Taken from the September/October 2012 issue of the Women's Health Activist Newsletter.

When polls break the law down into its component parts (like giving tax credits to small businesses or allowing young people to stay on their parents’ plans), its specific sections are often very popular. The bottom line is that many people either know very little about what the law actually does, or believe the negative messages spread by anti-health care law activists in order to foster mistrust and opposition to the law. As an example of the sort of misinformation out there, my 82-year-old grandmother recently sent me a frantic email complaining that the health care law will eliminate care for people over age 75.¹ I know that’s not true; you know that’s not true; but my grandmother honestly believes that this is what is going to happen.

There is some good news, however; as people find out more about the law and as its provisions go into effect, overall support for health care reform is slowly increasing. As of July 2012, 48 percent of those surveyed said they supported the law, up from 43 percent the month before.²

The National Women Health Network has been working to help increase support for the law — and awareness of how it’s helping people — with our campaign, Countdown to Coverage. The campaign, launched in March of this year, is designed to raise women’s awareness about the many benefits they stand to gain from the new law. The campaign draws on research released last year that shows that people don’t know the concrete details about how the law will make health services more affordable and protect people from insurance company abuses. When people learned about the law’s specific benefits, their views changed dramatically, in many cases flipping from opposition to support: for example, young women’s support increased seven-fold and older women went from opposing the law to firmly supporting it.³

The health care law has already helped millions of people get the care they need by letting young adults stay on their parents’ insurance plans until age 26; eliminating lifetime limits that used to let insurance companies end coverage when people reached a financial cap; and ensuring that children are not discriminated against for pre-existing conditions. On August 1^st, women got a long list of new reasons to feel good about the health care law.

Enormous Coverage Benefits for Women Started August 1st

On August 1^st, another historic and important change to the U.S. health care system went into effect. On that date, most health insurance plans were required to start covering important preventive health care services for women without charging anything extra, like co-pays or deductibles. These services include:

• Comprehensive contraceptive care;
• Counseling and testing for sexually transmitted infections, including Human papillomavirus (HPV) and HIV;
• Well-woman preventive care visits, so women can get the services they need at each specific age;
• Screening and counseling for intimate partner violence;
• Screening for gestational diabetes; and
• Breastfeeding counseling and equipment.

Preventive services are incredibly important in protecting the health of women and our families, but expensive co-pays have long been a serious barrier to access for many women, particularly young and low-income women. “Often because of cost, Americans used preventive services at about half the recommended rate… A report by the Commonwealth Fund found that in 2009 more than half of women delayed or avoided necessary care because of cost.”⁴ So, expanding access to these critical health services is an extraordinary accomplishment.

This is illustrated by looking at just one of the preventive care services, contraceptive care. Contraceptive care is a vital aspect of preventive health care because it helps women avoid unintended pregnancies and facilitates birth spacing, which are both important and necessary to ensure healthy mothers and healthy babies. Thanks to the Affordable Care Act (ACA), insurers will now have to provide coverage without co-pays for all contraceptive methods that have been approved by the Food and Drug Administration (FDA) including oral contraception, shots, the ring, intrauterine devices (IUDs), diaphragms, cervical caps, and tubal ligation. This means that all women who have health insurance — regardless of their age, contraceptive choices, or health status — can get affordable contraceptive care that’s right for them. Thanks, Affordable Care Act!

Although the requirement that insurance companies start providing these preventive health services without co-pays went into effect on August 1, 2012, the changes in women’s policies didn’t all happen on that date. Every new insurance plan that a woman purchases after August 1 must include the new coverage, and all old plans that make a significant change in coverage must too. The U.S. Department of Health & Human Services estimates that approximately 47 million women will have access to the additional services without cost-sharing on or after August 1. Most plans run on a calendar year, and most make some changes each year so many women will first see the effect when their plan year starts on January 1, 2013.  Women enrolled in student health plans are likely to see the benefit immediately, since these health plans are usually aligned with the start of the school year. So, if you go to your doctor for preventive health care in the next few months, you may still get charged a co-pay, but that experience will become more and more uncommon. To find out when your plan year starts, check your plan documents or ask your employer.

