Health Care Reform and Women: A First Step in the Long Journey to Access

The affordability of health insurance is only one of the many issues facing women in accessing care. Gender-based disparities are exacerbated by a woman’s race or residential location and are issues the Affordable Care Act (ACA), our country’s new health reform law, only begins to address. A lack of adequate health care – and how skewed health determinants are – is something that many groups have touched upon in their research but is an issue that needs more attention. Studies have shown that women report a higher number of days of poor physical and mental health than men. Unfortunately, to date most studies on inequalities have not focused enough on the barriers that women, more specifically women of color, face in accessing health care.

The ACA does have good first steps in improving accessibility of preventive health services for women. The ACA is expected to stabilize and reverse women's growing exposure to health care costs.

New health plans will cover preventive health care services provided to women under both the new ACA task force recommendations and guidelines, which are being developed by an independent group of experts (expected to be issued by August 1, 2011). These services include preliminary screenings such as mammograms. The ACA also prohibits insurance companies from rating based on sex and offering higher premiums due to pregnancy being considered a preexisting condition. In addition, bans on lifetime limits, recissions, preexisting conditions being used to reject or confer higher premium plans, and expansions in Medicaid will likely result in a decrease in the number of uninsured women and protect some women.

However, minority women still experience barriers that the ACA will have to overcome in order to confer equitable care for all women.

The number of minority women who either do not have access to or take advantage of health care when they need it is staggering. One of the ACA’s main focuses is on increasing the number of Americans who have health insurance through Medicaid expansions, small business vouchers, individual and employer mandates, and consumer protections for the privately insured. These are important health system improvements that expand insurance coverage to many people. Currently 50.7 million Americans are uninsured and even more people are underinsured. Sadly, having health insurance doesn’t always mean that accessing good care is possible.

Several barriers remain for women to access adequate care. One of these obstacles is race. While 9.5 percent of Caucasian women reported to be in poor or fair health, more than twice that, 19.7 percent, of minority groups reported being in the poor or fair range. Additionally, 9.9 percent of minorities had low birthweight infants and 22.7 percent had late prenatal care compared to Caucasian women with 7.2 percent and 11.1 percent respectively. Though startling, these figures do not represent the entire picture. Minority women are almost twice as likely to have no health coverage and/or have no primary care doctor (27.9 percent and 25.7 percent compared to Caucasian women at 12.8 percent and 13.2 percent respectively). Also, the cost burden falls disproportionately on minority women, with 22.8 percent reporting not visiting a doctor due to cost while strikingly less, 14.7 percent, of Caucasian women report the same.

The Kaiser Family Foundation, a leader in health care utilization studies, points out that “while women of color in the U.S. are resilient in a number of respects, they continue to face many health and socioeconomic challenges.” However, these disparities persist even if insurance status, income, age, and severity of conditions are comparable, according to a new report from the National Academies' Institute of Medicine: Unequal Treatment: Confronting Racial and Ethnic Disparities in HealthCare. For women of color, the burden of  health care accessibility may have much more to do with residential segregation and household pressures, as reported in a 2009 Henry J. Kaiser Family Foundation (KFF) report, Putting Women’s Health Care on The Map: Examining Racial and Ethnic Disparities at the State Level. It is also visible in the significant geographical distribution in outcomes and access.

Although reducing the costs of preventive services and attaining insurance coverage does not always translate into accessibility for some populations--the most important thing for Americans to remember is that the ACA is a first step: deals with the tip of the iceberg. The challenges that women, especially minority women, face in accessing health care and having positive outcomes is something that requires an overall assessment of our societies’ and communities’ values. Hopefully the ACA will work as intended, and set up a framework and the support that those at the community level can use to address disparities. This work will require that states and communities take the next steps in implementing provisions in unique ways that will address and recognize the individualities and cultural necessities of racial and ethnic groups. Successful implementation will improve outcomes and make the system more equitable for all Americans.