What health reform means for women and our families Lois Uttley, MPP Co-founder, Raising Womens Voices FDR Presidential Library and Museum Hyde Park, NY, April 5, 2011

Affordable Care Act is 1 Year Old Affordable Care Act (ACA) signed into law by President Obama on March 23, Since then, a number of lawsuits have been filed challenging the ACA and some members of Congress are trying to defund or stall it. However, implementation is moving ahead at the federal level and in many states.

Health reform owners manual for women Why did we need it? How does it work? How will our life change with it? What aspects of health reform especially benefit women and our children?

Why did we need health reform? Too many people have no health insurance coverage. 2.7 million in NYS Estimated 52 million people nationwide

Who are the uninsured women? When I was pregnant, I got the first health insurance of my life. It covered me for 3 months after pregnancy. Then… Nothing! I could not qualify, even though I made little as a pre-school teacher.

Other people are losing coverage, or have gaps in their coverage Workers losing their health insurance, as employers drop it. Young people losing family coverage. Women losing dependent coverage upon divorce or death of a spouse. Seniors falling into the Medicare prescription drug donut hole. Some policies dont cover maternity care

Who are the women who have lost coverage? I am a 40-year-old survivor of breast cancer. I lost my coverage. Ive lived in this country and worked all my life. Why dont I have health insurance when I need it?

Women and health insurance: the national statistics 19 million women (almost 1 in 5) have no health insurance 1 in 4 women has dependent coverage through a spouse.

The consequences of no insurance (2008 Kaiser Foundation survey of women 18 to 64)

Reform goal: Cover more people, make it affordable Provide public coverage for low-income people who cant afford it. Encourage businesses to cover their workers. Help everybody else to buy private insurance.

The headlines: good news for women Nationwide, as many as 15 million uninsured women will gain subsidized health insurance coverage as the law is fully implemented. An estimated 14.5 million insured women will benefit from provisions that improve coverage or prevent big hikes in premiums. Source - Commonwealth Fund issue brief: Realizing Health Reforms Potential: Women and the Affordable Care Act of 2010

: Health reform takes baby steps Insurance companies can no longer cancel our policies when we get sick or impose lifetime limits on the amount of care they will cover. Women who have breast cancer or other conditions can now obtain affordable coverage through the Pre-existing Condition Insurance Plans. NYS has the Bridge Plan.

No coverage denials for kids with pre-existing conditions Nurse Abby Druckers grand-niece was born with hearing loss. The familys health insurer denied coverage for treatment, calling it a pre-existing condition. That is now against the law.

Young women (and men) can stay on family coverage until age 26 Young adult does not have to live at home, be unmarried or be a dependent for tax purposes. Important for young women in prime reproductive health years.

Preventive services covered with no co-pays, deductibles Cervical cancer screening, Pap smears and mammograms Counseling about quitting smoking, losing weight, choosing healthy foods, treating depression and reducing alcohol use Blood pressure, diabetes and cholesterol testing

Covered preventive services for pregnant women Folic Acid supplements for women who may become pregnant Hepatitis B screening at the first prenatal visit Anemia screening on a routine basis Bacteriuria urinary tract or other infection screening Rh Incompatibility screening

Preventive care for new moms and babies Interventions to support and promote breast feeding Well-baby visits, health screenings and vaccinations There is much more! To get the list, go to:

Bad news: contraception not included Law uses USPSTF list of evidence-based preventive care, and birth control is missing. Womens Health Amendment allows HHS to add womens preventive services to the list. HHS cautiously orders a year-long review by an Institute of Medicine expert panel. Bottom line: Birth control couldnt make the list until at least 2012 or 2013.

Urging HHS to add contraception 60 national and state womens health groups sign on to RWV letter to HHS urging swift action to add contraception. RWV testifies at Institute of Medicine hearings on contraception as prevention. RWV gathering signatures on petition to HHS.

New doctor choice provisions benefit women and children You can choose any available participating primary care provider as your doctor and any available participating pediatrician as your childs primary care doctor. Health plans cannot require a referral from a primary care provider before a woman seeks care from a participating OB-GYN specialist.

Birthing and newborn provisions Licensed practitioners serving women at free-standing birthing centers now eligible for Medicaid reimbursement. $1.5 billion over five years for nurse home visits to at-risk mothers and newborns. Employers must give breastfeeding women break time and private space to express milk.

Having it both ways about sex ed New funds for comprehensive sex education ($75 million a year for 5 years) And more funds for Title V abstinence-only education ($50 million a year for 5 years)

When health reform grows up Between now and 2014, our health reform baby will be learning to walk and talk. States and the federal government will be developing new regulations and processes to carry out provisions of the law. In 2014, the new health reform law will be revealed in its adult version.

Insurers must comply with new rules Maternity care and well- baby care must be covered. No denials of coverage to adults with pre-existing conditions. No charging women more than men (gender rating) Limits on age rating

More uninsured women will be eligible for Medicaid coverage Income eligibility goes up to 133% of federal poverty level, or $29,327 for a family of four. No more complicated categorical requirements for eligibility. In NYS, an estimated 47% of the 1 million uninsured women (18 to 64 years) will qualify for Medicaid. (Source: Kaiser Family Foundation)

Moderate-income women and families will get help to buy coverage Estimated 40% of New Yorks 1 million uninsured women will qualify for federal subsidies to help them buy private coverage through NYs insurance exchange. –Source: Kaiser Family Foundation

What is an insurance exchange? Think of it as a health insurance supermarket. Each state will create an exchange that has a website and telephone hotline to help individuals and small businesses purchase and enroll into qualified health plans.

Helping us choose the right plan: Comparing apples to apples Exchange will describe each plan in a standard format: –Monthly cost and co-pays –Plan performance on quality measures –Plan ratings by quality and price –Information on current customer satisfaction

What are the exchange rules on abortion coverage? The ACA continues the ban on use of federal funds to pay for abortions, except in cases of rape, incest or threat to the life of the woman. States may allow, restrict or ban abortion coverage in private policies to be sold in their state exchanges. If abortion coverage is included in a policy sold in a state exchange, only private $$ may be used for that portion of the premium.

What role will employers play? Employers will be encouraged to provide coverage for their workers. Those who dont will face a fine of $2,000 for each uninsured employee who buys coverage in the exchange using federal subsidies. Small businesses up to 100 workers can shop in the exchange and get larger tax credits to help them afford to cover workers.

What is our personal responsibility? As of 2014, we must carry health insurance, just like car insurance. If we dont, we face a fine of $95 a year or 1% of household income in This gradually increases over time. Exemptions for low-income households, financial hardship, religious objections.

Whats going on with health reform in NY? NYS government must enact enabling legislation, starting this year, to create a state insurance exchange that will open in Many decisions must be made, including: – Who or what will run the exchange (state agency, non-profit?)? –Will our exchange be an active purchaser of health insurance for a large group of people or operate more like a flea market.

Is health reform a perfect baby? No. It was born with a number of problems. For example, immigrants are excluded from many provisions. The subsidies may not be enough to make insurance affordable.

Sources of more information Henry J. Kaiser Family Foundation: –Womens Health Insurance Coverage, December 2010 –Impact of Health Reform on Womens Access to Coverage and Care, December 2010 Commonwealth Fund: –Realizing Health Reforms Potential: Women and the Affordable Care Act of 2010, S. Collins, S. Rustig & M. Doty, July –Federal health reform website

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