By Kay Johnson

Passed three years ago, the Affordable Care Act (ACA) is perhaps most important women's health legislation in 40 years. The ACA aims to provide health care coverage for all U.S. citizens, and is specifically designed to address issues that affect women's health.

Some ACA provisions have already taken affect to require most health plans and insurance policies to cover women's clinical preventive services without co-payments and deductibles. This includes well-woman visits, preconception and prenatal care, family planning, breastfeeding support, and other preventive services. More than 1 million young women under age 26 already have already gained access to continued dependent coverage through their parents' health insurance.

Between now and 2016, an estimated 18.6 million more uninsured women will have access to health coverage as a result of the ACA and almost 9 million will gain maternity coverage. An estimated 4 in 10 uninsured women will qualify for subsidies to make health coverage more affordable. What has become clear, however, is that too many women do not know they will benefit from ACA, and that providing coverage does not guarantee women will receive health care.

Most of the new coverage under ACA will take effect in January 2014, with enrollment beginning October 1, 2013. Now is the time to take action to maximize the impact of new coverage policy.  

Here are some opportunities for the next six months.

• Inform yourself and others about the health insurance marketplace (also known as the exchange) in your state.  It may be run by the state or by the federal government, but every state will have a marketplace where women can choose from a range of health plans that cover essential benefits. The marketplace will help people compare costs. There is a website, telephone number, and single application for the marketplace - start here.
• Use your organizational resources to promote awareness of new coverage and knowledge of how women can apply for coverage from the health insurance marketplace in your state. Find out which organizations in your state are designated "navigators" and encourage their use. People can call 1-800-318-2596, 24 hours a day, 7 days a week. Click here for more information on how to provide one-to-one assistance to enroll in the marketplace.
• Encourage use of women's clinical preventive services, including preconception screening in well woman visits.  This might take the form of public education campaigns, but equally important is changing the knowledge, attitudes, and behaviors of clinical providers.  Click here to view the regulations. 
• Increase awareness of the ACA required essential benefits offered by plans in the marketplace, including preventive services, ambulatory care, hospitalization, emergency services, maternity care, mental health and substance abuse services, and more. Click here for more information.   

Unfortunately, not all health coverage challenges were solved  by the ACA. Perhaps the most important gaps are related to Medicaid. The Supreme Court determined that the ACA cannot require states to expand Medicaid and not all states will use their option to do so. In states that do not expand Medicaid, a gap will be left between current eligibility levels and 133% of the federal poverty level. In addition, even for those who do qualify based on income, Medicaid benefits are not required to be the same as for the marketplace plans.  Advocates and providers of health care to women can help to overcome these challenges.

• Educate your state policy makers about the importance of Medicaid to the health of women, infants, children, and families. For a great resource on how to do this, check out this "Outreach and Enrollment Toolkit for Elected Officials" prepared by CMS.
• Encourage your states to cover specified preventive services without cost sharing, and thereby qualify for a 1% point increase in federal matching payments for Medicaid. Whether or not your state expands Medicaid coverage, find out whether or not Medicaid covers preventive services without cost sharing.  Click here to find out more.
• If your state does expand Medicaid, verify that the outreach, enrollment, navigation and other supports for the marketplace equally assist women who may qualify for Medicaid.
• Whether or not your state expands Medicaid coverage, assess your state's Medicaid coverage of family planning services, comprehensive prenatal care, smoking cessation for pregnant women, birth-related care, postpartum visits, breastfeeding supports, postpartum depression, and interconception care services.  These should be evidence-based and up-to-date benefits, ideally reflecting what is in marketplace plans or better. Quality improvement projects, modified provider manuals, or provider payment incentives are levers for change.
• If your state does not expand Medicaid, encourage use of a state plan amendment to provide family planning coverage for those with income up to 185 percent of poverty (i.e., without a waiver).
• If your state does not expand Medicaid, encourage use of approaches to providing interconception care to women whose coverage continues following maternity care and 60-day postpartum.  The Health Resources and Services Administration, Maternal and Child Health Bureau Collaborative Innovation and Improvement Network (CoIIN) strategy teams on "interconception care and Medicaid" are piloting such efforts in states across the South.

One Key Question®: Integrating Preventive Reproductive Health into Primary Care

By Hannah Rosenau 

Policy & Access Coordinator, OFRH

The Oregon Foundation for Reproductive Health (OFRH) 

proposes to increase the availability of reproductive health services by establishing a new standard in primary care - to screen women for their pregnancy intentions.  The One Key Question®(OKQ) Initiative encourages primary care clinicians to ask women of reproductive age "Would you like to become pregnant in the next year?"  Those who answer "yes" would be offered  preconception care and screenings to ensure a pregnancy is as healthy as possible.  Those who answer "no" would be offered contraception options to make sure they are using a method that meets their needs.  By screening women for their pregnancy intentions, primary care clinicians can proactively offer preconception and contraception services as a core preventive service.  Click here to read the full article on One Key Question and how it is integrating preventative reproductive health into primary care.