Health Care Coverage: It’s Finally Happening!
Taken from the September/October 2013 issue of the Women's Health Activist Newsletter.
Over the last few years, we’ve reported on our progress to build support for national health reform, and to ensure that the law is implemented in a way that meets the needs of women and their families. We’ve told you about setbacks and victories along the way – and you’ve celebrated with us when young adults were able to stay on their parents’ health insurance, when kids could no longer be denied coverage for pre-existing conditions, and when women’s preventive health services were covered without any additional fees. Those victories have already touched the lives of millions of women. And now, we’re re-doubling our effects to ensure that women know how they and the people they care about can get good coverage through the new health insurance Marketplaces. Here’s what you need to know:
Starting January 1, 2014, you can get insurance no matter where you work.
Because so many Americans get insurance through their own or their spouse’s employers, many used to (rightly) fear that they risked losing their coverage if they switched jobs or went part-time, got divorced, or retired early. Many were unable to get health insurance, or to afford premiums for available coverage. Before the new health care law was passed, 29 million women were uninsured;1 many more reported being trapped in a bad job or marriage because that was how they got their insurance.
Health reform is about to change all that. This fall, women will be able to shop for health insurance at an online Health Marketplace, a virtual shopping center for health insurance — similar to how we use Expedia and Travelocity to search for flights or hotels. Consumers will be able to shop around, assess different plans’ prices, and find coverage features. Best of all, the Health Marketplaces offer the security of knowing that all of the plans offered are legitimate. The Marketplaces open on October 1, 2013, with coverage beginning on January 1, 2014.
A surprising number of people mistakenly believe that politicians have been able to stop the Marketplaces and that the health law isn’t being implemented.2 Not so! The Marketplaces will function in all states and territories; some are being run by the Federal government, but every state has to offer a Marketplace. Just visit www.healthcare.gov to start the application process.
Anyone who makes less than 400 percent of the Federal poverty level (which is $42,000 for an individual) will get tax subsidies to help cover the cost of insurance. People whose incomes fall below the poverty line, will be covered by expanded Medicaid benefits. Lower-cost options are also available to make sure there’s an option for all people at all income levels, and with all different family sizes. And, the insurers can’t say no, or reject you for having a pre-existing condition. Just like the airlines – if the insurance company offers a policy and you’re willing to pay for it – you’re covered.
Unless you’re an immigrant or resident of a state that refuses to expand its Medicaid program.
This is the part of health reform that’s not such good news. Back in 2009, when Members of Congress debated health care reform, some of them got a little bit nasty. Not only did Congress ban undocumented immigrants from buying health insurance through the Health Marketplaces (even with their own money, for goodness' sake!), but members also prohibited legal immigrants from participating. This ban includes young adults who were brought to the U.S. as children and have permission to stay here. No Health Marketplaces for them.
Others who won’t get the full benefits of the health care law are those whose state policymakers refuse to accept Federal funding to expand state Medicaid programs and cover all residents who live in poverty. The list of states refusing to expand Medicaid changes all the time; you can look up your state here: http://www.advisory.com/Daily-Briefing/Resources/Primers/MedicaidMap. We don’t believe that women’s rights to get health care should depend on what state she lives in, but we’ve got some persuading to do to convince Governors who are still blocking their low-income residents from getting covered. If your state is among the 16 or so that are not expanding Medicaid, learn how you can weigh in at www.RaisingWomensVoice.net.
Insurance companies have to treat women fairly.
What a concept! No more sexism in health insurance. No more charging women more than men, excluding maternity care from covered benefits, and treating cesarean birth as a pre-existing condition. And, policies now have to cover preventive services without charging extra fees like co-pays or deductibles. These services include well-woman exams, contraception, breastfeeding supplies, cancer screening (i.e., mammograms and Pap tests), domestic violence screening, and counseling for sexually transmitted infections (STIs). Another key provision that affects women is that policies have to do a better job of helping women access midwives’ services, too.
