November 12, 2013 — Although the Affordable Care Act (PL 111-148) will improve coverage of preventive care for those with health insurance, nearly 30 million people are expected to remain uninsured and reliant on "a patchwork of federal and state prevention programs whose funding is anything but certain," Kaiser Health News reports.
Access to preventive care is especially critical for women, particularly for reproductive health needs like contraception and exams, according to KHN.
Several groups will not have access to health insurance under the ACA. One of the largest groups is individuals who live in states that are not implementing the law's Medicaid expansion. Although the ACA expands Medicaid to cover individuals with incomes up to 138% of the poverty level, the U.S. Supreme Court ruling that upheld the law allowed states to opt out of expanding Medicaid. Adults with incomes below the poverty level are not eligible for subsidies to purchase coverage through the law's marketplaces; thus, in states that have not expanded Medicaid, they likely will remain uninsured.
Undocumented immigrants also are prohibited from purchasing coverage through the health insurance marketplaces. In addition, low-income documented immigrants have to wait until they have lived in the country for five years before they can qualify for Medicaid coverage, although they are eligible for subsidies to purchase coverage through the state marketplaces.
Access to Preventive Care
The ACA requires health plans to cover many preventive services without consumer cost-sharing. However, women's health advocates are concerned that programs providing cancer screenings, family planning and other reproductive health services to low-income un- or under-insured women will be cut because of a misconception that all U.S. residents will have health insurance.
"We don't want to take steps backwards," said Citseko Staples Miller, senior specialist for state and local campaigns at the American Cancer Society Cancer Action Network. "Maybe a woman gets a free screening, and then she's told she has cancer but she's no longer eligible for any other screening or treatment," she said.
Advocates also have raised concern about preserving access to family planning services. Twenty-six states have waivers from the federal government that allow them to increase access to family planning services through Medicaid, typically to individuals with incomes up to 200% of the poverty level. This coverage will be especially important for women in states that opted against the ACA's Medicaid expansion, noted Kinsey Hasstedt, a public policy associate at the Guttmacher Institute.
In addition, the federal Title X family planning program provides grants that support more than 4,000 health centers nationwide that provide low- and no-cost contraception and other services to women and men (Andrews, Kaiser Health News, 11/12).