5 ways women's health care has been improved by Obamacare

Chris Kissell

Obamacare and womenHealth care reform has been controversial from the start. Opinion polls consistently show that a majority of Americans have major misgivings about the landmark legislation. For example, a recent Gallup poll showed that just 43 percent of Americans approve of Obamacare, while 51 percent disapprove.

Yet, the heated debate has obscured some fundamental changes that have boosted health care options for people, especially women.

These changes have impacted everything from preventive care to birth control and the right to breastfeed at work, says Judy Waxman, vice president for health and reproductive rights for the National Women's Law Center (NWLC).

"We have made a significant step forward," she says.

Following are five overlooked developments that have substantially improved women's health care.

1. Woman can't be charged more for health insurance.

Before health care reform, insurance companies could set different premium rates for men and women. However, Obamacare bans the practice of charging more based on a person's sex.

In the past, women often were charged more because they tend to use medical care more often than men, and they may require expensive services such as maternity care.

A 2012 report by the NWLC found that women paid about $1 billion more in health insurance premium costs annually due to insurers' gender-rating practices.

The U.S. Department of Health and Human Services highlights the fact that previously, a 22-year-old woman could have been charged a premium 150 percent higher than a 22-year-old man simply because she was a woman.

The new rule restores fairness to health insurance pricing, says Amy Allina, deputy director of the National Women's Health Network in Washington, D.C.

The change is especially important for low-income women, who often have to shop for health coverage on the individual insurance market, which tends to be more expense than group coverage, Waxman says.

"More women are low-wage workers than men, and that often means they don't get health insurance through their job," she says.

While 43 percent of men are covered by health insurance through their own employer, the number dips to 35 percent for women, according to a 2013 analysis of census data by the Kaiser Family Foundation and the Urban Institute.

2. Health plans must cover preventive services without fees.

Health care reform mandates that health insurance plans must cover many preventive care services without charging copays, coinsurance or deductibles. (Grandfathered plans - those in place without major changes since March 23, 2010 - may not have to cover all these services.)

Every woman now is entitled to a yearly well-woman visit without cost. And the free care doesn't stop there.

"The law requires health plans to provide FDA-approved preventive services without cost sharing," says Sara Collins, vice president of health care coverage and access for The Commonwealth Fund, a New York-based organization that promotes better access to health care.

Such cost-free preventive services now include:

  • Bone scans for osteoporosis.
  • Cervical cancer screenings.
  • Mammograms.
  • Pap smears.

Some limits do apply. For example, free mammograms are limited to every one to two years for women over age 40, and screening for human papillomavirus (HPV) is allowed every three years for women over 30 with normal cytology results.

To find out about other restrictions, visit HealthCare.gov, which has a list of what's covered at no cost for women.

In addition, plans now must cover well-baby visits and other services for children at no cost, which is bound to be a relief to many mothers, Allina says.

3. All policies must cover maternity care.

Waxman says mandatory maternity coverage is one of health reform's biggest victories.

Health insurance plans now must cover maternity care and childbirth services. Before health reform, some health plans didn't offer maternity coverage.

In the past, Allina says many women wrongly assumed all health plans offered maternity coverage. Those women often were shocked to find that they didn't have coverage, or that it was very expensive.

Now, all health plans must provide a "summary of benefits and coverage" that details how a plan covers the cost of having a baby.

Also, because health reform mandates that insurers can't deny coverage due to pre-existing conditions, women have a right to maternity care services even if they became pregnant before joining their current plan.

4. Birth control is free.

All health insurance plans now must cover birth control services for women without charge -- including copayments, coinsurance or deductibles -- so long as the services come from a provider within the health plan's network.

Services that must be covered include:

  • Barrier methods (diaphragms, sponges).
  • Hormonal methods (birth control pills, vaginal rings).
  • Implanted devices (intrauterine devices).
  • Emergency contraception (Plan B, ella).
  • Patient education and counseling.

Plans don't have to cover any drugs that induce abortions, or services for men such as vasectomies.

5. Breastfeeding equipment and privacy must be provided.

Health insurance plans now must provide breastfeeding support, counseling and equipment to women throughout the entire time they're breastfeeding.

In addition, all employers must provide break time for an employer to express breast milk for nursing for one year after a child is born. Employers also must provide a private place -- beyond a bathroom -- for women to express breast milk.

"It came about because there are women who need to work and also want to breastfeed, and were finding that they couldn't because there was no time or place to pump," Waxman says.