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Grantmakers in Health Audioconference December 8, 2010

Grantmakers in Health Audioconference December 8, 2010. Judy Waxman National Women’s Law Center. On average, women use more health services than men. Reproductive health needs Prescription drugs More likely to have a chronic condition (38% vs. 30%)

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Grantmakers in Health Audioconference December 8, 2010

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  1. Grantmakers in HealthAudioconferenceDecember 8, 2010 Judy Waxman National Women’s Law Center

  2. On average, women use more health services than men. • Reproductive health needs • Prescription drugs • More likely to have a chronic condition (38% vs. 30%) • Certain mental health problems affect twice as many women

  3. Women have more trouble affording necessary health care Percent of Adults ages 19-64 reporting any one of four problems* accessing care *Did not fill a prescription; did not see a specialist when needed; skipped recommended medical test, treatment, or follow-up; had a medical problem but did not visit doctor or clinic. Source: The Commonwealth Fund Biennial Health Insurance Survey (2007).

  4. Women delay or do not get preventive care because of cost. Percentage of adults 19-64 who delay or do not get preventive care Source: The Commonwealth Fund Biennial Health Insurance Survey (2007).

  5. Women face unfair and discriminatory insurance industry practices. • Gender rating is prevalent throughout the country among similar plans in the individual market. • At age 25, women are charged between 6% and 45% more than men. • At age 40, women are charged between 4% and 48% more than men. • At age 55, women are charged between 22% less and 37% more than men. • Wide variations across and within states undercuts insurance industry defense of gender rating as actuarially justified- and raise questions or arbitrariness. • Maternity coverage does not explain the difference.

  6. Women struggle to find coverage for the benefits they need.Maternity Coverage - Individual MarketMost Individual Market Insurance Policies Do Not Cover Maternity Care * ** *Comprehensive maternity coverage includes coverage for prenatal care, labor, delivery, and postnatal care, for both routine pregnancies and in case of complications. **Less-than-comprehensive maternity coverage includes coverage for a limited scope of maternity services, such as coverage for inpatient (i.e. labor and delivery) or outpatient (i.e. prenatal and postnatal office visits) maternity care only, or coverage only for complications of pregnancy.

  7. AFFORDABLE CARE ACT A Three Legged Stool • Coverage • Medicaid: to 133% FPL • Exchange: to 400% FPL • Insurance Reforms • Personal Responsibility • Exceptions

  8. Employers Choices • Coverage with current insurance plan. • Coverage as a group in the Exchange. • Do not provide insurance for employees. • “Free rider” fee for big businesses (over 50) whose employees get help.

  9. Small Business Health Insurance Tax Credit You may qualify if: • You have fewer that 25 full time employees. • If you have part-time employees, calculate the number of full-time equivalents by dividing the total number of hours of part time employees by 2080. • Your organization pays average annual wages of less than $50,000 to its employees. • Your organization pays at least half of the cost of health insurance for its employees. * For more information you can visit our website for our Small Business Health Insurance Tax Credit Fact Sheet.

  10. Essential Health Benefits • Ambulatory patient services. • Emergency services. • Hospitalization. • Laboratory services. • Maternity and newborn care. • Mental health and substance use disorder services, including behavioral health treatment. • Pediatric services, including oral and vision care. • Prescription drugs. • Preventive and wellness services and chronic disease management. • Rehabilitative and habilitative services and devices. • Special rules for abortion.

  11. Maternity Coverage • Cap on payment • Pregnancy complications • Inpatient/Outpatient • Comprehensive coverage

  12. Contraception • Preventive Service • Essential Benefit Package

  13. Abortion: Special Rules • Cannot be required in the benefit package • BUT plans can choose to cover: • None • Some (Hyde exceptions) • All • One plan must not cover abortion • Plans must not discriminate against providers

  14. If a plan covers abortion…(beyond Hyde Exceptions) • No federal funds can be used for abortion services. • Enrollees make two separate payments. • Payments must be segregated into separate accounts. • State insurance commissioners ensure compliance.

  15. Other Provisions: • State abortion bans are not preempted. • Broad non-discrimination provision.

  16. ACA Will Improve the Health and Well-Being of Women and Their Families • Extends mental health parity. • Women will have “direct access” to obstetrical and gynecological care. • Older women will benefit from a provision that closes the Medicare Part D “donut hole.” • Alleviates burdens on family caregivers. • Allows young adults to remain on their parents’ health insurance. • Requires “nursing” time at work.

  17. Workforce Improvement • Scholarships/Loans • More residency slots • Primary care • General surgery • Community Health Centers

  18. Quality Measures • Medical Homes • Comparative Effectiveness

  19. Thank You! For more information, please contact: Judy Waxman Vice President, Health and Reproductive Rights jwaxman@nwlc.org – (202) 588-5188

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