Countdown to Coverage

The Countdown to Coverage campaign strives to help women understand the law’s concrete benefits and the many benefits they stand to gain. In addition, the campaign also collects and shares women’s stories about how the law is making real changes to our lives. Its tagline is “the incredible true story of the Affordable Care Act (ACA),” because we all have our own story about how the law helps us stay healthy.  Like Robyn, who tells her family’s story:

Last year, my son, Jax, was born with a genetic disorder and a serious heart condition. It’s too early for me to know the actual cost of the medical services Jax needed and will continue to need, but I do know that the health care law has already helped to keep my family’s health coverage secure by eliminating lifetime limits for health care costs. Before the health care law, my insurance company could have dropped my family’s coverage once we met our plan’s lifetime limit, but now we feel safer because the law guarantees that cannot happen. I also know that Jax can never be denied coverage due to his condition, because insurers can no longer refuse to cover children up to age 19 on the basis of pre-existing conditions. As of 2014, adults can’t be denied coverage because of a pre-existing condition, either. The health care law helps protect my family and keep us healthy.

Earlier this year, we waited with anticipation for the U.S. Supreme Court to rule on the health care law’s constitutionality. For those of us, like Robyn and Jax, who have already benefitted so much from the ACA, it was unfathomable that its benefits might be taken away if the Court ruled against the law. When the Court upheld the vast majority of the health care law, we all celebrated because it meant the law would continue to help women and families get the care we need to stay healthy.

Advocates were disappointed, however, that the Court decision may have jeopardized the part of the law that offered improved access to the poorest women and families. The health care law expanded eligibility for the Medicaid program to include people making less than 138 percent of the Federal Poverty Level annually (about $29,000 for a family of four). This expansion would help an estimated 17 million people get the health care services they need. To encourage states to implement the expansion, the health care law included both a carrot and a stick. The carrot: the Federal government provided a significant amount of financial support, so the states would not have to bear these costs. The stick: the Federal government could withhold all Medicaid funding (funds for the expansion as well as other Medicaid funding) from states that did not implement the expansion. But the Court ruled that withholding those funds is unconstitutional, so the stick has been taken away.

Unfortunately, some conservative governors are using that part of the decision to make political statements about their opposition to the health care law, declaring that they will not expand Medicaid in their states. If these governors follow through on their declarations, it will deprive some of the nation’s poorest communities of the benefits of the law and access to care. It will also leave those states with some very burdensome health care costs that could have been paid for with Federal support, if they had implemented the Medicaid expansion. The Network and our allies will be advocating for full implementation of the health care law — including the Medicaid expansion — in all 50 states. And, as the furor of the election year dies down, we hope that more and more states will see the practical advantage of taking the carrot, rather than making a political stand that doesn’t serve the interests of the states’ residents and taxpayers.

What’s Next?

In 2014, the health care law will make additional, significant changes to the health insurance system. As more and more aspects of the health care law go into effect, women will continue to gain more affordable coverage for the health care we need.

First, insurance companies will no longer be able to charge women more than men for the same insurance plan and they won’t be able to place arbitrary annual limits on the amount of medical care they will cover per year; so, if you or a member of your family get sick, you’ll remain covered no matter what type or amount of care you need. And, they won’t be allowed to discriminate against people for having pre-existing conditions — a change that will impact pregnant women, cancer patients, survivors of abusive relationships, and many others. In addition, insurance companies will also be required to cover maternity care. This ; is a huge advance for women, since many plans have historically excluded coverage for the care and services that women need when we are pregnant and giving birth.

And, in the same year, families will start getting help paying for health insurance. Families that earn up to 400 percent of the FPL (about $88,400 for a family of four) will be eligible for Federal subsidies to buy health insurance. Families earning up to 138 percent of the FPL will be eligible for Medicaid, which will be available to them if they live in a state that implements the program expansion.

THIS is what the Countdown to Coverage campaign is all about: telling the Incredible True Story of the Affordable Care Act. From protecting women and their families from long-standing discriminatory practices by the insurance industry, to securing consistent and affordable health insurance, women stand to gain so much from the health care law. To find out more about what the health care law can do for you, and how you can help spread the word, please visit the Countdown to Coverage website: www.CountdowntoCoverage.org.

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Keely Monroe was a Law Students for Reproductive Justice (LSRJ) fellow and NWHN Program Coordinator during 2011-2012.

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