American Public Health AssociationAnnual MeetingNovember 2010

Judy WaxmanNational Women’s Law Center

Where Do Women Get Their Health Where Do Women Get Their Health Coverage?Coverage?

Source: National Women’s Law Center analysis of 2008 and 2009 health insurance data from the U.S. Census Bureau CurrentPopulation Survey’s (CPS) 2009 and 2010 Annual Social and Economic (ASEC) Supplements

On average, women use more health On average, women use more health

services than men.services than men. • Reproductive health needs

• Prescription drugs

• More likely to have a chronic condition (38% vs. 30%)

• Certain mental health problems affect twice as many women

Women have more trouble Women have more trouble affording necessary health careaffording necessary health care

39

52

6776

49

69

2534

0

25

50

75

100

Total Uninsured in the pastyear

Insured all year,underinsured

Insured all year, notunderinsured

Men Women

Percent of Adults ages 19-64 reporting

any one of four problems* accessing care

*Did not fill a prescription; did not see a specialist when needed; skipped recommended medical test, treatment, or follow-up; had a medical problem but did not visit doctor or clinic.

Source: The Commonwealth Fund Biennial Health Insurance Survey (2007).

Women delay or do not get preventive Women delay or do not get preventive care because of cost.care because of cost.

1621

34

4236

45

0

10

20

30

40

50

60

PreventiveScreenings

Dental Care Either

Men

Women

Percentage of adults 19-64 who delay or do not get preventive care

Source: The Commonwealth Fund Biennial Health Insurance Survey (2007).

Women face unfair and discriminatory Women face unfair and discriminatory

insurance industry practices.insurance industry practices. • Gender rating is prevalent throughout the

country among similar plans in the individual market. – At age 25, women are charged between 6% and 45%

more than men. – At age 40, women are charged between 4% and 48%

more than men.– At age 55, women are charged between 22% less and

37% more than men. • Wide variations across and within states

undercuts insurance industry defense of gender rating as actuarially justified- and raise questions or arbitrariness.

• Maternity coverage does not explain the difference.

Women struggle to find coverage for the Women struggle to find coverage for the benefits they need.benefits they need.

Maternity Coverage - Individual MarketMost Individual Market Insurance Policies Do Not

Cover Maternity Care

n=3,512 policies (offered in 47 states and D.C.)

12%

9%

20%59%

ComprehensiveMaternity Coverage

Less-than-ComprehensiveMaternity Coverage

SupplementalMaternity RiderOffered

No Maternity CoverageAvailable

*Comprehensive maternity coverage includes coverage for prenatal care, labor, delivery, and postnatal care, for both routine pregnancies and in case of complications.

**Less-than-comprehensive maternity coverage includes coverage for a limited scope of maternity services, such as coverage for inpatient (i.e. labor and delivery) or outpatient (i.e. prenatal and postnatal office visits) maternity care only, or coverage only for complications of pregnancy.

*

**

AFFORDABLE CARE ACT AFFORDABLE CARE ACT COVERAGE FOR ALL (?)COVERAGE FOR ALL (?)

• Medicaid to 133% Federal Poverty Level.

• New market place.

• Subsidies up to 400% of Federal Poverty Level.

INSURANCE REFORMSINSURANCE REFORMS

• No pre-existing conditions refusals.

• Gender.

• Health Status.

• No lifetime or annual limits.

• No dropping your insurance coverage when you get sick.

ESSENTIAL HEALTH BENEFITSESSENTIAL HEALTH BENEFITS• Ambulatory patient services.• Emergency services.• Hospitalization.• Laboratory services.• Maternity and newborn care.• Mental health and substance use disorder

services, including behavioral health treatment.• Pediatric services, including oral and vision care.• Prescription drugs.• Preventive and wellness services and chronic

disease management.• Rehabilitative and habilitative services and

devices.• Special rules for abortion.

MATERNITY COVERAGEMATERNITY COVERAGE

• Cap on payment

• Pregnancy complications

• Inpatient/Outpatient

• Comprehensive coverage

CONTRACEPTIONCONTRACEPTION

• Preventive Service

• Essential Benefit Package

ABORTION: SPECIAL RULESABORTION: SPECIAL RULES

• Cannot be required in the benefit package

• BUT plans can choose to cover:– None– Some (Hyde exceptions)– All

• One plan must not cover abortion• Plans must not discriminate against

providers

If a plan covers abortion…If a plan covers abortion…(beyond Hyde Exceptions)(beyond Hyde Exceptions)

• No federal funds can be used for abortion services.

• Enrollees make two separate payments.

• Payments must be segregated into separate accounts.

• State insurance commissioners ensure compliance.

OTHER PROVISIONS:OTHER PROVISIONS:

• State abortion bans are not preemptive.

• Insurance plans cannot discriminate.

ACA Will Improve the Health and Well-Being ACA Will Improve the Health and Well-Being of Women and Their Familiesof Women and Their Families

• Extends mental health parity.

• Women will have “direct access” to obstetrical and gynecological care.

• Older women will benefit from a provision that closes the Medicare Part D “donut hole.”

• Alleviates burdens on family caregivers.

• Allows young adults to remain on their parents’ health insurance.

• Requires “nursing” time at work.

Thank You!

For more information, please contact:

Judy WaxmanVice President, Health and Reproductive Rights

jwaxman@nwlc.org – (202) 588-5188