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August 8, 2012

Good medicine

A look at what the Affordable Care Act means for women

Key provisions of the Affordable Care Act went into effect last week, meaning an estimated 47 million women nationwide — and 650,000 in Kentucky — will now have access to a wide range of preventative screenings, counseling and services without any additional charges.

As of Aug. 1, women with private health care coverage — or those renewing their coverage after that date — will have the right to the following services, with no co-payment, co-insurance or deductible necessary:

Contraception: Women will have access to all Food and Drug Administration-approved contraceptive methods and sterilization procedures, plus patient education and counseling. This will include intrauterine devices, which are 20 times more effective than the pill, but are not commonly used because of the upfront price tag of roughly $500 to $1,000. However, the lack of additional payment will only be for generic prescriptions in order to cut costs.

Gestational diabetes screening: Women who are 24-28 weeks pregnant and at high risk of developing gestational diabetes will receive this screening to prevent the development of Type 2 diabetes, protecting the health of both the baby and mother.

Breastfeeding supplies and support: Pregnant and postpartum women will have access to both lactation counseling and free breast pumps. Though breastfeeding is widely regarded as beneficial to the health of children, the costs of breast pumps is often a barrier for women to do so.

Well-woman doctor visits: These annual check-ups provide patients with recommendations for necessary preventative services to stay healthy.

Sexually transmitted infection screening and counseling: Sexually active women will receive annual counseling on sexually transmitted infections — in addition to annual HIV screening and counseling — in an effort to reduce risky behavior. Women 30 and older can have DNA testing for the human papillomavirus every three years, regardless of their Pap smear results — a key to reducing cervical cancer. Currently, only 28 percent of women 18-44 say they have discussed sexually transmitted infections with a doctor or nurse.

Domestic violence screening and counseling: With 25 percent of women being the target of intimate partner violence in their lifetime, such services can facilitate early detection and interventions to help abused women.

These screenings at no additional charge expand the additional preventative services guaranteed under the Affordable Care Act (ACA) last year, including mammograms and Pap smears. In 2011, 538,000 Kentuckians gained access to such services with no cost sharing under Medicare, and 732,000 through their private insurance.

By 2014, the ACA seeks to cover preventative care for the currently uninsured, with more people gaining affordable coverage with federal subsidies through state health care exchanges, and — if states so choose — an expansion in Medicaid coverage. Additionally, a large increase in funding for community health centers in medically underserved areas is already under way.

Also by 2014, it will be illegal to deny coverage to anyone with a pre-existing condition — which often includes pregnancy — and to charge women higher premiums than men, as insurance companies currently do.

A recent study by the Commonwealth Fund shows that more than 50 percent of women delay or avoid necessary care due to concerns over cost, so the new services seek not only to save lives but also to save money on treating diseases in advanced stages.

Despite the new rules going into effect, not all women with private insurance will have such services right away. Besides those whose plans do not renew until after Aug. 1, many with employer-provided plans that have not reduced services or raised rates since 2010 (which is relatively few) will not immediately be eligible for all ACA benefits because their insurers were “grandfathered in,” meaning they don’t have to fully comply — yet. It is estimated that 90 percent of major insurance companies will lose grandfathered status by 2014, with all of them eventually being forced to adhere to the law.

Also, women with insurance through a religious organization may be denied contraceptive services due to the religious objections of their employer for the next year. After that time, the Obama administration has proposed that such employers would not have to pay for those services, but women would have “alternative access” (the meaning of which is still unclear) to such coverage without cost sharing.

Such a stand by President Obama has caused a firestorm in conservative circles, as Christian and Republican leaders have denounced guaranteed contraceptive care as an assault on religious liberty.

The rhetoric against birth control access reached a new low at an Aug. 1 press conference by U.S. Rep. Mike Kelly (R-Pa.), who said the implementation of the new rule was one of the worst days in American history.

“I know in your mind you can think of times when America was attacked,” Kelly said. “One is Dec. 7, that’s Pearl Harbor Day. The other is Sept. 11, and that’s the day of the terrorist attack. I want you to remember Aug. 1, 2012, the attack on our religious freedom. That is a day that will live in infamy, along with those other dates.”

Despite the new contraceptive services most likely decreasing one of Republicans’ worst enemies — abortion — the party continues to stand in lockstep against the ACA, calling for its full repeal.

While Republicans — led in the Senate by Kentucky’s Mitch McConnell and Rand Paul — call the contraception rule and the requirement to purchase insurance a dangerous encroachment on individual liberty and freedom, they’ve also stepped up efforts to push a constitutional amendment banning and criminalizing abortion on the federal level.

As an election day that could decide the fate of the ACA approaches, female voters might be tempted to believe Republicans — who prioritize government surveillance of every uterus over women’s access to basic preventative care — have greater enemies than abortion. 

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