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From the desk of ... Debra L. Ness

10 Things to LOVE About the Affordable Care Act

March 21, 2012 | Health Care | Reproductive Health

This week, the Affordable Care Act (ACA) turns two. Let's not mince words: This law is the greatest advance for women's health in a generation. Here are just a few things we love about the law:

1. Being a woman is no longer a pre-existing condition.

For the first time in history, gender discrimination will be prohibited in all federally funded health care. This basic protection means that any insurance companies receiving federal funds (including tax credits, subsidies and contracts) will be prohibited from discriminating against women.

2. The ACA helps to make health insurance more affordable for women.

Health care we can afford? Sign us up! The ACA establishes protections to make private health insurance options more affordable for women purchasing coverage on their own or through small businesses. This is due to new rules to keep premiums in check and prohibitions on charging higher premiums based on gender and health status or history. Beginning in 2014, lower-income women and families who don't receive insurance through their employers will be able to access financial assistance to help them buy insurance in the individual market.

3. Women will be guaranteed preventive services such as birth control, mammograms and cervical cancer screenings, with no deductibles or copays. Need we say more?

New private insurance plans will be required to cover a wide range of recommended services without cost-sharing, including well-women visits; screenings for gestational diabetes, osteoporosis, and colon cancer; pap smears and pelvic exams; STI and HIV screenings and counseling; all FDA-approved contraceptive methods; breastfeeding support, counseling, and supplies; and screenings and counseling related to interpersonal violence. Private plans also must cover screenings and vaccinations critical to children's health without out-of-pocket costs. The ACA also requires Medicare to waive cost-sharing for many of these services as well provide a free annual, comprehensive wellness visit that includes personalized prevention planning services.

4. Young adults can stay on their parents' insurance policies until age 26

To ensure that recent high school and college graduates aren't without coverage as they search for work and start their careers, the ACA allows young adults to stay on their parents' insurance plans until they are 26 years old. This provision is already benefitting 2.5 million young adults, including an estimated 1.1 million young women.

5. Universal maternity coverage

Currently, most individual health plans fail to provide any insurance coverage for maternity care. This means that even without complications, women face expenses that average $10,652 or more. Beginning in 2012, plans offered in the individual and small group market will be required to cover maternity and newborn care - ensuring better health for mothers and babies.

6. Closing the "donut hole"

Senior women will save thousands of dollars as reform closes the Medicare prescription drug coverage gap. Each year, about 16 percent of Medicare beneficiaries hit the "donut hole" in their prescription drug coverage, meaning that they are responsible for paying 100 percent of drug costs up to the point when Medicare begins to pay again. Under the ACA, a typical Medicare beneficiary who hits the donut hole could save more than $3,000 by 2020, when the donut hole will be closed completely.

7. Expanded Medicaid coverage for lower-income women

Restrictive state eligibility rules have long kept many women from accessing the benefits of Medicaid, which provides essential care over the spectrum of women's lives. In 2014, the ACA will close this gaping hole in the nation's safety net by expanding Medicaid eligibility to individuals and families with household family incomes up to 133 percent of the Federal Poverty Level (FPL). With this change, ten million more women will qualify for Medicaid's comprehensive health coverage with strong out-of-pocket cost protections.

8. Pre-existing condition? The ACA has you covered.

Today, it can be nearly impossible to access health insurance on the individual market without a blemish-free medical history. Health plans deny or drop women from coverage for conditions ranging from acne to C-sections to breast cancer. The ACA already prohibits private health insurers from retroactively canceling coverage when a person incurs high health care costs. Beginning in 2014, new private health plans will no longer be able to turn away women and families applying for or renewing coverage. Nor will they be able to exclude services from coverage on the basis of a pre-existing condition. These protections went into effect for children under age 19 in September 2010. To help uninsured adults with pre-existing conditions access coverage before 2014, new Pre-Existing Condition Insurance Plans (PCIP) are available in every state.

9. Higher quality, better coordinated care

It's about time! By investing in primary care, patient safety, and the new Center for Medicare and Medicaid Innovation, the ACA lays the groundwork to improve quality and coordination of care. This means older patients will be less likely to experience dangerous drug interactions, duplicative tests and procedures, conflicting diagnoses, and preventable readmissions.

10. Investment in the health care workforce to ensure access to health care providers

The ACA requires insurance plans to contract with essential community providers, including women's health centers, HIV/AIDS clinics, community health centers, and public hospitals that serve medically under-served and low-income populations. This will mean women who rely on these clinics can continue to receive care from their regular health care providers, and it will help alleviate the shortage of primary care providers, which is expected to worsen as reform increases the number of people with insurance coverage. In addition, the ACA establishes Geriatric Education Centers (GECs) to support training in geriatrics, chronic care management, and long term care issues for family caregivers, as well as health professionals and direct care workers. The GECs are required to train family care practices into their curricula.

The ACA is already beginning to deliver for women and their families - and some of the best is yet to come. But the health reform law faces challenges in Congress, in the states and at the Supreme Court. We can't let opponents distort the facts, control the debate, or take away a law that America's women need! So let's keep talking about all the ways the Affordable Care Act is helping women. Let's ensure we can continue the progress. It's time to protect our care - and protect the law.


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