The story so far. Last week I objected to the question "Are you better off now than you were four years ago?" I object to the idea that my well-being can be reduced purely to economics, or to few things that the president can affect. (One colleague wrote: My 90-year-old mother would certainly say she's not better off than she was four years ago, but that's more about her health than about her wallet!) So I'm going to hijack that question for my own purposes and ask: Are women better off than we were four years ago-not just financially, and not just in ways affected by President Barack Obama's administration, but overall? Last week we checked in on our financial well-being, given that finances are indeed important. But there's more to life than our checkbooks and retirement plans. So welcome to Episode Two: Our Bodies, Our Well-Being.
There's some good news and some bad news. As you know, this past year, some prominent menfolk have been deeply distressed to learn that we believe that our bodies are our own, and the choices about when and how to use our reproductive parts are also our own. And yet here's the good news: those cobweb-covered dudes have, as yet, had no federal effect. In fact, the federal government has actually made our lives a bit better. But many states have made our reproductive lives worse.
So today, let's start with the good news. As you recall, the Obama administration passed the Affordable Care Act, now universally known as Obamacare-which means that tens of millions more Americans will have comprehensive health insurance. That might not mean much in the corporate and Ivy League classes, where people feel securely employed in white collar jobs in major corporations. But that's not everyone. All the single ladies, all the married ladies, all the students, all the young women living hand to mouth in starter jobs, all the ladies with a high school degree waiting tables or cleaning WalMart floors: if the ACA does manage to go fully into effect, they will all have health-care coverage, whether they're employed or unemployed, working part-time or full-time. And that is life-changing.
The National Women's Law Center likes to say that the ACA means being a woman is no longer a pre-existing condition. We're no longer going to pay more for our health insurance just because we might, someday, get pregnant and give birth, both of which can be costly. (One difficult pregnancy or premature birth can involve extremely expensive hospitalizations, procedures, and interventions.) Instead of asking women to pay for that risk, insurers will now have to charge men and women equally, as if men are involved, somehow, in the fact that women get pregnant and give birth, and should therefore pay equally for the medical costs of reproducing the species.
Nor will women have to pay more for our health insurance, or have parts of our bodies excluded from coverage, if we've needed gynecological treatment of some kind. (Does any woman reach the age of 40 without some kind of condition in our repro parts, even if it's only needing a cyst removed? Having your body bathed in hormones every month means things grow.) There will be no more denying coverage just because you were raped. Huffington Post's Danielle Ivory reported last year on such women as Christina Turner, who had had to take anti-HIV meds for a month after being raped, just in case-and then couldn't get health insurance coverage for three years, and Kimberly Fallon, who couldn't get her gynecological exams covered after she'd been raped.
You've heard a little about preventive services, ladies, but mostly having to do with contraception. Judy Waxman of the NWLC explains that it goes further than that. "The law does a lot to move our country from a health system that deals with you when you're sick to a system that looks at you before you're sick and tries to keep you healthy." According to Waxman, the law was written insisting that certain basic health services had to be included in every health plan, for everybody. The breakthrough for the ladies, she said, came when Senator Barbara Mikulski said, Look at this from the women's point of view. As a result, HHS was instructed to consider preventive services from women's points of view, and ensure that we get all the services that HHS considers basic and appropriate.
That means that basic health care for all our lady parts is covered, with no copay, if it prevents us from getting sick. You've probably heard that that covers such repro essentials as contraception counseling and methods. Fully-covered contraception means fewer accidental pregnancies. That might cost your insurer a little more than if you used Foster Friess' favorite contraceptive method, but it's still less expensive than the pregnancy, which can leave insurance tabs thousands of dollars deep. But it also includes mammograms, STD screening, pap smears, cervical cancer screenings, nutritional care, immunizations, and the HPV vaccine.
"When you go for your mammogram, it's covered straight up, no copay and no deductible," says Waxman. "Your child's immunizations, no copay, no deductible. And now your birth control, no copay, no deductible. Ninety-nine percent of those of us who are hetersexually active use birth control at some point in our lives, so that is a major step forward. I just wish I I could tell Margaret Sanger. It's been around 100 years since she was campaigning to make contraception legal. This is a major step forward for American women. I'm getting calls from all over the country with people saying, 'Oh my god, thank you, thank you, ACA!'"
Meanwhile, no longer will pregnancy's potential expense be an excuse for insurers not to cover maternity. That matters, Adam Sonfeld of the Guttmacher Institute told me, in part because some insurance plans have in the past "tried to exclude things they think you are likely to use and that cost lots of money." Some health insurance plans for small employers or individuals wouldn't cover pregnancy and childbirth unless you bought a specific rider. Of course, if you buy the rider, the plan assumes that you were going to use it-which meant that the cost was extremely high. No longer can insurance force you to pay more for your insurance if you think you might someday have a baby. Under the ACA, all your prenatal and maternity care are fully covered with no copay. The list of what's covered is impressive: screenings, counseling, folic acid supplements, breastfeeding support, breast pumps, and on and on. Sonfeld believes that, as a result, the ACA might actually make a dent in the United States's appalling maternal mortality rate, which is higher than that of 30 other countries, including most of Europe. And for poor women, the ACA could mean the difference between sick infants and healthy ones-children who don't start out life behind. As Sonfeld wrote in the Guttmacher Policy Review:
A 2008 study by the National Women's Law Center found that among more than 3,500 individual insurance plans sold across the country, only 12% included comprehensive maternity coverage (see chart, page 15). In some cases, women could purchase a "rider" specifically for maternity coverage, but such add-on benefits can cost thousands of dollars per year and may have waiting periods and coverage limits. In addition, insurance plans may treat pregnancy itself or related conditions (such as a prior cesarean section) as grounds for denying coverage entirely, charging higher premiums or excluding pregnancy-related expenses as pre-existing conditions.
There are other ACA provisions that haven't been noticed yet-like the fact businesses have to set aside a time and place for women to breastfeed. That's critical for low-wage women, who have more often had to go quickly back to work after childbirth because they couldn't afford to take that unpaid time off-and who have had to wean their infants at four or eight weeks because a particular restaurant or factory or office won't make a safe place and time available to pump.
"It's a small miracle that this actually did pass and is moving forward," Waxman told me. "It will change a lot for American people, particularly women. Those preventive services in and of themselves make women better off considerably than four years ago."
At least federally. That's not quite as true in all the individual states, some of which appear quite intent upon, as Barney Frank once put it, protecting life from conception until birth. Tune in next episode!
