Americans remain deeply divided over the Affordable Care Act, particularly along party lines, with the majority of Democrats supporting former President Barack Obama’s 2010 health insurance overhaul, and most Republicans (and President Donald Trump) rejecting it.
But a new study published in the American Journal of Preventive Medicine claims that the Affordable Care Act (or the ACA, or “Obamacare”) has had “significant benefits” for women, with the greatest outcomes for low-income women below the federal poverty level.
The report notes that women faced challenges prior to the ACA that discouraged or prevented about one-third of them from getting affordable insurance and health care, citing examples such as: gender rating (women were charged higher insurance premiums than men); not being covered for pre-existing conditions (which included pregnancy or being a victim of domestic violence); and being denied coverage for maternity care and contraceptives. The ACA expanded coverage to address these issues, and to extend coverage to dependents ages 19-26. The gender pay gap can also cost women $500,000 in earnings over careers, which contributes to women having a harder time affording health care access compared to men. And as childbearers, women also bear unique health care needs, such as gynecological and breast exams.
So the study analyzed self-reported patterns of insurance affordability, access to health care and the use of preventive services (such as getting flu shots, mammograms or screenings for blood pressure and cholesterol) for a survey sample representing more than 41 million women ages 19-64. It compared women in low-, middle- and high-income groups before and after the ACA officially rolled out in 2014.
It found:
Before the ACA, 40% of low-income survey respondents were uninsured. Afterward, that percentage dropped to just 17% in 2014 and 11% in 2016. The number of women in the lowest income group who said they had seen a doctor within the past year increased 4.1% after the ACA was introduced. There was a 2.3% increase in the number of middle-income women who saw a doctor in the previous 12 months following the ACA rollout. (There was no significant difference for high-income women.) There were increases in blood pressure checks, cholesterol screenings and flu shots (between 3% and 7%) across all income groups after ACA policies went into effect. The number of low-income women getting mammograms to screen for breast cancer increased almost 5%.What’s more, a recent study published in the Journal of Public Economics found that this greater access to health insurance after the ACA went into effect saw a “significant reduction” in the number of Americans who were late on their rent and mortgage payments.
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There are some limitations to the study, such as the fact that it was self-reported; it’s possible the subjects misremembered or misreported how many times they had been to a doctor or received a vaccine, for example, or whether they were insured every year. Also, the data only covers the first three years after the ACA coverage expansions were introduced, and the report noted that this time frame may not be sufficient enough to demonstrate the full effect of the ACA. Indeed, enrollment in Obamacare declined to 8.4 million in 2019 from 8.7 million in 2018.
And the ACA hasn’t been a win for everyone. Taxes were raised on higher-income households (earning more than $200,000 as an individual or $250,000 as a family) to support the health care plan, for example. It’s also led to high premiums and deductibles of $3,000 and up for some people, which resulted in some middle-class families paying for health insurance that they then can’t afford to use.
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But the new American Journal of Preventive Medicine paper makes a plea for policy makers to note that expanding insurance coverage, upholding cost-sharing reductions and improving access to preventive care without cost-sharing are important to protect women’s health and health rights, regardless of income.
“Given current debates around the ACA and women’s historical challenges obtaining health care, this research is important to highlight how women’s access and affordability of care have improved as a result of the ACA,” concluded lead author Dr. Lois Kaye Lee, from Boston Children’s Hospital. “Efforts to alter the ACA should consider the impact of policy changes on women’s health and preventive care. We hope our findings will inform policy makers and result in more affordable, accessible, and equitable health care for all women.”
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