a report by the National Women’s Law Center, a staggering 87 percent (!) of individual insurance plans do not cover maternity care.  The ACA requires that all new plans in the individual and small group markets, as well as new Medicaid and state “Basic Health” plans, cover maternity care as a part of the Essential Health Benefits package.  Under this change, millions of women will have access to affordable coverage for the services they need to stay healthy during pregnancy and safely give birth to healthier babies.  This incredible victory is more than deserving of the final spot in our Top 5.

On behalf of all of us here at NHeLP, for all of these and other important health care gains, we wish you a happy second birthday, dear ACA!  Here’s hoping that the Supreme Court allows us to celebrate many more.

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