What is a pre-existing condition? It is a term used by insurance companies to deny coverage to people who have health needs. A pre-existing condition may be a condition a woman has received treatment for previously or a condition she does not even know about when she applied for insurance coverage. It may be a condition that occurred at any time in a woman’s life:
From Birth: A pre-existing condition can be a condition a woman has had since birth, like my friend Abby. Abby was born with a congenital condition that has no cure. She has been lucky to always have health insurance through her parents’ plan, but she always had concerns about what would happen in the future. Come January 1, Abby no longer has to worry about her health condition being a pre-existing condition.
From Childhood: I was eleven years old when I was taken to the emergency room because I was having trouble breathing. That was my first asthma attack. I had a pre-existing condition as of the age of eleven and if I ever had to apply for insurance on the individual market, that asthma diagnosis would be right there with me. Like Abby, I’ve been lucky to always have insurance through my parents, my work or my school. But I have also known that my life choices were limited by my access to health insurance. Come January 1, I will have a wave of relief to know that it no longer matters that I have a pre-existing condition.
I know this is not the most health conscious time of year. The holiday season kicked off last week with turkey, stuffing, and pie (and latkes for many of you!) and we are still several weeks away from New Year’s resolutions. Weeks that will be filled with eggnog and cookies and the ever expanding selection of holiday beers I keep eyeing in my grocery store cooler. No one wants to think about getting their cholesterol checked.
But this is also the time of year where we are surrounded by family and friends and spend a lot of time thinking about all we have to be grateful for. I spent Thanksgiving joking that what I would be most thankful for was a Texas Longhorn win against Texas Tech. But a few days later my cousins and I learned our beloved high school math teacher had passed away at age 54. It was a sobering reminder to stop making football jokes and take stock of what I was really thankful for. Like the fact that my family was healthy enough to gather around the table together.
And I’m especially thankful that staying healthy is getting easier for millions of other American families. Thanks to the Affordable Care Act, millions of Americans without affordable insurance coverage have new options. Read more »
My immediate family’s Thanksgiving celebration is full of tradition – maybe a little too full. We always gather at my step-sister’s house, and everybody who attends brings the same dish every year. For example, Stephanie has claimed my mother’s sweet potato recipe for the last 15 years. Maybe more. Brian brings the appetizers, but he is always late. Paula always brings a pecan pie, which looks delicious but I am just too full to eat it by the time we get to dessert.
Our conversation can be a little, um, traditional too. For example, we go around the table and everyone says what they are thankful for. In 2010, after passage of the Affordable Care Act earlier that year, I said I was thankful that my daughter would grow up in a country that provides affordable, high-quality health care to everyone, and that she would never need to worry having health coverage. My daughter said she was thankful for her nightgown. (She was three.)
I will be talking about the Affordable Care Act at Thanksgiving this year, too – even before we say what we are thankful for. I will be making sure that my friends who own their own small business know that they might qualify for tax credits to help them with the cost of buying health insurance. Read more »
Late last Friday, the 7th Circuit ruled in favor of two for-profit corporations and the individuals who own them in their challenge to the ACA’s contraceptive coverage rule. The court concluded not only that the rule substantially burdens the religious exercise rights of the company’s owners but also that the rule substantially burdens the independent religious exercise rights of the for-profit corporation. This is the first decision to find thatboth the for-profit corporation is a “person” capable of exercising religion and that the individuals who own it can challenge a rule that applies to their company (and not to them) under RFRA.
Two judges reached that conclusion over the strong dissent of Judge Ilana Rovner. At several points, she suspects there’s something fishy going on here with the birth control rule. And it has something to do with women, sex, and stigma. Read more »
As we marked the 35th anniversary of the Pregnancy Discrimination Act, we reflected on how pregnancy is still used as an excuse to push women out of work. It turns out lactating on the job can be just as dangerous for women. Take the case of Bobbi Bockoras. Bobbi works at a glass factory in Pennsylvania. She gave birth earlier this year and informed her employer she would be breastfeeding her child and so needed time to pump during her shift. Instead of providing Bobbi with a safe space to do so, her employer asked why she could not pump in a bathroom, which is prohibited by the federal law in light of health and privacy concerns. When Bobbi told her employer that she had a legal right to pump in a space that is not a bathroom, her employer placed her in a first-aid room, where her co-workers pounded on the door to get in, greased the doorknob to the room, and openly mocked her by insinuating she was a cow.
When Bobbi complained about these incidents, her supervisor instead placed her in an old locker room covered in dead bugs and with exposed electrical wiring and no air conditioning. He also retaliated against her by removing her from the day shift—which allowed her to breastfeed her baby on a regular schedule—to a rotating shift that took a toll on her body and caused her to produce less milk for her newborn. Read more »
Last night’s election results are in and it’s a game changer for women and families in Virginia. Governor-elect Terry McAuliffe made the state’s choice of whether or not to cover more people in the Medicaid program a central component of his platform and, last night, the effort to provide coverage for hard-working low-income Virginians just got a burst of momentum with a champion headed to the Governor’s office.
