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The Health Care Law and What Women Stand to Gain

Reproductive Law & Policy 101June 13th, 2014

Judy Waxman, Vice PresidentHealth & Reproductive RightsNational Women’s Law Center

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Current Scope: Where Do Women Get Their Health Coverage?

19.2%

59.7%

8%12.2%

1%

Women’s Insurance Coverage (age 18-64), 2012

UninsuredEmployer InsuranceIndividual MarketMedicaidOther

Source: National Women’s Law Center analysis of 2012 health insurance data from the U.S. Census Bureau CurrentPopulation Survey’s (CPS) 2012Annual Social and Economic (ASEC) Supplements

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Goals of the Affordable Care Act

• Facilitate coverage for more people

• Improve coverage for all insured

• Health workforce expansion

• Quality improvement

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Facilitate Coverage• 26 year olds can stay on parents plan• Medicaid

– Up to 138% FPL– 26 states including DC

• Exchange– Financial help to 400% FPL

• No gender rating• No pre-existing condition limits

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Improve Coverage: Coverage Must Be Comprehensive

• Ambulatory patient services• Emergency services• Hospitalization• Laboratory services• Maternity and newborn care • Mental health and substance use disorder services, including

behavioral health treatment• Pediatric services, including oral and vision care• Prescription drugs• Preventive and wellness services and chronic diseases management• Rehabilitative and habilitative services and devices

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Plans Must Cover Preventive Care (No Cost Sharing)

• USPSTF

• Immunizations

• Children

• Women

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USPSTF

• 35 preventive services• Examples:

– Blood pressure screening– Mammograms– Cholesterol screening– Depression– Osteoporosis

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Women’s Preventive Health Services

• Contraception methods and counseling• Well-woman visits• Gestational diabetes screening• HPV DNA testing for women > 30 years• STI counseling• HIV screening and counseling• Breastfeeding support, supplies, and counseling • Domestic violence screening and counseling

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Breastfeeding• Rental or purchase of breast pump• Counseling• Nursing time at work

Well Women Visit • At least one annually• Prenatal care visit included

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Contraception Coverage Rules

• All methods must be covered• Brands, if no generic available • Reasonable medical management• Plans must have a “waiver” process to obtain

medically appropriate contraceptives• Services related to contraception are covered;

insertion, removal, and follow up

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Accommodations For Certain Employers

• Houses of Worship exempted• Non-profit religiously affiliated entities are

accommodated– Organization certifies it is religiously affiliated– Insurer provides seamless coverage for women in

the plan • For profit entities must comply

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For Profit ChallengeBurwell v. Hobby Lobby and Conestoga Wood

• Can a corporation have religious beliefs? • Is the contraceptive coverage requirement a

burden on the corporation’s religion? • Does the government have a compelling reason

for imposing the contraceptive coverage mandate?

• Is there another way to provide the coverage that is easier on the employer?

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Non-Profit ChallengeNotre Dame v. Burwell

• Does the organization have religious beliefs?• Is the accommodation requirement a burden on

the organization’s religion? • Does the government have a compelling reason

for imposing the contraceptive coverage mandate?

• Is there another way to provide the coverage that is easier on the employer?

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Workforce Expansion

• Scholarships• More residency slots

– Primary care– General surgery

• Low interest loans/tax relief• Community Health Centers

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Quality Improvement

• Medical Homes

• Accountable Care Organizations

• Comparative Effectiveness

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Women’s Preventive Health ServicesLet us know!

1-866-745-5487 (contraception + other services)CoverHer@nwlc.org

Toolkit: www.nwlc.org/preventiveservices• Assistance calling your plan

• Template letters to appeal common coverage issues

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Thank You!