Insurance News

Thirty Million Women Will Gain From Health Reform Law, Including About 15 Million Uninsured

Posted on: August 3, 2010

Approximately thirty million American women will gain from the new health reform law over the next ten years, according to a new report from The Commonwealth Fund , a private foundation based in New York.

The authors state that the law will stabilize women’s growing exposure to ever-increasing health costs, and even reverse it, by subsidizing health insurance for approximately 15 million women who currently have to no health insurance cover, while at the same time strengthening existing coverage for another 14.5 million women deemed underinsured . Underinsured refers to individuals whose existing coverage only partly protects them from high medical bills.

Provisions of relevance to women include:Expanded eligibility for MedicaidProvision of subsidies to purchase health insuranceLimiting out-of-pocket expensesPreventing insurance providers from charging higher premiums or turning down coverage based on gender or health statusMandatory new plans to cover pregnancy, childbirth and newborn careUninsured women who earn too much to qualify for Medicaid or premium subsidies will be able to gain comprehensive coverage.

Why specifically women?The authors write that:Although the risk of not being insured is the same for both sexes, women’s health care needs leave them more vulnerable to high health care costs and difficulties associated with loss of health insurance.Insurers tend to see women, especially those of reproductive age, as a higher risk than men. This results in higher charges for women than men of the same age, and more difficulties in getting good cover in the insurance market.The majority of policies exclude pregnancy cover.Another key provision that will help out about 100,000 currently uninsured women gain coverage is the Pre-Existing Condition Insurance Plan (PCIP) to provide provisional coverage to adults with pre-existing conditions who are uninsured during the 2010 to 2013 period.

On July 12th, seventeen states and the District of Columbia commenced enrollment in PCIPs. Twelve more will start enrolling adults in August. In the 21 states without a PCIP the federal government began operation of a PCIP on July 1st.

Karen Davis, Commonwealth Fund President, said:

Historically, women have been more vulnerable to high health care costs and have had greater difficulty paying medical bills because of their lower incomes. This report provides good news to all women, who will be more likely to get the care they need, with reduced risk of incurring the unaffordable medical bills that have affected so many Americans.

Realizing Health Reform’s Potential: Women and the Affordable Care Act of 2010 is the first in a series of Fund reports that will look at the impact of health reform on various populations. It describes when provisions of the new law affecting women go into operation, and how many women will be affected by specific provisions.

As from 2014, fifteen million working-age women who currently lack insurance should benefit from Medicaid coverage expansions and subsidized coverage through state health insurance exchanges. Most of these gains come from Medicaid coverage expansions that may affect up to 8 million currently insured women who earn up to $14,000 or are in families with incomes up to $29,000.

The new law is expected to especiallyhelp women living in states with higher than average insurance rates. The states are:AlaskaArizonaArkansasCaliforniaFlorida and Louisiana (24% uninsured)GeorgiaIdahoKentuckyMississippiNevadaNew Mexico and Texas (29% uninsured in 2008)Oklahoma (at least 20% uninsured) West VirginiaSome early provisions will provide support before 2014 when most of this kicks in. Provisions commencing in 2010 include:More comprehensive insurance coverage for young adults, through policies that allow adult children up to age 26 to come on, or stay on, their parents’ plans, and bans on pre-existing condition exclusionsBans on lifetime benefit limits and phase-out of annual limits.Bans on rescissions (cancellations of contracts) of insurance policies.Coverage of recommended preventive services without cost-sharing including mammograms.Eligibility for a new plan that covers uninsured people with pre-existing conditions that currently make it difficult for them to gain coverage.Rebates to women enrolled in Medicare who reach the doughnut hole in their prescription drug plans; women, along with people with diabetes and Alzheimer’s or other forms of dementia are most likely to reach this gap in coverage. Insurance market reformsAn estimated 7.3 million women aged between 19 and 64 years who attempted to purchase individual insurance plans over a 3-year period were refused, charged a higher price, or had partial coverage which excluded pre-existing conditions from their plan. As from 2014 this will not be allowed – all health care insurance providers will have to accept all applicants. They will not be allowed to charge higher premiums based on gender or health status.

Additionally, maternity and newborn care will have to be covered by all health plans sold through new state insurance exchanges in both the individual and small group market as part of the federally determined benefit packages described below.

Lead study author Sara Collins, a vice president at the Commonwealth Fund, said:

Women who have an individual insurance market policy that charges them higher premiums than men, who have been unable to secure coverage for the cost of a pregnancy, or who have a preexisting health condition excluded from their benefits will ultimately find themselves on a level playing field with men, with a full range of comprehensive benefits, including maternity coverage. Insurance Exchanges and SubsidiesWomen with no health insurance cover who earn too much to qualify for Medicaid will be able to buy policies through state-run exchanges that will offer federally determined essential benefit plans with four levels of cost-sharing with an annual cap on out-of-pocket costs of $5,950 for individuals and $11,900 for families, beginning in 2014.

In addition, women with incomes under 400% of poverty, or $88,000 for a family of four, will be entitled for subsidies to make up for their premiums and out-of-pocket costs. The report states that up to 7 million currently uninsured women may gain subsidized coverage through the exchanges.

Collins added:

Today many health plans don’t provide a comprehensive set of affordable benefits, forcing women to choose between paying out-of-pocket for necessary service or delaying or skipping care. Better information and benefit plans that are easier to understand, along with subsidies to offset their costs, will make a significant difference for American families.
Women who own businesses with fewer than 50 or 100 employees, depending on the state, will also be able to purchase a health plan through the exchanges.

© 2010 MediLexicon International Ltd

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