AAUW Issues: Health Care
The American Association of University Women believes that everyone is entitled to
high-quality, affordable, and accessible health care.
“The Affordable Care Act and Women”
Department of Health and Human Services
Health care security is intrinsically tied to economic security, and this relationship is particularly true for women, who are paid less than men are on average and are therefore less able to afford insurance or care. Despite massive spending, health care outcomes in the United States continued to lag behind those of many other western nations.
Broken, Expensive, and Outdated
Prior to passage of the Affordable Care Act (ACA), there was a definite and compelling need for health care reform:
- In 2009, 4 million Americans — nearly 15 percent of the nation — were uninsured, which was a 60 percent increase from 2003.
- Middle-class families were the fastest-growing segment of the uninsured, reflecting the cost increases that have far exceeded wage increases in recent years.
Health Care Reform Is a Women’s Issue
While all Americans benefit from meaningful health care reform, the issue has particular resonance for women. According to the U.S. Department of Labor, women make approximately 80 percent of all family health care decisions, and about 60 percent of women report that they assume primary responsibility for decisions regarding family health insurance plans.
When it comes to their own health care, women face unique challenges. Women are paid around 78 cents for every dollar men are paid, but women also utilize more health care services than men do. As a result, women face a high level of health care insecurity. These factors add up to too many women and their families with unpaid medical bills and long-lasting debt as a result of health problems.
Affordable Care Act
The ACA, the health care reform law enacted in 2010, has had significant impacts on women’s health.
- It ends the practice of “gender rating.” Gender rating is the process by which insurance companies charge men and women different premiums for individually purchased health care plans. Under the ACA, gender rating was banned for plans offered in both the individual and small-group markets (defined as organizations employing 100 or fewer persons) beginning in 2014. Unfortunately, insurance companies may continue to pursue this discriminatory practice under plans offered in the large-group market.
- It requires coverage of women’s reproductive health services. While AAUW supported this coverage in the ACA, unfortunately the law also required insurance companies providing abortion coverage to collect two separate payments from each enrollee: one for the portion of the premium covering abortion care, and one for the remainder of the premium itself. This could endanger women’s health care access.
- It ensures access to and coverage of preventive services and care. The law contains a specific women’s health provision under which insurance companies will be required to cover additional preventive health care and screenings for women — such as contraceptives, mammograms, gestational diabetes screening, and pap smears — at no additional premium or co-payment cost.
Medicaid and Medicare
Medicaid is the national health insurance program for low-income Americans. It is a partnership jointly funded by the federal government and states. More than 41 million women are enrolled in Medicaid, which accounts for nearly 70 percent of the program’s total adult beneficiaries. One out of every 10 women in the United States receives her health care through this program.
A major part of the 2010 health care law was an expansion of Medicaid eligibility to people under age 65 with incomes of up to 133 percent of the poverty line. In its 2012 decision on the constitutionality of the law, the Supreme Court ruled that the federal government cannot make states’ current Medicaid funds contingent on participating in Medicaid expansion. Many states have cited the modest increase in state funding needed for Medicaid expansion as grounds to reject it.
Medicare is the national health insurance program for seniors, though it also covers younger people with certain conditions. In 2010–11, Medicare covered approximately 25 million women, comprising more than 55 percent of all program beneficiaries. Women live longer than men and on average have greater need for the services Medicare covers. For instance, more than 60 percent of enrollees in the prescription drug program are women.
At their core, Medicaid and Medicare represent two crucial elements of the social safety net. They, along with the federal-state State Children’s Health Insurance Program that has covered millions of previously uninsured children since its inception in 1997, are bedrocks of our health care system. Americans, especially women, rely heavily on the protections that Medicare and Medicaid offer and the services they provide. These programs must continue to be maintained and strengthened.
King v. Burwell
In 2014, the Supreme Court agreed to hear arguments challenging regulations that made tax credits accessible for enrollees in federally and state-run health care exchanges. The plaintiffs in the lawsuit argue that the tax credits should apply only to state exchanges and not to federally run exchanges. AAUW joined 67 other organizations in supporting the application of credits to all exchanges, noting that losing access would have significant implications for women’s health and financial standing, as well as the health and well-being of their families.
The Affordable Care Act has dramatically improved women’s access to affordable, quality health care, but many women would not have been able to enroll without the IRS subsidies. In 2014, 2.5 million women received tax credits to make health care more affordable, and there were 3 million women enrolled in the federally facilitated insurance marketplace.