For over three decades, Sarah Cox has given women pap smears, mammograms and advice about options for contraception. But her Louisville practice is small – only five people – and she can’t afford to provide her employees with health insurance. That benefit gap wasn’t usually a problem until one employee’s circumstances changed and they needed insurance.
Cox said that’s when the Affordable Care Act — also known as Obamacare — came to the rescue.
“It’s made it possible for her to keep insurance because it’s been available, which is huge for us,” Cox said. “She’s’ been with us since day one, so to keep her as an employee was very important to us.”
Cox’s employee gained coverage through Kentucky’s individual insurance market, known as Kynect at the time.
But the employee didn’t just gain health insurance. She also received ACA-required maternity coverage and free contraception — neither were routinely covered before the law was implemented. Also prior to Obamacare, health insurers could charge higher premiums to women because of age and they could deny coverage based on gender.
After the implementation of the ACA, the number of uninsured women in the U.S. fell from 20 percent in 2010, to 11 percent in 2016. That’s according to a new study out Thursday from the Commonwealth Fund.
That drop isn’t just good news for women. According to Alina Salganicoff with the Kaiser Family Foundation, women are often in charge of managing and taking care of the health care needs of their families. That includes making sure children have coverage, scheduling appointments and keeping up with prescriptions.
“They stay at home to take care of their sick kids,” Salganicoff said. “Mothers are much more likely to do this than fathers and more and more women are taking care of kids and aging relatives. The issues of taking care of those family members take a toll on women.”
Because many women keep up with the health care needs of their families, sometimes they put off caring for their own health. And when the primary caretaker’s health declines, the entire family’s care can suffer.
Cox said some of the biggest gains her practice has seen is with women under the age of 26. Because of the ACA, these women were able to stay on their parent’s health plans longer. According to the Commonwealth Fund report, 14 percent of women under 26 did not have health insurance in 2016, down from 25 percent of that age group in 2010.
“In that age group, the primary issues are STD testing, treatment and prevention, and contraceptive access,” Cox said.
She said prior to the ACA, things like long-lasting contraception devices were often out of reach. Intrauterine devices, for example, are implanted in the uterus and have proven much more reliable in preventing pregnancy than birth control pills.
“Before [the Affordable Care Act] passed we had many patients who would have benefited from an IUD and couldn’t afford it because the out-of-pocket was so extreme — upwards to $1,000,” said Cox.
Cox also noted that providing care for this younger population is important because of the risk of human papillomavirus infection (HPV). This virus can lead to cervical cancer, but regular pap smears can detect precancerous cells.
“We still see a percentage of people who will have abnormal paps, even who have been vaccinated, so having access to regular cancer screening is very important in that age group,” Cox said.
The Commonwealth Fund report found the biggest gains in coverage came for women between 50 and 64. Only 8 percent of women in that age range are now uninsured, down from 14 percent in 2010. And fewer women overall reported not getting health care due to cost or medical bills.
The Commonwealth Fund surveyed 4,186 women ages 19-64 between July and November of 2016. The survey has a sampling error of +/- 1.9 percentage points at a 95 percent confidence level.