Starting out with the obvious: The website rollout of Obamacare (i.e. the Affordable Care Act, or ACA) was ugly. That means no one has been talking about the serious issues of inequality it finally addresses. Before the ACA went into effect in 2011, A National Women’s Law Center (NWLC) report found that most health care plans charged women 80 percent more for premiums than men of the same age. 80 percent. Part of the reason cited for this disparity is that men are less likely than women to visit the doctor – an obvious benefit for the insurance guys because it reduces costs in the short-term. But in the long-term it starts to get ugly: men are significantly MORE likely than women to be hospitalized because of congestive heart failure and complications from diabetes – the kinds of chronic diseases responsible for 75% of the nation’s health care costs and 7 in 10 deaths in the US each year.
More shocking? Before now most insurance plans didn’t cover maternity services. The NWLC estimates that before the ACA’s rules kick in January 1, a pathetic 12% of policies in the individual insurance market have offered maternity coverage. Among the few plans that do offer prenatal care, most require a separate rider with deductibles of as much as $5,000 for maternity services, with benefits limited to a few thousand dollars, according to a 2010 survey by the House Committee on Energy and Commerce. All of which is estimated to cost women $1 billion a year.
How has this profound lack of affordable coverage affected our health in the U.S.? Many women aren’t taking advantage of the preventative care that helps avoid chronic disease in the first place. In fact, the high cost of care has led over half of American women to delay or avoid necessary visits with the doctor (for services like well-women checkups or Pap smears) that can catch and treat health issues early, before they cause greater harm, according to a 2009 report by the Commonwealth Fund. And you can bet these women aren’t getting enough of the preventative maternity care they need either. This lack of care is leading to devastating consequences: Compared to the rest of the world, child mortality rates in the U.S. are horrifying – worse than every western European country, Japan, South Korea, and Israel – at 7 deaths of kids under age five per 1,000 live births. And the low-income mothers who are especially likely to avoid health care are also statistically more likely to give birth to babies with low birth weight according to the March of Dimes – a condition experienced by nearly one in 10 babies in the US – putting their children at risk including chronic diseases like high blood pressure, diabetes and heart disease throughout life. It’s a vicious cycle.
When cost-sharing (that is, insurance copayments, co-insurance, and deductibles) are removed, however, 9 percent more women get mammograms, according to one study. That’s a trend that’s likely to continue as more people have access to affordable health care, and it saves costs down the line by catching adverse health conditions when they’re more treatable. The ACA guarantees this preventative coverage, encouraging women to get the care they need when they can benefit from it the most. Because of the ACA, women no longer pay more for insurance than men, and most health plans now cover preventative services without cost-sharing. And beginning in January 2014, pregnant women will be guaranteed coverage. The many benefits of this care are at no cost-sharing for the insured and include:
- Breastfeeding support/supplies/counseling
- Pregnancy and well-woman visits
- Coverage for preexisting conditions
- Birth control
- Gestational diabetes screening for women 24 to 28 weeks pregnant
- HPV DNA testing for women 30 and older
- Interpersonal and domestic violence screening and counseling for the estimated 25 percent of women in the US who are victims of this type of violence during their lives
Because of the new benefits available in January 2014:
- 8.7 million women now buying individual insurance will gain maternity coverage
- 18.6 million uninsured women will have new opportunities for coverage in the Health Insurance Marketplace
How does it all work, and at what cost? The ACA is based on cross-subsidies –meaning your uncle subsidizes your maternity care, you subsidize your brother’s prostate cancer treatments, you and your sister subsidize your parent’s Alzheimer’s care, your best friend covers your diabetes coverage, and so on. This concept is in many ways like education, or roads, or wastewater systems. All of these are benefits considered a “social good” that’s bundled into the tax rate that everyone pays. That’s because the thinking on taxes has always been that if you don’t directly benefit from one way your tax dollars are being spent (maternity care when you’re a man), you might benefit more than the next person for another expenditure (roads when you’re a truck driver). There’s something to think about that the next time you hear a friend has been diagnosed with melanoma, or a pregnant friend just lost her job. The social support offered by the ACA is something that can make all of us feel better – in more ways than one.