Why Women Still Face Barriers to Healthcare Coverage

Women face barriers to healthcare coverage that men will never deal with. The Affordable Care Act (ACA) arguably narrowed this gap by expanding access to coverage to previously uninsured women through Medicaid expansions, private insurance reforms and premium tax credits. As a result, most of the 98 American million women aged 19 to 64 had some form of health insurance coverage last year, according to the Kaiser Family Foundation.

“The ACA has been a landmark improvement in healthcare access for women – the greatest advance for women’s health in a generation,” Lauren Birchfield Kennedy, director of health policy for the National Partnership for Women and Families, told TriplePundit.  Founded in 1971 as the Women’s Legal Defense Fund, the National Partnership for Women and Families is a nonprofit that advocates for women's and family rights, including fairness in the workplace, access to affordable healthcare, and policies that "help women and men meet the dual demands of work and family," according to the organization.

Birchfield Kennedy said the ACA makes sure women with healthcare coverage “have access to key women's preventive health services, such as birth control and breast cancer screenings, with no additional out-of-pocket cost sharing, and to essential health benefits such as maternity care." Before the ACA, most of the plans sold on the individual market did not cover maternity care, she added.

The ACA guarantees that no American will be denied coverage due to a pre-existing condition -- and this especially crucial for women. Before the ACA, a Caesarean section or complications with childbirth could have been considered pre-existing conditions.

Dr. Allison Bryant, an obstetrician-gynecologist affiliated with Mass General and a fellow with the American Congress of Obstetricians and Gynecologists, spoke with TriplePundit to explain the distinction. Before the passage of the ACA, she told us, doctors “often took care of women who, for example, would qualify for Medicaid (public health insurance for low-income Americans) because they were pregnant, then when the pregnancy was over, would lose that insurance and have no way to access primary or speciality care to keep themselves healthy.” The women might then have an unplanned pregnancy “with health problems that might have been addressed had they had access to care.”

But gaps remain in both private-sector and publicly-funded programs that left a little over 1 in 10 women uninsured in 2015. One factor: Women are more likely to be insured through their spouse’s employer-based coverage than men. About 57.5 million women aged 19 to 64 received health insurance coverage in 2015 through their spouse’s employer (59 percent). The fact that many women obtain coverage as dependents makes them at greater risk of losing coverage if they become divorced or widowed, their spouse loses a job, or their spouse’s employer either drops family coverage or increases premium and out-of-pocket costs.

Low-income women, women of color and immigrant women are at a greater risk of being uninsured. Although the number of uninsured women has dropped sharply since the ACA went into effect, some still lack coverage. That includes 1.3 million poor women who lived in states that have not expanded their Medicaid programs as of this year. In 2012, the Supreme Court ruled that Medicaid expansion is optional for states. As of October, 19 states still opted not to expand their Medicaid coverage. “Not all states elected to expand Medicaid under the ACA," Bryant said, "so the benefits afforded by the overall program did not extend to all women."

Another factor: Women are more likely to be poor. That is particularly true for minority women and single women who are heads of households. In 2014, the poverty rate for women was 14.7 and only 10.9 percent for men, according to U.S. Census records. And poverty rates for female heads of household was a staggering 39.8 percent. The wage gap between women and men makes the problem even worse. Women working full-time still only receive 79 cents for every dollar paid to their male counterparts, and African American women working full time are paid only 60 cents on the dollar.

Women who lack health coverage tend to delay or forgo treatment. Over half of women reported having delayed healthcare because of cost, according to the National Partnership for Women and Families. Women, particularly lower-income women, are disproportionately likely to not fill prescriptions, see specialists, see doctors or get recommended medical tests due to costs. Women are three-quarters of the adults covered by Medicaid.

“All totaled, health care is expensive and presents a challenge to women and their families," Bryant said. "In addition, above and beyond financial access, women have competing priorities and often care for their families above and beyond themselves."

How can coverage be expanded to include more women?

Underserved women are defined by the American Congress of Obstetricians and Gynecologists as being unable to get quality healthcare because due to barriers such poverty, cultural differences, race or ethnicity, or geography. They are at an increased risk of health problems “related to to limited access to quality health care in addition to elevated levels of poverty and geographic and social isolation,” the group says.

One way to insure underserved women is by “protecting the ACA and preserving the integrity of the law is critical to ensuring that we sustain access, and are able to expand it further,” Birchfield Kennedy told us. Repealing key provisions of the ACA like premium subsidies and cost-sharing reductions “would put the cost of coverage and care out of reach for millions of women and roll back progress we have made in helping women and their families access the care they need,” she added.

“It is also important that we continue supporting the transition of our healthcare system to value-based payment, which will help drive down the cost of care and promote quality improvement,” Birchfield Kennedy said. “Delivery of higher-quality, higher-value care plays an important role in keeping health coverage affordable, so that women do not face insurmountable financial barriers when they try to access care.”

A number of healthcare systems provide services for underserved women, including hospitals, publicly-funded clinics, community health centers, federally-qualified health centers, and clinics at retail locations like CVS Health’s MinuteClinics. CVS Health operates over 1,100 medical clinics in CVS Pharmacy and Target stores across the U.S. These clinics employ nurse practitioners and physician assistants who specialize in family healthcare, and they are able to diagnose, treat, and write prescriptions for common illnesses like strep throat and bronchial infections. They also offer prevention and wellness services, such as screening and monitoring diabetes, high blood pressure and high cholesterol. Tuberculosis (TB) testing, contraceptive care and help to quit smoking are also provided.

CVS Health launched women’s health services at its MinuteClinics earlier this year. Some of the services these clinics provide for women include birth control care, birth control injection, HPV (human papillomavirus) vaccines, pregnancy testing, and yeast infection diagnosis and treatment. In the “coming months,” CVS Health will launch services to “diagnose and, in some cases, treat sexually transmitted infections,” Dr. Andrew Sussman, president of MinuteClinic and executive vice president of CVS Health, told TriplePundit.

Through MinuteClinics, CVS Health offers “an array of services that support women’s health care needs when they are not able to get to their primary care provider or an OB/GYN,” Sussman said. Some of the patients who come to a MinuteClinic may not have a primary doctor, so nurse practitioners and physician assistants are able to “provide convenient, high-quality and compassionate care based on patients’ individual needs at times and locations that are convenient for them,” he said.

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