Most descriptions of a post-ACA world paint a worrisome picture of millions of Americans becoming suddenly uninsured when their subsidies or Medicaid coverage disappear. But that’s just looking at the parts of Obamacare above the surface. The ACA actually maintains an extensive root system whose tendrils snake out in all directions.
It’s some of these more subterranean aspects of the law that get less attention but prompt worry among specific sectors, such as women’s health advocates. They’re concerned about health coverage guarantees that could disappear as Republicans in Congress and the White House go about dismantling Obamacare. These include everything from contraceptive coverage to breast cancer screenings to equity in the premiums women pay for insurance.
Some women are so concerned that their health plans will make contraception unaffordable in a post-ACA landscape that they are having long-acting birth control, such as intrauterine devices. Birth control limitations are an issue not just because of the ACA’s requirement that it be provided without copays. Republicans are also targeting providers—namely, Planned Parenthood—for funding cuts.
The ACA is a game-changer for women’s health because it contains protections and cost savings for women, says Janel George of the National Women’s Law Center.
“The general public doesn’t always see the connection between the ACA” and women’s health benefits such as birth control coverage with no copay, says Janel George, director of federal reproductive rights and health for the National Women’s Law Center. “The law has been a game changer because pre-ACA women were more likely than men to forgo health care due to costs. The ACA includes some huge protections and cost savings for women.”
The most direct way that the ACA’s women’s health protections could be lost is if health plans are no longer required to provide particular coverage or if they can be sold with premiums that are higher for women. Advocates worry that insurers will quickly roll back the coverage in their exchange and individual market plans to save money and get rising premiums under control.
However, those markets represent just 5% of the insurance coverage in the U.S. Far more significant is the question of how employers, whether they self-insure or buy coverage, will maintain the gains the ACA made for their female employees. Benefits consultants predict that rolling back contraceptive coverage (as well as preventive screenings for women’s health problems) would generate a lot of bad feeling with little to show for it because they are not big-ticket items, particularly for large employers.
Small employers may think twice about health plans that include contraceptive covearge if the ACA mandates are repealed, says Tracy Watts at Mercer.
“In a job market with very low unemployment relatively few employers will want to roll back existing benefits,” said Jeff Levin-Scherz, MD, national leader of Willis Towers Watson’s health management practice, in an email. Coverage of contraceptives and other services for women were all part of benefit packages for most large employers before the ACA, he notes. “We expect that employers will continue to offer their employees the coverage that they value, which includes many of the mandates that will expire if the ACA is repealed.”
Even if the contraceptive coverage mandate ends up on the cutting room floor, the worst outcome for women with coverage from a large employer would be paying a 20% copay, predicts Tracy Watts, health care reform leader for Mercer. For small employers, though, the cost of any optional coverage might have them thinking twice if the federal mandates disappear.