LGBTQ families aren’t left out.
Health Marketplaces are not allowed to discriminate against consumers because of their sexual orientation or gender identity. Same-sex couples can search for plans that offer coverage for domestic partners through the Health Plan Finder tool at www.healthcare.gov. Advocates are still working to ensure all health plans understand that transmen and women are people, too; and that their health care needs can’t be ignored.
What about abortion?
Abortion coverage varies by state; at press time, in July 2013, 20 states have prohibited the insurers in their Health Marketplaces from covering abortion care. Eight of those states prohibit insurance coverage of abortion altogether. If state law doesn’t prohibit it, insurance companies almost always cover abortion care. You may need to read the fine print to find out about abortion care coverage; if you don’t see the answer, don’t be afraid to ask. Access to safe abortion care helps women maintain their good health and take care of the children they already have. We should all buy plans that include abortion care coverage, even if we think we’ll never need it.
There’s still fine print – and you still need to read it.
While the health care law does a lot to protect consumers, we all still need to be smart shoppers when picking health insurance. All Health Marketplace plans will cover essential benefits, but you may have to do a little digging to make sure the plan you pick includes the specific types of providers and services you value. You will have to read the fine print -- and you should – to find out if specific providers and services, like Nurse Practitioners and abortion care, are included in the coverage. You should also check if the insurer has limits on seeing providers outside of the plan’s network.
This assessment is particularly critical if you want excellent access to family planning and abortion. By law, all insurance has to cover contraceptive counseling and services. But, will you still be able to get those services at the same place you do now? Will those providers bill your new insurance company directly? Some insurance companies don’t like paying for care received at family planning clinics because they’re used to dealing with individual physicians. Advocates are trying to get states to require insurance companies to work with any willing provider, especially ones that provide essential community services. So, if you love your provider, check to see what plans they’re already working with.
Coverage doesn’t happen automatically – you have to enroll.
We wish comprehensive coverage happened automatically and lasted your whole lifetime — but we’re not there yet. For now, you have to enroll to get covered. But, starting October 1, 2013, this is easy to do through the online Health Marketplaces for coverage beginning on January 1, 2014. If you can’t find what you need on-line, or can’t get on-line, help center staff can assist you in figuring out what’s right for you; call 1-800-318-2596 to reach them. And, the centers have translation assistance in 150 languages! Many states will also offer face-to-face assistance to those without Internet access.
You’re important – and so are the men who listen to you.
You may feel like it’s not worth your trouble to enroll, particularly if you are young and/or healthy. For those on a budget, even the least expensive plans may seem unaffordable at around $200 per month. In 2014 people who don’t sign up for coverage will pay a $95 penalty at tax time. But, you’re really shortchanging yourself if you pay the penalty instead of paying for insurance. Bad things can happen unexpectedly, making insurance very important. So sign up and, if you already have coverage, encourage others to enroll as well. Women are often the decision-makers when it comes to a family’s health care decisions — we should use our influence to protect the ones we care about and make sure they get the coverage they need. Use your power! Make sure your boyfriend, son, cousin, and other family members know that getting health insurance is important.
Want to know more or get involved in local outreach efforts?
For helpful fact sheets about what women get from health reform, and clear explanations of how the Health Marketplaces will work, visit: www.RaisingWomensVoice.net. Raising Women’s Voices (RWV) is campaigning for effective implementation of the health law in many states. If there isn’t a local RWV campaign near you, the Get Covered America campaign is also hosting outreach events in many states. See: http://www.getcoveredamerica.org.
Cindy Pearson was the NWHN’s Executive Director from 1996 to 2021. One of the nation's leading advocates for women's health, Cindy often testified before Congress, NIH and the FDA and was frequently featured in the news as a consumer expert on women’s health issues. When she retired, Cindy received a Congressional Resolution in honor of her outstanding contributions to the health of women and girls.
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