The Affordable Care Act Improves Access

The Affordable Care Act (ACA) has significantly improved women’s health coverage. Not only does it require insurers to cover preventive screenings, family planning, and prenatal care, the ACA also prevents insurance companies from charging women higher premiums than men or denying women coverage for pre-existing conditions such as pregnancy or breast cancer. 

Using data from the National Health Interview Survey (NHIS), researchers studied the association between the ACA and changes in insurance and access to care for reproductive-aged women. The authors found that the ACA was associated with a 7.4 percentage point decrease in the predicted probability of uninsurance. This change accompanied a simultaneous increase in insurance coverage by Medicaid and nongroup private insurance. The researchers also noted a reduction in cost-related barriers to care and not having a usual source of care. 

This analysis makes sense considering the uninsured rate has dropped after the ACA’s implementation. That is why Trump administration actions to weaken the ACA in terms of coverage of essential health benefits, pre-existing conditions, and attempts to repeal are so concerning. 

Including contraception as an essential health benefit has made it more affordable for women and families to control fertility. While the Trump administration has tried to allow more exemptions for birth control coverage, federal courts have stopped these attempts. Moreover, the administration continues to try to prevent Planned Parenthood from receiving payments from Medicaid and Title X. A major provider of preventive screening and family planning services, cutting funding to Planned Parenthood would harm many low-income women. After Texas removed Planned Parenthood from its women’s health program, fewer women continued contraception and therefore Medicaid covered more births.  

The Trump administration has cut the open enrollment period for the ACA, decreased funding for enrollment outreach, and supported plans that do not cover all essential health benefits. Most recently, the administration has argued in court to invalidate the entire ACA. 

If the President is trying to keep his campaign promise of health “insurance for everybody,” he has an unconventional way of getting there. Unless the administration proposes a comprehensive health insurance plan that improves upon the advances made by the ACA, they should stop trying to take it away from folks. 

Abstract

OBJECTIVES: To estimate the association between the Affordable Care Act (ACA), health insurance coverage, and access to care among reproductive-aged and pregnant women. 

METHODS: We performed an observational study comparing current insurance type, cost-related barriers to medical care, and no usual source of care among reproductive-aged (n = 128 352) and pregnant (n = 2179) female respondents to the National Health Interview Survey in the United States, before (2010–2013) and after (2015–2016) the ACA coverage expansions. 

RESULTS: Among reproductive-aged women, the ACA was associated with a 7.4 percentage-point decrease in the probability of uninsurance (95% confidence interval [CI] = –8.6, –6.2), a 3.6 percentage-point increase in Medicaid (95% CI = 2.5, 4.7), and a 3.1 percentage-point increase in nongroup private coverage (95% CI = 2.1, 4.1). The ACA was also associated with a 1.5 percentage-point decline in cost-related barriers to medical care (95% CI = –2.6, –0.5) and a 2.4 percentage-point reduction in lacking a usual source of care (95% CI = –4.5, –0.3). We did not find significant changes in insurance or cost-related barriers to care for pregnant women. 

CONCLUSION: The ACA was associated with expanded insurance coverage and improvements in access to care for women of reproductive age, particularly for those with lower incomes.

PMID: 30789761

Daw, JR and Sommers, BD. Am J Public Health. 2019; 109 (4): 565-571.