Women's health: Affordable Care Act improves insurance options ...

Meet Tracy Puhl. She?s 26, lives in Southeast Portland, owns a small business, and is an unofficial guinea pig of the Affordable Care Act. Until her last birthday she stayed on her parents? health insurance plan, a benefit granted under the new law last August. As for her annual check-up, Puhl paid nothing out of pocket, also because of the new law.

Elements of the Affordable Care Act have trickled in since it passed in 2010, but the major changes ? including mandatory health insurance for all ? take effect Jan. 1. The changes constitute the most drastic remake to the U.S. health care system in generations.

Puhl?s lifetime of health care will shift with the ACA, especially since much of the law targets the way women pay for and receive health care.

Currently, Puhl and her one employee receive health insurance through her Portland-based company, GladRags, which sells reusable menstrual pads. She says although the costs feel high, ?they?re not a huge part of our expenses.?

Puhl, though, is already ahead by virtue of living in Oregon. In the 1990s, the state prohibited insurance companies from charging women more than men for health care. In 36 states, insurers can charge women higher premiums, as much as 80 percent more than a man of the same age for the same plan. The ACA bans gender-rating across the country Jan. 1.

In the states without restrictions, 92 percent of the best-selling plans gender-rate, according to the National Women?s Law Center.

Take Idaho, for example. A popular Blue Cross plan in Boise costs a 35-year-old man about $159 a month and a 35-year-old woman $226 a month ?about 42 percent more, according to eHealthInsurance.com.

Insurance companies generally justify the higher premiums because women visit the doctor more and use more health care services than men. That often flips as men age and begin to use more medical services.

?In the long run, it doesn?t really even out,? said Danielle Garrett, law center analyst. ?It is a much longer time period of their life in which (women) are paying more.? The law center found that women pay an aggregate $1 billion more for health care in the individual market because of gender-rating.

As for Puhl, she was happy to discover that she can get well-woman exams without a co-pay or deductible.

?That?s the main preventative care that women our age need,? she said.

Under the ACA, women get 21 total preventative services without cost-sharing in addition to their annual exams, including contraception, HIV screening, breastfeeding supplies and domestic violence counseling, all implemented last August.

While Puhl is happy to be guaranteed these services, many older women feel as though they have already been punished for things out of their control in the form of higher premiums ? or worse, by being denied coverage altogether. Insurance companies have denied women coverage for being pregnant or having a C-section, citing these factors as pre-existing conditions, according to the NWLC. The ACA mandates that companies cannot deny coverage because of pre-existing conditions.

When web designer Fellene Gaylord, 58, was laid off from her job at the height of the recession in 2009, she tried to buy individual health insurance.

?I was turned down time and time again,? she said. Gaylord, who was also trying to find insurance coverage for her two college-aged children, said the companies cited mild arthritis in her knee and being overweight as pre-existing conditions that meant they could not cover her.

It took Gaylord two years, and several rejections, to find coverage.

Though Gaylord isn?t looking to switch plans anytime soon, other people shopping for insurance next year will be spared the hassle. In January as the final health care changes begin, insurance companies can no longer deny coverage to people because of pre-existing conditions for adults, including heart disease or cancer.

As many as 129 million Americans under 65 have a pre-existing health condition, and between 15 and 30 percent of healthy Americans are likely to develop one in the eight years after the study, conducted by the U.S. Department of Health and Human Services, was published in 2011.

Earlier ACA changes already prohibited these practices for children.

?Soumya Karlamangla

Source: http://www.oregonlive.com/health/index.ssf/2013/06/womens_health_affordable_care.html

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