Meningococcal Vaccine: Protection, Risk, Schedule
Women's Awareness Of ACA Preventive Services Remains Low Amid Ongoing Legal Challenges
Many women remain unaware that the Affordable Care Act (ACA) mandates cost-free preventive services; however, ongoing legal challenges threaten the future of this coverage.
Although the Affordable Care Act (ACA) was passed over 14 years ago, many women remain unaware that it mandates most private health plans and Medicaid expansion programs to fully cover recommended female health care services, like annual checkups, mammograms, and contraceptives.1
Many women remain unaware that the Affordable Care Act (ACA) mandates cost-free preventive services; however, ongoing legal challenges threaten the future of this coverage.Image Credit: Syda Productions - stock.Adobe.Com
KFF conducted the 2024 KFF Women's Health Survey to understand how many women know that the ACA covers female-specific preventive services. It was conducted between May 13 and June 18, 2024, both online and by telephone, among a nationally representative sample of 6246 adults between the ages of 18 and 64 years, which included 3901 women between the ages of 18 and 49.
Most women surveyed (71%) knew that the ACA's preventive services requirements cover annual check-ups for women without cost sharing, but about 3 in 10 women (29%) did not know or believe they do not.
Unawareness of this benefit was more prevalent among those aged between 18 and 25 years compared with those aged 50 to 64 (52% vs 77%). Similarly, knowledge of the ACA requirement to cover routine mammograms was high among women over 40 (73%), but 1 in 4 are unaware (26%).
Additionally, despite most women using contraceptives, less than half of reproductive-age women (43%) and contraceptive users (47%) knew that their insurance should cover the full costs of all FDA-approved prescription methods. In terms of race/ethnicity, a higher share of Black women (49%) were aware of this requirement than White, Hispanic, or Asian or Pacific Islander women (42% of each).
As for insurance type, less than half of women with private insurance were aware of this requirement despite it applying to them (44%). Consequently, some may have paid out-of-pocket costs for their contraception as recent Congressional investigations found that some health insurers have continued to charge for contraception that is supposed to be fully covered.
Because of this, the federal government continues to release guidance that clarifies and reiterates the ACA health plan requirements. However, limited awareness may reduce the number of women accessing recommended preventive care. Also, the future of these requirements remains uncertain due to ongoing ACA legal challenges, including Braidwood Management Inc. V Becerra, which could eliminate the coverage requirement for certain preventive services.2
The ongoing lawsuit argues that the ACA's preventive services requirement is unconstitutional, alleging that the US Preventive Services Task Force (USPSTF) lacks the authority to mandate cost-free preventive services in the commercial market. Therefore, the plaintiffs claimed that this violates the Appointments Clause, which requires that officials performing certain duties be appointed by the president, confirmed by the Senate, or appointed by a Cabinet secretary.
Additionally, the plaintiffs argued that the requirement violates the Religious Freedom Restoration Act as it demands they cover services they morally object to, causing religious harm.3 They also claim economic harm from paying more for a health plan that includes services they do not want or need.
As ongoing legal challenges threaten the ACA, providers are urging their peers to prioritize coverage of preventive care services to ensure patients, especially women, can access essential health services without financial barriers.2
References
Opinion: Affordable Health Care Is Just Common Sense
As a primary care doctor in Wisconsin for the past 35 years, I've taken care of people with and without insurance. My message is simple: medical care is better at preventing and treating disease when people have insurance coverage. That can come through their employer, through Medicare, through safety net programs for low income folks such as Medicaid, and through the Affordable Care Act (ACA), which provides options for all those who fall through the cracks.
Access to healthcare coverage is on the ballot in this election at every level of government, from Wisconsin state representatives, to Congress, to the Presidency. The stakes are high: preserving the Affordable Care Act, preserving women's reproductive health choices, and in Wisconsin, the important opportunity to expand Medicaid.
Let's consider the need to preserve the Affordable Care Act. Julie was a patient of mine who had good insurance through her local employer in Milwaukee when we diagnosed a rare but treatable endocrine disorder. Then she had to leave her job to take care of her elderly mother. Without insurance she stopped her treatment and her disease symptoms flared, so she would periodically go to the ER or urgent care – a very expensive and inefficient way to get care, but often the only option for the uninsured. She finally got ACA coverage and got her treatment back on track, but she was stuck with years of paying off medical debt.
Before 2014, when the ACA took effect, patients like Julie with pre-existing conditions only had the option of expensive, high-deductible health plans that usually didn't cover preventive care. The ACA has so many benefits for Americans, but preventing insurers from denying coverage to people with pre-existing conditions is key. The ACA also mandates that there are no co-pays for preventive care, like Pap smears, cancer screening, and immunizations. Let's remember that Sen. Tammy Baldwin introduced the popular ACA provision allowing young adults to stay on their parents' insurance until age 26, letting them get established in the workforce without risking medical debt.
