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Can Obamacare ensure uninsured women get health insurance?

One in five American women lacks health insurance, with young, low-income women most likely to be uninsured. But experts say Obamacare is helping more women get insured -- with better, more affordable coverage.

About 19 million women in the U.S. are uninsured, according to a November 2013 fact sheet from the Kaiser Family Foundation (KFF). But a January 2014 report from the U.S. Department of Health and Human Services shows that, of the 2.2 million consumers who bought insurance by the end of December in the marketplaces created by the Affordable Care Act, 54 percent are women.

Uninsured women and Obamacare

Why are women more likely to be uninsured than men?

There are four big reasons women -- especially those under 25, according to the KFF -- tend to be more vulnerable than men to falling through the insurance cracks.

  1. Industry. More women than men work in service industries, from fast food to hotels, says John Rother, president and CEO of the National Coalition on Health Care. Service jobs are less likely to come with employer-provided insurance than jobs in other industries, Rother says. In fact, only 35 percent of all U.S. women under 65 have coverage through their own jobs, compared with 43 percent of all men in that age range, according to the KFF.
  1. Poverty. Women are more likely than men to be poor. In 2012, the poverty rate for women was 14.5 percent, compared with 11 percent for men, according to a 2013 report by the National Women's Law Center. Thirty-nine percent of poor women -- whose incomes are at or below the federal poverty level, which is $11,670 for a single person in 2014 -- are uninsured, according to the KFF.
  1. Type of coverage. Women are more likely than men to have public insurance such as Medicaid, says Lois Uttley, co-founder of Raising Women's Voices, a national initiative that is working to get women and families benefitting from health care reform. In some cases, women who otherwise make too much to qualify for Medicaid -- up to 185 percent of the federal poverty level ($21,589 for one person in 2014) in some states -- get insured through the program during and shortly after a pregnancy. But 60 days after giving birth, these women are left without coverage, says Dania Palanker, senior counsel for health and reproductive rights at the National Women's Law Center, resulting in women going in and out of coverage.   
  1. Dependent coverage. Women are more likely than men to be covered as a dependent on a family member's plan, according to the KFF. In fact, 23 percent of women are covered as dependents, compared with only 15 percent of men. So, women often get coverage through their spouse's employer, and that leaves them more vulnerable to losing coverage through death or divorce, Uttley says. Also, she adds, women with older husbands often lose coverage in their late 50s and early 60s when their husbands retire and go on Medicare.

Why is it important for women to have consistent health coverage?

Not having health insurance negatively affects women's health in several ways. According to KFF, uninsured women are more likely to forgo preventive health care and fail to get medical care when they need it.

Only 62 percent of uninsured women ages 18 to 64 got a Pap test, which can detect cervical cancer, in the past three years, compared with 83 percent of insured women, according to KFF. And only 36 percent of uninsured women ages 40 to 64 got a mammogram in the past two years, compared with 74 percent of insured women.

When they do get care, uninsured women get lower-quality care and have worse health outcomes than insured women, according to Kaiser.

How does Obamacare help uninsured women?

The Affordable Care Act will help to reduce the number of uninsured women, Uttley says. Here are five ways Obamacare will help uninsured women.

  1. Medicaid is available to more women in some states. The ACA provides federal money for states to expand their Medicaid programs to cover individual residents with annual incomes up to $16,104.

"The single most important thing that will reduce the number of uninsured women in the United States is the Medicaid expansion," Uttley says, noting that getting other states to agree to expand Medicaid is crucial to getting more women insured. Some states opted out of expanding Medicaid, including Texas, Florida and Louisiana.

  1. Women can more easily get individual health insurance. Before the ACA, many women got denied individual insurance due to preexisting conditions, experts say. For example, Palanker says some insurers counted having had a baby via C-section or having undergone infertility treatments as preexisting conditions. However, under Obamacare insurers can no longer deny coverage due to preexisting conditions.
  1. Coverage is more affordable for women. The ACA prevents insurers from charging women more for coverage, but before the rule went into effect, women were paying $1 billion more a year in premiums on the individual market, according to a NWLC analysis, Palanker says. The higher costs reflected the fact that women under 50 use more health care than men, according to insurer Aetna.

The availability of Obamacare subsidies to help pay premiums is helping women afford coverage, Uttley says. Before Obamacare, an individual policy in New York could cost as much as $1,200 a month, Uttley says. This was a big problem for women, who on average earn less then men.

Now, a single Brooklyn woman who makes $20,000 a year could pay $85 a month (with a yearly subsidy of $3,362) for a silver plan, which covers 70 percent of health care costs.

A woman living in the same area who makes $100,000 a year would get no subsidy and might pay about $365 a month for a silver plan, the calculator shows.

  1. The quality of coverage has improved for women. Before the ACA, women who could get individual insurance often couldn't get maternity coverage without an expensive rider that might force them to wait a year or two before the coverage kicked in, Palanker says.

Now, maternity care is one of the 10 essential health benefits that must be covered by plans sold inside and outside the health insurance marketplaces, created by the ACA to allow consumers to shop for and purchase plans. The plans must cover preventive services -- including birth control, mammograms and some cancer screenings -- with no cost sharing, Palanker says.

  1. Women at risk of losing coverage have a safety net. The ACA marketplaces provide an option for women who lose their coverage due to job loss, divorce or death, Uttley says. Women who experience such a "qualifying life event" can enroll through the marketplaces at any point during the year and they don't have to wait for the open-enrollment period, Rother says.

When Uttley speaks to women's groups, she tells women who are uninsured or worry about losing their coverage: "Don't despair. There's an option for you now."

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