1. American Public Health Association Annual Meeting November 2010 Judy Waxman National Women’s Law Center

2. Where Do Women Get Their Health Coverage? Source: National Women’s Law Center analysis of 2008 and 2009 health insurance data from the U.S. Census Bureau Current Population Survey’s (CPS) 2009 and 2010 Annual Social and Economic (ASEC) Supplements

3. 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

4. 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).

5. 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).

6. 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.

7. Women struggle to find coverage for the benefits they need. Women struggle to find coverage for the benefits they need. Maternity Coverage - Individual Market Most 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. * **

9. AFFORDABLE CARE ACT COVERAGE FOR ALL (?) Medicaid to 133% Federal Poverty Level. New market place. Subsidies up to 400% of Federal Poverty Level.

10. INSURANCE REFORMS No pre-existing conditions refusals. Gender. Health Status. No lifetime or annual limits. No dropping your insurance coverage when you get sick.

11. 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.

12. MATERNITY COVERAGE Cap on payment Pregnancy complications Inpatient/Outpatient Comprehensive coverage

13. CONTRACEPTION Preventive Service Essential Benefit Package

14. 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

15. 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.

16. OTHER PROVISIONS: State abortion bans are not preemptive. Insurance plans cannot discriminate.

17. 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.

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