After many years of hard work creating a health reform plan that would work for the American people, Congress has just passed a historic bill. But with all the misinformation that has been spread and the recent preoccupation with process, many of us may have lost sight of an important fact: the health care reform bill will help Americans. In fact, it has many provisions that will tangibly help American women in particular. In the next couple of weeks, we will be sharing with you specific reasons women should be celebrating health care reform.
Today, we’ll start with three of the ways in which women have won:
Reason 1: Maternity Care Will Be Covered By Your Basic Insurance
Currently, the vast majority of individual plans don’t cover maternity care. In most states, insurance companies are not required to provide maternity coverage, and in many other places it is completely unavailable. Even where maternity coverage is available as a separate buy-in (called a rider), it is very difficult to get. If a woman is already pregnant she cannot purchase a maternity rider because pregnancy is a pre-existing condition. Moreover, the cost of the coverage is unaffordable and the coverage itself is not regulated, so the benefits are often so skimpy that those who buy it often end up with huge out-of-pocket expenses.
Let’s see how the issue of maternity care works in some real world examples:
- A 30 year old self-employed woman in Ohio goes on ehealthinsurance.com to look for a comprehensive policy that will cover her if she gets pregnant; she finds that not a single plan offers maternity coverage as part of its benefits package. Health care reform means that all new individual and small business health insurance packages –including those available in and outside of the exchanges— will include maternity care, ensuring that everyone has coverage for these essential services.
- A woman in Colorado who has had a c-section tries to buy an insurance policy; she is denied, unless she shows proof that she has been sterilized, because a c-section is a pre-existing condition. Health care reform means that there will no longer be pre-existing condition denials, so women won’t be denied insurance because they are pregnant or because they have had a c-section.
- A woman in D.C. pays for both basic health coverage and an additional maternity rider on the individual market. She pays over $8000 in insurance premiums while she is trying to get pregnant and during her pregnancy, only to discover after giving birth that her maternity benefits are capped at $3000. She ends up owing the hospital $22,000, even though she thought she was covered. Health care reform means that insurance companies will be prohibited from having annual or lifetime caps on benefits and there will be limits on out-of-pocket costs, ending the insurance industry scam of limiting maternity coverage so that women and their families are left thousands of dollars in debt.
Reason 2: Gender Rating Will Be Eliminated in the Exchange
Gender rating is a widely-accepted insurance industry practice that allows insurance companies to charge men and women different premiums for the same coverage, even though the insurance doesn’t cover maternity. Though 11 states have banned gender rating in the individual health market, women across the country are usually charged significantly more than men for the exact same health care coverage.
Let’s see how the health reform bill that passed yesterday will affect gender rating by taking a couple of examples.
- In Lincoln, Nebraska, a 40 year old woman looks for health insurance on the individual health market. This woman is charged $63.83 more per month for the same health insurance plan as a man of her identical age, location, and medical history. This means that she ends up paying $765 more over the course of a year than a man would – simply by virtue of her gender.
- A self-employed 40 year old woman in Lansing, Michigan looks for coverage on the individual health market, and learns that she would be charged $40 more per month than a man. This means that she must pay nearly $500 more over the course of a year than her male counterpart, for the same health coverage!
Health care reform means that gender rating will be completely eliminated in the individual and group health insurance market so that women will never again be charged up to 84% more than men for the same health coverage.
Reason 3: 32 Million More People Will Have Insurance Coverage, Including 4.5 Million Women Who Will Be Newly Eligible For Medicaid
Currently, nearly 15% of Americans lack health insurance. Health insurance is especially difficult for those in the lowest-income brackets to attain, which is why Medicaid plays a critical role in providing health coverage, especially for women. The current economic recession has increased the demand for Medicaid, as a growing number of families experiencing job and income loss look to the program as their only source of coverage. The expansion of health insurance coverage, especially for low-income people, will help millions of women and their families secure access to desperately needed health care.
- The 15% of Americans that are currently uninsured affects many more than just those specific people. Americans with health insurance bear the costs of those without health insurance: an insured family pays an average of $1,017 per year to make up for the unpaid medical expenses of the uninsured.Health care reform means that about 30 million more Americans have insurance coverage, distributing the burden and the cost of health care.
- Health care is costly and often inaccessible. Under health care reform, families making up to 400% of poverty (or about $88,000 for a family of four) will be eligible for subsides to help them pay insurance premiums.
- 40% percent of women living in poverty are uninsured – more than twice the uninsured rate for women overall – and those who cannot afford health coverage are forced to forgo essential medical services. Under the health reform bill that President Obama signed, 4.5 million more low-income American women who are currently uninsured will be newly eligible for Medicaid and have access to a comprehensive set of health benefits.
The inclusion of maternity care in basic health insurance plans, the elimination of gender rating in the new Exchange and the expansion of affordable health coverage in health care reform are tremendous steps forward.
Unfortunately, health reform also includes a provision that sets women back; the bill on the way to the President’s desk includes onerous restrictions on coverage for abortion care initially inserted by Senator Nelson. Although less extreme than those originally sought by Representative Stupak, these restrictions, added to those already in place under Hyde, create harmful and dangerous barriers to women's ability to secure the health care that they need. An executive order to be issued by the President after passage of health care reform reflects the serious limitations on abortion care that will result. NWLC remains committed to eliminating these barriers to abortion access, even as we celebrate the benefits of passage of this historic legislation.
To see how the health reform bill that passed Congress is going to help women in your state, visit http://nwlc.org/reformmatters/shareresources.html.