The Medicaid eligibility expansion is a crucial part of the Affordable Care Act (ACA)—and is a main component of the ACA’s strategy for achieving near-universal health coverage. States may accept federal funding to expand coverage through Medicaid to all qualified individuals under age 65 who have incomes below 138 percent of the federal poverty line (FPL), or about $32,500 for a family of four. Approximately 15 million uninsured Americans, including 7 million women, will be newly eligible for health coverage through Medicaid. Read more »
As the rollout of health care law – also known as Obamacare – continues, recent news reports have focused on rate increases and the potential that health insurance premiums will be more expensive for some consumers. It’s true – some consumers may start paying more for health coverage purchased on the individual market (although, some who think they will pay more may be pleasantly surprised when subsidies and the details of the new plan are analyzed). But it’s also true that across the country women, in particular, will actually get a better deal because of the health care law. As our recent report Making Insurance Work highlights, the law ensures millions of individuals and families will have access to insurance that works for their budget and that premium dollars go towards high quality, affordable, and reliable health insurance.
Here are five reasons why women are getting a better deal:
Care when you need it: Before the health care law, women could be denied for pre-existing conditions like cancer, asthma, an old knee injury, or even pregnancy. According to the Department of Health and Human Services, up to 129 million non-elderly Americans have preexisting conditions, and 1 out of 5 are uninsured. Beginning in January, health insurance companies can no longer deny coverage because of pre-existing conditions, so these millions of American who need care can get it.
CBS and other news outlets have reported on the fact that many Americans are signing up for Medicaid coverage as part of the Affordable Care Act (ACA). Some of these reports suggest that this is somehow a crisis or a major problem with the law, but in fact, this is how Congress designed the ACA. The ACA extends health coverage to up to 30 million currently uninsured Americans through tax credits to purchase private insurance on the newly launched Health Insurance Marketplaces and through a major expansion of Medicaid eligibility. The Medicaid eligibility expansion is a crucial part of the health care law—and is a main component of the ACA’s strategy for achieving near-universal health coverage. States may accept federal funding to expand coverage through Medicaid to all qualified individuals under age 65 who have incomes below 138 percent of the federal poverty line (FPL), or about $32,500 for a family of four. Approximately 15 million uninsured Americans, including 7 million women, will be newly eligible for health coverage through Medicaid.
Here are a few facts that put these reports into context:
This is how the ACA is supposed to work. According to estimates by the Urban Institute and the Kaiser Family Foundation almost half (47%) of the uninsured population could be eligible for coverage through the ACA’s opportunity to expand Medicaid eligibility. This Medicaid eligibility expansion was always going to be a big part of the ACA’s coverage goals.
CBS recently aired a segment about the Affordable Care Act (ACA) and new requirements that insurance plans must cover maternity care. But instead of focusing on women who will benefit, CBS interviewed a man who does not want his family’s insurance to include maternity coverage because they no longer need these services.
Let’s set the record straight. Health insurance does not work like an a la carte menu. You don’t get to decide that you don’t want to cover diabetes care because you aren’t at risk for diabetes, but do feel like covering cancer treatment given that your mom had breast cancer. Instead, health coverage pools your premium payments and your health care risks with everyone else’s premiums and health care risks—and therefore protects you against the health costs you can predict and also the health costs you can’t predict. As for maternity care, the individual market is substantially improved by the Affordable Care Act. State and federal anti-discrimination protections insure that most women with employer-based health insurance receive maternity benefits. However, prior to the ACA, there were no federal requirements to provide maternity coverage in the individual insurance market.
Before the Affordable Care Act:
Women face unfair and discriminatory insurance practices, such as being denied coverage or paying more for health insurance than men. At the same time, individual market health plans often exclude coverage for services that only women need like maternity care. In most states, women are routinely denied coverage because of pre-existing conditions such as being pregnant or having had a C-section, breast or cervical cancer, or receiving medical treatment for domestic or sexual violence.
As the Affordable Care Act moves closer to full implementation — including the application of new standards for health insurance plans on January 1, 2014 — some critics of the health care law have seized on recent insurance plan notices as evidence that the law won't work. These notices, issued by individual-market insurance plans and sent to their enrollees, inform plan subscribers that their health insurance plan does not meet the standards of the ACA, and they will need to choose a new plan that does meet these requirements. These critics charge that the law does not live up to President Obama’s promise that "if you like your plan, you can keep it." Here are five things to keep in mind as the controversy swirls around you:
New plan requirements improve coverage
Starting January 1, health plans sold on the individual market must cover all essential health benefits — including maternity care, preventive care, mental health treatment and prescription drugs. Today, policies in this market often skimp on these critical services. For example, NWLC's own research demonstrates that only 12 percent of these plans cover maternity care, while coverage for mental health and prescription drugs is also spotty.
Most people don't "keep" their coverage in the individual market
In most states, health plans don't have to renew your policy year after year in the individual market — if you get sick, your plan can kick you out once your 12-month contract ends. And lots of people buy coverage in this market for only a short period of time — leaving the market once they receive an offer of employer-sponsored coverage or qualify for Medicare, perhaps. One estimate is that only 17 percent of subscribers purchase the same policy for two years or longer.
The whole point of the health care law is to reform the individual market
Ok, this is just one of several major goals for the law — but it is right up there with helping people afford coverage and controlling the growth of health care costs.