Obamacare and women’s access to reproductive care

—Theresa Morris

In a recent opinion piece for the Washington Post, Joann Weiner shares her thoughts on the ways in which Obamacare will affect women. Though the title of her article is “Women win some, lose some under Obamacare,” Weiner makes clear in her analysis that women gain more than they lose under the Affordable Health Care Act. Probably the most significant gain for women is in the area of reproductive health. According to the U.S. Department of Health and Human Services, women with private insurance have gained expanded preventative services with no co-pays for well-woman visits, mammograms, cervical cancer screenings, prenatal care, gestational diabetes screening, breastfeeding supplies, and contraceptive services.

Beginning in 2014, insurance companies will no longer be able to charge higher premiums to women. Companies charge these higher premiums with the justification that women use health care more than men do. Surprisingly, some insurance companies charge higher rates to women even when the plan excludes maternity care. Gender disparity in insurance premiums especially affects women with prior c-section deliveries, who are often charged higher premiums unless they are sterilized or past their childbearing years. The Affordable Care Act forbids using gender in computing insurance premiums. Further, 18.6 million uninsured women will gain access to health insurance through the Health Insurance Marketplace and preventative reproductive healthcare will be guaranteed to these women (U.S. Department of Health and Human Services).

It is hard not to see the House Republicans’ 42 attempts to defund Obamacare as part of the Republican Party’s War on Women. This can be seen, especially, in the September 29th House vote to fund a stopgap spending measure to prevent an October 1st government shutdown by tacking on a “conscience clause,” which would delay an Obamacare requirement that employers provide health insurance that covers contraceptive care.

The holes in the Affordable Healthcare Act that will most affect women are holes that have plagued women with private health insurance for years. First, health insurance providers in the health exchange systems will not cover all hospitals and providers. I advise women to always seek intervention rates (e.g. rates of labor induction, epidural use, labor augmentation) and c-section rates of hospitals and providers in deciding on a care provider and place for birth. Because rates vary drastically by provider and hospital, women should be given choice in this matter to lower their likelihood of an unnecessary c-section. Second, for the most part, Obamacare does little to help abortion access and probably hurts access if the Stupak-Pitts Amendment, which forbids government funding of abortion except in the cases of rape or incest or when the mother’s life is in danger, is not overturned. This amendment has a more far-reaching effect than does the current Hyde Amendment, 1976 legislation that does not allow federal Medicaid dollars to be spent on abortion except in the cases listed above, because The Stupak-Pitts Amendment affects health insurance policies offered by the health insurance exchange systems and is, thus, more broad in its reach.

On the whole, Obamacare addresses many women’s reproductive health issues, but continues to leave women a lack of choice in health providers and hospitals and a lack of coverage of abortion care.

Theresa Morris is Professor of Sociology at Trinity College in Hartford, Connecticut. She is the author of Cut It Out: The C-Section Epidemic in America (NYU Press, October 2013).