Today we celebrate the seventh anniversary of the Patient Protection and Affordable Care Act (ACA), the biggest leap forward for women’s health in a generation. Those first two words of the law’s name are often dropped for convenience but as we reflect on everything the law has done, it’s important to remember that “patient protection” is at the core of the ACA.
The law has changed what Americans expect from their health system and their government—even as Republicans attempt to strip insurance coverage from millions of people this week on the House floor.
Some of these benefits are well known. For example, the law prohibits insurance companies from charging women more than men or denying women coverage based on pre-existing conditions. Pre-ACA, healthy, non-smoking women were often charged more than smoking men for the exact same policies, and small businesses employing women faced much higher premiums than identical businesses employing men. A firm might opt to hire a less qualified man over a more qualified woman simply because he would cost the company less to insure, and many industries dominated by women were priced out of providing employer-based insurance. Meanwhile, everything from pregnancy to domestic violence could be used as an excuse to deny women health insurance altogether.
Likewise, the law requires plans to cover essential health services—such as maternity, newborn, and mental health care—instead of requiring women to buy separate (and costly!) add-on coverage. And insurance plans must cover preventive health services ranging from mammograms and Pap tests to osteoporosis screenings to the full range of contraceptive methods, all without co-pay.
And, under the ACA, insurance must cover what it is supposed to cover! Pre-ACA, even people with insurance could find themselves facing medical bankruptcy when they reached their annual or lifetime limit on coverage, or when their insurance companies rescinded their coverage the moment they became ill. A prematurely-born baby in the neonatal intensive care unit could use up her lifetime coverage limit before she turned three months old. A woman diagnosed with breast cancer could find her insurance abruptly canceled because she once failed to report teenage eczema as a pre-existing condition. The ACA repealed annual and lifetime limits and blocked insurance companies from rescinding policies without clear evidence of fraud.
Because the ACA was the first law to prevent discrimination in health care based on sex, it also paved the way for protections for trans* health care rights. Under regulations issued by the Obama Administration, the law bars discrimination against people based on gender identity, pregnancy, and sex stereotypes. For example, insurance plans now must remove categorical exclusions of coverage for transgender care, such as hormones and gender transition surgeries.
But the ACA has also empowered women in more subtle ways. Women live in poverty at higher rates than men do and are much less likely than men to have employer-provided insurance in their own names. They’re also much more likely to serve as family caretakers. That means even women with insurance are at greater risk than men of losing it following changes in their relationship status or in the family coverage offered by their spouse’s employer. The “affordable care” part of the ACA means subsidies to help low- and moderate-income households purchase private insurance and an expansion of Medicaid for households living near the poverty line. The ACA’s subsidies are pegged to age, income, and cost of insurance, so they rise even if premiums do. As a result, the law has provided not only health benefits but also much greater financial independence and stability. These benefits have ranged from fewer missed housing payments to the freedom to leave an abusive partner.
But that’s not the only way that the ACA has worked toward affordable care. Under the law, insurance companies can’t spend more than 15 percent (or 20 percent for small group plans) of the premiums they collect on administrative expenses, including executive salaries and bonuses. That helps tamp down on rising premiums. And out-of-pocket costs are capped to limit how much insurance companies can charge in deductibles, copays, and other cost-sharing each year.
And for older women, the ACA closes the prescription drug “donut hole” for seniors on Medicare, saving women millions of dollars in prescription drug costs. Women not only live longer than men on average, but they enter their senior years with far less financial security.
As we reflect back on the last seven years and fight to save the future of our care, it’s important to remember why we can never go back.