The Affordable Care Act (ACA) has improved access to health care for many women across the country. By requiring all health insurance policies to include preventive care specifically focused on women's health needs, the ACA spares most women from worry about out-of-pocket costs for prenatal care, mammograms or cervical cancer screening. However, despite these improvements, many American women still can't afford health care. The Urban Institute released a study showing that almost 50 percent of women report either an unmet medical need due to cost or the inability to pay the medical bills they already have.
Too Poor to Qualify for Assistance
In the states that chose not to expand their Medicaid eligibility with federal funding, 3.1 million low-income women are unable to qualify for ACA insurance subsidies. Many of these states limit Medicaid coverage to children or the elderly and disabled, leaving low-income adults with no options for health insurance. In these states, residents with incomes above 100 percent of the current federal poverty level can qualify to receive federal ACA subsidies for private health insurance, but those with incomes below this level ($11,670 for one person or $23,850 for a family of four) do not qualify for any type of ACA benefits.
Medicaid May Not Be Perfect, But It Improves Health Outcomes
Research discussed in The Commonwealth Fund blog reveals that, despite the sometimes low reimbursement rates offered by Medicaid, people who receive this federal benefit make good use of it. New recipients of Medicaid statistically show much better health outcomes and more access to preventive services.
Private Health Insurance Leaves Unmanageable Deductibles While expanded Medicaid in the 29 states that offer it gives new health care access to poor women, middle-class women all over the nation are suddenly facing new barriers to care: USA Today notes that eight years ago, 55 percent of working people had to pay annual deductibles (yearly out-of-pocket costs) to receive medical care, and now this figure stands at 80 percent. Furthermore, the amount of these deductibles has more than doubled in the past eight years. While more employers offer health insurance, the insurance they provide is often limited to catastrophic hospitalization coverage. The USA Today article profiles a professional woman with high blood pressure and congestive heart failure who recently went without her medications for three months, risking a stroke, because she couldn't afford the medicine. Her health insurance doesn't begin to pay for anything until she has met her $2,500 annual deductible amount. A second woman postponed arthritis treatment until she was so disabled she could barely lift a fork because her husband's insurance has a $7,500 annual deductible.
Women Experience Greater Barriers
While the cost barriers caused by the new health care landscape are applicable to men as well as women, women suffer more from lack of access to affordable health care. The research study by the Urban Institute shows that "women report more unmet need than men for every category." Over 40 percent of women, but only 29.5 percent of men, in the survey report having to leave medical needs unmet due to cost. Similarly, nearly one-quarter of women surveyed stated that they had problems paying medical bills in the past 12 months, compared with just 16 percent of the men. The group that has the greatest problem accessing affordable care is women between the ages of 26 and 44.
It is becoming increasingly clear that health care access is a work in progress. As the Urban Institute points out, "Health insurance coverage does not eliminate cost-related barriers to care for women." Policymakers need to continue working on a medical payment environment in which American women can receive the health care they need.
"Dilemma Over Deductibles: Costs Crippling Middle Class." USA Today. http://www.usatoday.com/story/news/nation/2015/01/01/middle-class-workers-struggle-to-pay-for-care-despite-insurance/19841235/ Accessed 2/20/15.
"Health Reform Monitoring Survey." Urban Institute Health Policy Center. http://hrms.urban.org/briefs/Health-Care-Costs-Are-a-Barrier-to-Care-for-Many-Women.html Accessed 2/20/15.
"Medicaid Expansion & What it Means for You." HealthCare.gov. https://www.healthcare.gov/medicaid-chip/medicaid-expansion-and-you/ Accessed 2/20/15.
"Affordable Care Act Expands Prevention Coverage for Women's Health and Well-Being." Health Resources and Services Administration. http://www.hrsa.gov/womensguidelines/ Accessed 2/20/15.
"Low-Income Americans and Health Reform: Unmet Needs, Significant Opportunities." The Commonwealth Fund Blog. http://www.commonwealthfund.org/publications/blog/2014/oct/low-income-americans-and-health-reform Accessed 2/20/15.
"Status of State Action on the Medicaid Expansion Decision." The Henry J. Kaiser Family Foundation. http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/ Accessed 2/20/15.