October 28, 2015 — Although 5.5 million reproductive-age women have gained insurance under the Affordable Care Act (PL 111-148) in the past two years, many continue to face challenges meeting their health care needs, according to a report released Tuesday by the March of Dimes Foundation and the Urban Institute, Kaiser Health News reports.
According to KHN, the ACA made maternal and newborn care essential benefits for all health plans. Health plans under the ACA also have to provide breast pumps and gynecological exams, among other preventive health services, at no cost.
Prior research has found that costs can prevent uninsured women from accessing health care, KHN reports. Meanwhile, women and children have better health outcomes when women receive needed care before and between their pregnancies.
According to KHN, the March of Dimes Foundation funded the report to analyze the ACA's effect on birth outcomes and maternal care. For the report, researchers from the March of Dimes Foundation and the Urban Institute used information from a quarterly online survey called the Health Reform Monitoring Survey. HRMS, which is funded by the Robert Wood Johnson Foundation and the Urban Institute, is tracking the effect of the ACA before federal data on the law is released.
The report found that the uninsured rate among women ages 18 to 44 declined from 19.6% in the summer of 2013 to 13.3% in the winter of 2014-2015. According to the report, that decline represents about 5.5 million women gaining insurance coverage. Further, the report found that fewer women, including low-income women, said they had difficulty paying for their families' health care and that cost prevented them from accessing necessary health care (Gillespie, Kaiser Health News, 10/27).
According to the report, the percentage of low-income women who were uninsured dropped from 36.9% in the summer of 2013 to 24.9% in the winter of 2014-2015, while the rate of women reporting unmet health care needs because of cost dropped from 57.6% to 48.1% in that same time period (Shartzer et al., Health Reform Monitoring Survey, October 2015).
The report also found discrepancies in states that expanded Medicaid under the ACA and states that did not, with low-income women in non-expansion states reporting fewer gains than women in expansion states (Kaiser Health News, 10/27). Specifically, the report found the uninsurance rate among low-income women in expansion states declined from 33.3% in the summer of 2013 to 19.8% in the winter of 2014-2015, while the uninsurance rate among women in non-expansion states declined from 42.8% to 32.3%. Meanwhile, the percentage of women in expansion states reporting unmet health care needs because of cost dropped from 55.8% to 45.4% in that timeframe, while dropping from 59.5% to 51.7% in non-expansion states (Health Reform Monitoring Survey, October 2015).
Cynthia Pellegrini, senior vice president of public policy at the March of Dimes Foundation, praised the findings, noting, "They're getting the coverage they need and that's the first step."
However, among women who are reporting unmet health care needs because of cost, some might be doing so because they are enrolled in high-deductible plans, which offer consumers lower premiums but require them to meet their yearly deductible before insurance begins to cover the cost of health care services. David Newman, executive director of the Health Care Cost Institute, said, "You'd have a high psychological concern about cost, no question about it. You'd also have a reluctance to see a doctor."
Further, women might be reporting unmet health needs because of costs associated with taking time off work and paying for transportation and child care, according to KHN. Atul Grover, chief public policy officer at the Association of American Medical Colleges, said, "For low-income women without great benefits, there are all sorts of issues that stop them from getting to the doctor. Access to insurance isn't going to alleviate those other problems."
Meanwhile, Claire Brindis, a professor of health policy at the University of California-San Francisco, said future enrollment periods must focus on reaching more minority and low-income women, noting, "We're still at the beginning of a major upheaval" (Kaiser Health News, 10/27).