We're also voting for candidates who can sink or swim Medicaid expansion for low income folks. At a free clinic in Janesville I saw Susie, a nursing assistant with two young kids at home. During the pandemic, she qualified for Medicaid and was able to get her diabetes under control. Last month when I saw her she'd been off medications since early 2024 after the Medicaid "unwinding" spooled her into the uninsured pool. She'd already had one ER visit after getting woozy at work with a wonky blood sugar. We cobbled together a treatment plan, not as good as what she could get with insurance, but the patchwork of intermittent, limited free care and expensive emergency care is what she's got.
Wisconsin has a special opportunity with this election to finally join the 40 states that have taken advantage of provisions in the ACA to expand Medicaid to 138% of the federal poverty level – that's an annual income of $20,783 for an individual and $35,632 for a family of three in 2024 – an opportunity that Wisconsin legislative leadership has blocked for the last decade. Shockingly, Wisconsin is one of only two states that has not accepted incentives to expand postpartum Medicaid coverage to 12 months after delivery for new mothers, an especially vulnerable time when access to care has tremendous benefits for infants and moms.
This intransigence has lost Wisconsin tens of millions of dollars from the federal government to support Medicaid funding. There's no evidence to support the argument that expanding Medicaid will keep people from working, according to a Wisconsin Policy Forum report. And expanding Medicaid will save money for Wisconsin taxpayers!
While I despair at this fiscal irresponsibility, as a doctor I'm excited about the good evidence that accessing Medicaid improves treatment of chronic conditions like cancer, diabetes and mental health, reduces mortality, and improves rural health access. While Wisconsinites throughout the state will benefit from Medicaid expansion, the impact will be biggest in rural areas.
Common sense tells me that it's better for all of us when people don't spiral into debt for their appendectomy; when the loving choice to have a baby doesn't cycle into calls from a collection agency; when an early breast cancer is found on a screening mammogram rather than morphing into an ulcerating mess. Common sense (and lots of data) tells me that helping the poorest among us get access to medical care is not going to keep people from working to pay their rent, utilities, and grocery bills. Common sense tells me that getting medical care to keep healthy helps people stay employed.
Most of all, common sense tells me that Wisconsin voters want their families and neighbors to be healthy. We need our elected officials to support and improve the Affordable Care Act and commit to Medicaid expansion in Wisconsin.
Biden-Harris Administration Proposes New Rule To Expand Affordable Contraception Coverage
Groundbreaking proposal to expand contraception coverage under the ACA marks the most significant update in over 10 years.
In a continued effort to protect and expand access to reproductive health care, President Joe Biden and Vice President Kamala Harris have announced a new proposed rule that would significantly enhance contraception coverage under the Affordable Care Act (ACA).1
The proposed rule marks a critical advancement in reproductive health care, significantly expanding access to affordable contraception for millions of women.Image credit: RFBSIP - stock.Adobe.Com
This move comes at a critical time, as reproductive rights face increasing threats following the Supreme Court's decision to overturn Roe v Wade. The proposed rule aims to expand contraception access without cost-sharing for millions of women, making over-the-counter contraceptives (OTC) more affordable and accessible and ensuring comprehensive coverage for all FDA-approved contraception methods.
"Every woman in every state must have reproductive freedom and access to the health care they need," Harris said in a statement.2 "That is why I have fought to lower health care costs and protect the ability of every woman to make her own decisions about her own body."
Since 2012, the ACA has guaranteed women insurance coverage for all methods of birth control without additional out-of-pocket costs, regardless of where they live or how they are insured.3 Because of this ACA rule, over 62.4 million women now have coverage of birth control and other preventive services, improving health care access and economic security. The birth control benefit saved women $1.4 billion on birth control pills alone in 2013, according to a Health Affairs analysis.4 This means that women no longer must choose between paying for birth control and paying for other necessities, like groceries and utilities.
However, limited awareness may reduce the number of women accessing recommended preventive care.5 Also, the future of these requirements remains uncertain due to ongoing ACA legal challenges, including Braidwood Management Inc. V Becerra, which could eliminate the coverage requirement for certain preventive services.6
Details of the proposed rule include the introduction of no-cost access to OTC contraception, including emergency contraception and daily oral contraceptives.1 Additionally, the rule would require health plans to disclose OTC contraceptive coverage, making it easier for women to understand their benefits. Furthermore, the rule would streamline access to all FDA-approved contraceptives without cost sharing, helping to eliminate barriers to care.
The proposed rule would also have a significant impact on the 52 million women of reproductive age with private health insurance. For many, especially low-income women and those in rural areas, this expansion means easier access to emergency contraception and daily oral contraceptives, which can be critical for preventing unintended pregnancies. The rule also addresses health equity by potentially reducing disparities in access to contraception among marginalized communities, including women of color, who face disproportionate barriers to reproductive health care.
