By Dr. Paula Johnson
August 1, 2012 marks the first time in history that insurers will be required to provide women with a set of core women’s health preventive services without cost-sharing. These services are part of the Affordable Care Act’s (ACA) robust plan of preventive care for women across the lifespan and represent a paradigm shift from a health care system built on diagnostic treatment of disease toward a foundation of disease prevention and wellness promotion.
Unfortunately, not all U.S. women will benefit from the new system of care. With June’s Supreme Court ruling, some states may refuse to expand Medicaid to millions of our country’s poorest women, many of whom are near elderly, depriving them of access to preventive services available to Medicaid recipients and a better chance at a healthy life.
Let’s be clear that the preventive health services available under the ACA will allow women to become healthier and help reduce cost. Prior to reform, more than half of U.S. women were not up-to-date on recommended preventive health services, a fact not surprising given the growing epidemic of chronic illness among women that is costly, at an estimated $466 billion per year, yet preventable.
The new preventive services available to women with private insurance include:
Well-woman visits: Half of women delay or avoid well-woman preventive services due to cost barriers.
Screening for gestational diabetes: Gestational diabetes affects 1 in 20 pregnant women with 18% higher associated health care costs.
Human papillomavirus (HPV) testing: HPV, associated with many conditions including cervical cancer, infects one in four U.S. females with direct costs of $3.6 billion annually.
Counseling for sexually transmitted infections: Nineteen million new occurrences of STIs emerge each year at an estimated annual cost of $17 billion.
Annual counseling and screening for HIV for all sexually active women: Women represent one in four HIV cases#. Lifetime direct medical costs are about $1 billion or between $73 million and $93 million annually.
Contraceptive methods and counseling for all women with reproductive capacity: Nearly half of U.S. pregnancies are unplanned resulting in three million pregnancies each year and a cost of $19 billion annually.
Breastfeeding support, supplies, and counseling: Breastfeeding helps reduce Sudden Infant Death Syndrome, chronic childhood conditions and lowers the risk of breast and ovarian cancers in mothers. If 80 percent of mothers breastfed their children exclusively for the first six months of life, the U.S could save 741 lives and $10.5 billion annually.
Screening and counseling for interpersonal and domestic violence (IPV): One in three women will report IPV in their lifetime. Millions of women in the U.S. are abused by their partners each year at a cost of over $5 billion annually.
The Supreme Court recently ruled that states can decide whether to expand Medicaid coverage to the poorest Americans. In states refusing to expand coverage, many women will be denied access to care, including preventive care. Given that the uninsured are less likely to obtain preventive services, expanding Medicaid offers an avenue for women to receive preventive care, crucial to stemming the rising tide of chronic disease among this population. Furthermore, the resultant increase in preventive service utilization that insurance is likely to bring can lower chronic illness rates and the associated health care costs that often contribute to growing government budgets.
And for Massachusetts women in particular:
Massachusetts has a long history of requiring private insurers to cover a list of comprehensive medical and preventive services for its residents. Many of these mandates existed prior to Massachusetts reform (Chapter 58) and were incorporated into the 2006 state health reform law. The ACA enhances Massachusetts’ existing benefits in two important ways. First, the federal law eliminates consumer cost-sharing for some of Massachusetts’ mandatory women’s health benefits like contraception and pap smears. Commonwealth Care has voluntarily covered contraception without cost-sharing since Summer of 2011, and now most employer-sponsored plans and Commonwealth Choice Plans will follow suit. Second, the ACA provides Massachusetts women with additional mandatory benefits, including well woman visits, breastfeeding support, gestational diabetes screening and screening for interpersonal violence. Overall, the U.S. Department of Health and Human Services estimates that 1,212,350 women in Massachusetts will have guaranteed access to these additional preventive services without cost-sharing for policies renewing on or after August 1, 2012. While Massachusetts women continue to gain access to preventive care under health reform, many women in other states may not be as fortunate.
America, one of the world’s wealthiest countries, spends more per capita on health care than any other nation yet has one of the lowest life expectancy rates in the developed world. To improve quality and reduce cost, all roads lead to prevention. Today marks another step in the right direction. States can do their part by accepting federal Medicaid expansion funding extending prevention and wellness to all women, regardless of income or state of residence.
Paula Johnson, MD, MPH was a member of the IOM Committee on Women’s Health Preventive Services. She is the Executive Director of the Connors Center for Women’s Health and Gender Biology and Chief of the Division of Women’s Health at Brigham and Women’s Hospital.