This week the president signed into law historic legislation that will vastly improve the U.S. health care system, allowing tens of millions more Americans to get the health insurance and health care they need. One group that stands to gain immensely from the new health care system is unmarried women, one-quarter of whom (age 18-64) are uninsured.
Unmarried women currently face several obstacles to obtaining insurance. Many work in jobs that do not offer insurance and many cannot afford insurance on the individual market. If they try they’ll likely run up against discriminatory pricing based on their gender (“gender rating”) or face denial because of pre-existing conditions, which in some states include domestic violence or just having had a baby. And while many poor unmarried women may be able to qualify for Medicaid, eligibility rules are very strict, differ widely by state, and women without children usually do not qualify.
Further, women’s access to health insurance continues to be linked to their marital status. Forty percent of married women have insurance as a dependent through a husband’s plan, but unmarried women rarely have this avenue open to them. Some employers offer family coverage to domestic partners or to the young adult children of employees, but most do not.
Meanwhile, high out-of-pocket expenses and lifetime limits on medical coverage mean that many unmarried women who have insurance but obtain care for serious illnesses or injuries may face extraordinarily high, unaffordable costs. In these situations medical bankruptcy is all too common.
Thankfully, after the new legislation comes into effect most of these problems will be largely resolved. The expansion of an individual’s ability to obtain insurance will mean that a woman’s marital status will not be the barrier to coverage it has been. Anyone—including unmarried women—working in a small business or for a large employer that does not offer insurance will be allowed to buy insurance through new state-based insurance marketplaces, called “exchanges.” Subsidies in the form of affordability tax credits will make insurance much more affordable for exchange customers. And large employers will be required to offer insurance to their employees or pay a penalty if at least one of their employees gets federal subsidies.
Other measures in the legislation will mean that:
- Pre-existing conditions will no longer be a basis for denying coverage
- Insurance companies will be prohibited from pricing based on gender rating
- Medicaid will be expanded to all poor and near-poor people regardless of their parental status
- Young adults—most of whom are unmarried—will be able to stay on their parents’ employer-sponsored insurance up to age 26
- Annual and lifetime limits on coverage will be banned, which should help prevent medical bankruptcy
- Everyone will have access to preventive services without deductibles, copays, and other cost sharing
- For elderly women, who are currently nearly universally covered under Medicare, a number of changes to that program will lower onerous out-of-pocket costs including filling the gap in prescription drug coverage referred to as the “doughnut hole”
One drawback, however, is that more women may have a harder time accessing abortion services. There are current prohibitions on the use of Medicaid and other federal funds for abortion care, but federal subsidies will also be barred from paying for abortion coverage in any private insurance plans offered in an exchange. Instead, women will have to pay two premiums each month—one for their abortion coverage and one for the rest of the services offered in their plan.
This unnecessary rule may discourage women from selecting plans with abortion coverage or disincentivize insurance companies from offering such coverage—leading to lower availability in the insurance market of a service that is currently a standard part of most private plans. Moreover, it will further stigmatize abortion by treating it as something other than basic health care.
Several of the reforms will be implemented in a matter of months, including extension of parents’ coverage to their young adult children, a ban on lifetime limits on medical coverage, free preventive services, and the establishment of a new high-risk pool for people unable to obtain insurance because of a pre-existing condition. Other more complicated provisions will take longer to design and implement including the establishment of the new health insurance exchanges, which won’t go into effect until 2014.
Congress will also need to make sure the reformed system is working well down the road, especially with regard to affordability. There is concern that subsidies and tax credits—which are intended to make insurance affordable—may not keep up with inflation and rising medical costs.
It’s been a long road to the bill’s passage. But this historic progress will benefit unmarried women and all Americans for generations to come.
Liz Weiss is a Policy Analyst with the Economic Policy Team at the Center for American Progress.