Women’s Health Care and the Affordable Care Act

Only one year after the landmark legislation was signed, the Affordable Care Act (ACA) is already improving women’s access to high quality, affordable health care. When the law is fully implemented in 2014, it will signify the greatest leap forward for American women’s health in decades.

New protections for women under the ACA include:

• Improved Access to Affordable Coverage: Under the ACA, adolescents and young adults up to age 26 may now remain on their families’ plans. Due to substantial new tax credits, more small businesses are now offering health care coverage to their employees. And beginning in 2014, expanded Medicaid eligibility means improved access to healthcare coverage for lower income women and families.
• Free Preventive Care: Under the ACA, women receive recommended preventive services without copayments or deductibles. This includes U.S. Preventive Services Task Force A- and B-rated services such as mammograms, screenings for cervical cancer and chlamydia, prenatal care and more.
• The End of Gender-Based Discrimination: Before the ACA, women could be charged higher premiums than men for the same insurance policy. Beginning in 2014, it will be illegal for insurance companies to charge women higher premiums on the basis of gender.
• Being a Woman is No Longer a Pre-Existing Condition: Before the ACA became law, insurers could deny women coverage for “pre-existing conditions” such as pregnancy, Cesarean sections, and breast cancer. Beginning in 2014, insurers cannot deny coverage to anyone based on pre-existing conditions. Already under the ACA, children cannot be denied coverage because of pre-existing conditions.
• The End of Lifetime Limits: Under the ACA, insurance companies cannot place a lifetime limit on the amount of coverage an individual receives. Beginning in 2014, annual limits are banned as well.

For more information about the important rights and benefits the ACA provides for women and their families, see healthcare.gov’s new page on Women and the Affordable Care Act.

Partnership Urges CMS to Clarify Tobacco Cessation Coverage for Pregnant Women on Medicaid

Partnership for Prevention is proud to be one of six groups telling Centers for Medicare and Medicaid Services (CMS), “Medicaid should cover the full range of proven and effective treatment options so that pregnant women can find the particular service or combination of services that will best help them to quit using tobacco and not relapse.” Partnership made these comments in a letter yesterday to CMS on our views on the implementation of Section 4107 of the Patient Protection and Affordable Care Act (PPACA).

This section of the PPACA will be implemented October 1st of this year and will require state Medicaid programs to cover comprehensive tobacco cessation services, including “diagnostic, therapy, and counseling services and pharmacotherapy (including the coverage of prescription and non-prescription tobacco cessation agents approved by the Food and Drug Administration)”, for pregnant women. While this is certainly an improvement to the Social Security Act, Partnership urges CMS to clarify exactly what states must do to comply with Section 4107.

In its current state, the PPACA does not specify the type of counseling or the amount and duration of counseling sessions that pregnant women should receive. The Public Health Service’s Treating Tobacco Use and Dependence clinical practice guideline (PHS Guideline) found that proactive telephone counseling (quitlines, call-back counseling), individual counseling, and group counseling formats are all effective in reducing tobacco use. The PHS Guideline also confirmed that there is a strong dose-response relationship between the frequency and length of the counseling sessions and successful quit attempts. Furthermore, the PHS Guideline found that an effective strategy for producing high, long-term abstinence rates is “relatively intense cessation counseling (e.g., four or more sessions that are 10 minutes or more in length each)” and recommends that, if possible, clinicians should strive to meet with individuals four or more times.

Based on these guidelines, Partnership feels that the PPACA should require states to cover all three counseling formats: individual, group, and telephone-based. They should also cover a minimum of four counseling sessions per quit attempt and should be strongly encouraged to cover more sessions since accumulating evidence suggests that states cover a minimum of two quit attempts per year.

In terms of cessation medications, the current PHS Guideline does not make recommendations. In the event that a subsequent PHS Guideline does recommend use of cessation medications during pregnancy or if new evidence emerges that cessation medications can be used safely and effectively by pregnant women, Partnership encourages CMS to inform states that they must cover those medications in their Medicaid programs with no cost-sharing requirement.

Partnership for Prevention believes that effective implementation of this new policy will result in fewer health risks and save lives and money.

Health Reform Benefits Women

The good news is that 30 million women who are currently uninsured or underinsured will benefit from the recently passed Affordable Care Act (ACA). These women and their children will enjoy a full range of comprehensive benefits through private insurance, or the Medicare and Medicaid programs. A recently released study by the Commonwealth Fund, “Realizing Health Reform’s Potential: Women and the Affordable Care Act of 2010,” examined the ACA’s provisions to identify their impact on access to health services, as well as future cost implications. Provisions eliminating the pre-existing condition exclusion, requiring coverage for maternity and newborn care, providing insurance purchase subsidies, limiting out-of-pocket expenses and prohibiting higher premiums based on gender, all contribute to a significantly more positive future for women seeking health care.

The report also highlights the new preventive care benefits that will provide increased access to high value recommended services from the U.S. Preventative Services Task Force (USPSTF) without cost-sharing. However, the report missed the mark by failing to mention tobacco cessation. Tobacco-related disease is the leading cause of death in the U.S. causing over 170,000 deaths per year among women. In 2006, 18 percent of adults with private health insurance were current smokers, compared to 35 percent of Medicaid recipients and 34 percent of the uninsured population. All USPSTF recommendations are linked to a letter grade that reflects the level of certainty of the evidence supporting the preventive service. The ACA will make access to the “A” ranked smoking cessation treatments a reality for more women. And, their children will benefit from reduced exposure to secondhand smoke, thereby decreasing incidence of asthma and other related conditions. Under the federal Medicaid program, tobacco cessation services are a mandated benefit for pregnant women. A good start, but all Medicaid enrollees should have access to smoking cessation counseling and medications.

Preventive services not only help keep people healthy, they also save lives. 42,000 lives can be saved each year by helping more smokers quit.

Read the full report - Realizing Health Reform's Potential: Women and the Affordable Care Act of 2010.


Diane Canova
Vice President, Policy & Programs
Partnership for Prevention

World No Tobacco Day 2010

The World Health Organization’s World No Tobacco Day 2010 will be celebrated on May 31. This year’s health theme is “Gender and Tobacco”, with an emphasis on marketing to women. Though women comprise only 20% of the world’s one billion smokers, the rise in prevalence, especially among girls, is alarming.

The new WHO report, Women and Health, cites the fact that the tobacco industry has ramped up its marketing efforts to women in countries worldwide.

Details about the event and the 2010 focus on women can be found on the WHO website.

On World No Tobacco Day 2010, and throughout the following year, WHO will encourage governments to pay particular attention to protecting women from the tobacco companies' attempts to lure them into lifetimes of nicotine dependence. By responding to WHO's call, governments can reduce the toll of fatal and crippling heart attacks, strokes, cancers and respiratory diseases that have become increasingly prevalent among women. Tobacco use could kill one billion people during this century. Recognizing the importance of reducing tobacco use among women, and acting upon that recognition, would save many lives.

David Zauche
Managing Senior Fellow & Senior Program Officer
Partnership for Prevention