Kaiser Family Foundation Research

As ACA Rollout Continues, Gaps Remain in Women's Health Care

May 27, 2014 04:24 pm Michael Laff Washington –

Women may be the primary caregivers in many families, but they often sacrifice their own health care, according to a recent study.

"I hope people's knowledge and understanding of insurance will improve," says Francisco Garcia, M.D., of the Pima County Health Department in Arizona. Garcia spoke during a panel discussion by health experts convened by the Kaiser Family Foundation to examine a report on women's health.

Compared with men, a higher percentage of women choose to delay or forgo health care entirely. When medical costs are taken into account, the gender gap widens even further because 10 percent more women than men are paying off bills.

Earlier this month, the Kaiser Family Foundation released the results of a survey that explores the impact of the Patient Protection and Affordable Care Act (ACA) on women's health. The survey report, dubbed Women and Health Care in the Early Years of the ACA: Key Findings from the 2013 Kaiser Women's Health Survey,(kaiserfamilyfoundation.files.wordpress.com) details the proportion of women with insurance, what barriers they encounter to obtaining care, where they go for care and their general knowledge about what is and is not covered under the ACA. Kaiser marked the announcement by hosting a panel discussion(kff.org) to analyze the report's findings.

The survey was based on responses from 3,000 women ages 15-64. Among the survey's findings was that 40 percent of low-income women are not covered by insurance. A startling 65 percent of women surveyed who do not have insurance said they delayed or went without health care.

Story highlights
  • According to a new report by the Kaiser Family Foundation, women encounter greater barriers to accessing health care than men do because of a number of factors.
  • Expansion of insurance coverage does not necessarily mean that newly insured people will seek the care they need.
  • The level of knowledge about health care coverage needs to improve among patients and health professionals.

According to Amy Allina, deputy director of the National Women's Health Network, one of the strongest benefits of the ACA was the provision that allowed children to remain on their parents' health insurance until age 26. That provision has enabled 45 percent of women ages 18-25 to retain coverage through their parents' insurance plans, she said.

Still, she and other panelists noted, obtaining insurance is only the first step toward improving health outcomes for women.

For example, women who participated in the survey said they had difficulty finding the time to take care of their health needs, said Allina. Despite the advantages afforded by the ACA, she said political decisions at the state level are hampering the goal of universal coverage.

"The fact that half of the states turned down federal expansion of Medicaid is shameful," Allina said. "We have to hold policymakers to account for that decision."

Francisco Garcia, M.D., chief medical officer for the Pima County Health Department in Arizona, said that although many people think the ACA will eliminate the need for community clinics, federally qualified health centers and rural clinics, these facilities will, in fact, continue to serve a large number of low-income and minority patients.

"Just because you have a Medicaid card or an insurance card doesn't mean you will use it," he said. "That does not represent good health outcomes."

Several panelists cited the difficulty of persuading people who are newly insured that seeking care is important. In many cases, women face the prospect of additional costs related to accessing medical facilities, including transportation, child care and missed time from work.

Cara James, center, director of the Office of Minority Health at CMS, announces that HHS plans to launch a health education program for consumers this summer.

"In our district, we see young women who are taking care of parents and siblings," Garcia said. "We have to lower the barriers. Safety-net institutions become a crucial component for those families."

Although the law has helped close the gap in insurance coverage, Garcia noted that large sectors of the population are left out -- notably, children who are legal U.S. residents but whose parents may not be, individuals who do not use the banking system and the incarcerated population.

What physicians and health care analysts are discovering is that many newly insured patients are unfamiliar with provisions included in their health insurance plans. According to Cara James, director of the Office of Minority Health at CMS, HHS plans to launch a health education program this summer that will teach individuals who recently obtained insurance how to use their benefits.

Vanessa Cullins, M.D., vice president for external medical affairs at Planned Parenthood Federation of America, said the level of knowledge about health care coverage needs to be increased among both patients and health care professionals. Many women, for example, think that screenings for STDs are part of a routine physical exam and, therefore, would constitute a covered benefit. The fact is, however, that this type of testing is typically not covered by insurance.

Although all women should receive at least one wellness visit per year that is covered by insurance, some women will require two or three. Trying to meet the needs of patients with multiple health concerns is difficult because delivery of preventive care delivery can often be fragmented, Cullins noted.

"A lot of providers are at a loss to explain what should be included in a preventive visit," she said.

When asked to envision the ACA's impact going forward, the panelists agreed that measuring the long-term effects of the law will be the most difficult challenge. Allina said the goal of universal coverage will not be achieved in four years and that policymakers will be discussing many of the same issues years in the future that they are confronting today.

In addition, there is no way to measure whether the recently insured population will be able to adjust to paying health care premiums consistently, especially if they are in a lower-income bracket. Garcia said he was concerned that such individuals will "churn in and out" of the insurance market. They might pay premiums for a short period, then stop paying and drop out.

"We need to do as much as we can to keep people in the system," he said.

Additional Resource
Kaiser Family Foundation news release: "New Survey Documents Women's Health Care, Coverage and Early Experiences with the Affordable Care Act"(kff.org)
(May 15, 2014)