The Biden-Harris Administration's proposed rule comes at a pivotal moment in the political and social landscape. With abortion access under attack in many states, contraception access has also become a target for restrictive legislation. By reinforcing access to contraception, the administration seeks to safeguard reproductive freedom and empower women to make their own health care decisions, despite ongoing political opposition.
"The majority of Americans believe in a woman's right to make decisions about her own body," Harris said during the presidential debate.7 "And that is why in every state where this issue has been on the ballot, in red and blue states both, the people of America have voted for freedom."
The proposed rule represents the most significant update to contraception coverage under the ACA since 2012.1 The rule builds on actions that the Biden-Harris Administration has already taken to expand access to affordable contraception, including implementing the President's Executive Order on Strengthening Access to Affordable, High-Quality Contraception and Family Planning Services from June 2023.
The proposed expansion of contraception coverage under the ACA may face legal challenges from conservative groups and states opposed to increased access to reproductive health care, particularly in regions where restrictions on contraception are being pursued. Additionally, the insurance industry may push back on the cost implications of covering more contraceptive options without cost-sharing, potentially complicating the rule's implementation. The timeline for finalizing and enforcing the rule will depend on the regulatory process, including public comment and review. To ensure the rule's success, the Biden-Harris Administration may need to defend it in court and engage in continued efforts to safeguard reproductive health access.
Overall, the proposed rule marks a critical advancement in reproductive health care, significantly expanding access to affordable contraception for millions of women. By building on the original ACA mandate, this rule will not only increase access to OTC and prescribed contraceptives but also help address health inequities in underserved communities.
"While we fight to protect and expand health care, extremist so-called leaders are attacking reproductive freedom at every turn," Harris said.2 "Republicans in Congress have repeatedly blocked legislation to protect the right to contraception across the country. They have also consistently refused to protect access to IVF [in vitro fertilization] and continue to propose national abortion bans."
As legal and political challenges to reproductive rights persist, this proposal demonstrates the administration's ongoing commitment to safeguarding women's health care. If finalized, this rule will provide greater autonomy for women in making personal health care decisions and represent a meaningful step toward protecting reproductive freedoms nationwide.
References
1. Fact sheet: Biden-Harris Administration proposes rule to expand coverage of affordable contraception under the Affordable Care Act. The White House. October 19, 2024. Accessed October 22, 2024. Https://www.Whitehouse.Gov/briefing-room/statements-releases/2024/10/21/fact-sheet-biden-harris-administration-proposes-rule-to-expand-coverage-of-affordable-contraception-under-the-affordable-care-act/.
2. Statement from vice president Kamala Harris on new rulemaking to expand access to contraception. The White House. October 21, 2024. Accessed October 22, 2024. Https://www.Whitehouse.Gov/briefing-room/statements-releases/2024/10/21/statement-from-vice-president-kamala-harris-on-new-rulemaking-to-expand-access-to-contraception/.
3. The Affordable Care Act's birth control benefit: Too important to lose. National Women's Law Center. June 25, 2018. Accessed October 22, 2024. Https://nwlc.Org/resource/the-affordable-care-acts-birth-control-benefit-too-important-to-lose/#:~:text=It%20first%20went%20into%20effect%20in%202012%2C,an%20incredibly%20popular%20part%20of%20the%20ACA.&text=The%20ACA's%20birth%20control%20benefit%20accomplished%20a,education%20and%20counseling%20without%20any%20out%2Dof%2Dpocket%20costs.
4. Kliff S. Report: Obamacare has saved women $1.4 billion on birth control pills. Vox. July 7, 2015. Accessed October 22, 2024. Https://www.Vox.Com/2015/7/7/8907389/obamacare-birth-control-savings.
5. McCormick B. Women's awareness of ACA preventive services remains low amid ongoing legal challenges. AJMC. October 21, 2024. Accessed October 22, 2024. Https://www.Ajmc.Com/view/women-s-awareness-of-aca-preventive-services-remains-low-amid-ongoing-legal-challenges.
6. Joszt L. Covered preventive services at risk: V-BID Summit breaks down the Braidwood v Becerra case. AJMC. March 20, 2024. Accessed October 22, 2024. Https://www.Ajmc.Com/view/covered-preventive-services-at-risk-v-bid-summit-breaks-down-the-braidwood-v-becerra-case.
7. Grossi G. Abortion in the presidential debate: Trump defends state bans, Harris vows national protections. AJMC. September 16, 2024. Accessed October 22, 2024. Https://www.Ajmc.Com/view/abortion-in-the-presidential-debate-trump-defends-state-bans-harris-vows-national-protections.
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