Where We Stand: Health Care
AAUW believes that everyone is entitled to high-quality, affordable, and accessible health care.
Health care security is intrinsically tied to economic security, and this relationship is particularly true for women who earn less than men on average and are therefore less able to afford insurance or care. Despite massive spending, health care outcomes in the United States continue to lag behind many other Western nations. But more Americans are now able to access affordable health insurance and the preventive care they need thanks to the Affordable Care Act (ACA), which passed into law in 2010.
Drastic Drop of Uninsured Rates
The implementation of the ACA has begun to make significant progress in reducing the number of uninsured Americans.
- In 2009, 50.7 million Americans were uninsured—nearly 17% of the nation.
- In 2015, the uninsured rate hit a historic low; only 9.1% of Americans remain uninsured.
- The ACA is making progress in reducing ethnic disparities in health care access, with 5.2% more young women, 5.1% more black women, and 6.5% more Hispanic women gaining access to a regular source of care.
Health Care Reform Is a Women’s Issue
While all Americans have benefitted from meaningful health care reform, the issue has particular resonance for women. According to the Department of Labor, women make approximately 80% of all family health care decisions, and about 60% 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 earn around 82 cents for every dollar men earn, but women also utilize more health care services than men. 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 problems as a result of health problems.
Affordable Care Act
The Affordable Care Act has made a significant impact on women’s health.
- Fewer women of reproductive age are uninsured. The number of uninsured women ages 15–44 has dropped by 36% under the first two full years of ACA implementation. In the first year alone we saw a 20% decrease in the number of uninsured women living below the poverty line.
- The practice of “gender rating” ended. 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. This discriminatory practice was costing women approximately $1 billion more than men for health coverage, which the ACA has eliminated.
- Coverage of women’s reproductive health services is required. Under the ACA’s coverage of contraception, 67% more women have been able to access birth control without a copay. In addition, 87% of insured women no longer pay out of pocket for a hormonal IUD. An increased use of contraception has led to a decline in the number of unplanned pregnancies.
- The ACA ensured access to and coverage of preventive services and care. The ACA has secured preventive services to women including contraception, breastfeeding support, and sexually transmitted infection and HIV screenings. About 137 million Americans now have access to preventive services without cost sharing, including 55 million women.
Despite these clear benefits from ACA for millions of Americans, Congress has repeatedly voted on repealing the law without replacing these critical policies and ensuring all Americans have healthcare coverage. A repeal of the Affordable Care Act would eradicate years of progress in expanding health care access to women. Birth control coverage, well-woman visits, and the end of discrimination are all at stake if the law is repealed. AAUW is committed to fighting against attempts to abolish women’s health care access as we know it.
Medicaid and Medicare
Medicaid is the national health insurance program for low-income Americans jointly funded by the federal government and states. More than 39 million women are enrolled in Medicaid, which accounts for nearly 58% 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% 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 2015, Medicare covered approximately 28.7 million women, making up more than 55% of all program beneficiaries. Women live longer and on average have greater need for the services Medicare covers. For instance, more than 60% 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 Children’s Health Insurance Program, which 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 these programs offer and the services they provide. As implementation of health care reform begins, these programs must continue to be maintained and strengthened.
Standing against Privatization
Congressional Republicans are also proposing to change the structure of Medicaid by converting it into a block grant. This means the federal government would shift from covering a set share of Medicaid costs for each state to covering a set dollar amount for each state. By changing how Medicaid works, states would gain the ability to restrict eligibility, cut benefits, and increase barriers to enrollment. One place this proposal has been detailed was in a House Budget Committee plan, which suggested cutting $913 billion from the program and would result in 14 million people losing coverage or the ability to gain coverage in the future. The change in structure is detrimental to states and the millions of Americans who would lose crucial health care coverage or be deterred from enrolling.