The Affordable Care Act's Dramatic Impact on Health Care for Women
As we celebrate Women’s History Month, it is important to recognize a defining moment in the history of women’s health care in America – the passage of the Affordable Care Act (ACA) 12 years ago this month. This landmark legislation ushered in a decade of expanded and accessible coverage while decreasing health care costs for millions of women in the United States. As the ACA turns another year older, it’s a critical moment to take stock of our progress and reflect on opportunities to better cover women’s needs.
Shortly after the ACA passed, the National Conference of State Legislatures noted that women were more likely than men to suffer from chronic diseases, to more consistently require health care throughout their lives, and crucially – to lack health insurance. The Affordable Care Act set up Essential Health Benefits, that all Qualified Health Plans are required to cover, which included both maternity care and birth control. Today, only 10 percent of women in the U.S. remain without health insurance, down from 19 percent in 2010, according to the Kaiser Family Foundation (KFF). Since the opening of the ACA marketplaces in 2013, the number of uninsured women in the U.S. has fallen by nearly half. In the 2022 open enrollment period, 6.5 million out of the record-breaking 14.5 million Americans who signed up for health insurance were women, an increase of more than 280,000 since the 2020 open enrollment period.
This increase is due in part to the growth of state-based marketplaces, which allow individual states to create and maintain their own health insurance shopping and enrollment platform independent of the federal HealthCare.gov marketplace. This gives states more control over the health insurance eligibility and enrollment process, keeps operational costs low, and lowers the cost of premiums for residents in the state. There are currently 17 states – and the District of Columbia – that run their own exchange without the support of the federal platform.
At GetInsured, we work with seven states to build and manage their own health insurance exchanges. Across the board, we have seen high enrollment numbers, particularly when it comes to enrollment among women. But it’s not just our company.
In 2021, the 17 states and D.C. that operate their own health care exchange outside of the federally facilitated marketplace accounted for 32 percent of the 6.5 million new female enrollees during this year’s open enrollment period. And 69 percent of those new female enrollees in 2021 enrolled through a GetInsured administered program, according to GetInsured internal analysis and KFF data.
As the former Executive Director of Nevada’s state-based marketplace, the Silver State Health Insurance Exchange (SSHIE), I’ve seen first-hand the benefits of a well-run, technologically-sound, state-run exchange. As one of the first states in the nation to transition from the federal exchange to a state-based marketplace, Nevada is a model for other states now plotting a similar trajectory.
By percentage, state-based exchanges have a better track record on insurance rates among women compared to states on the federal program. Ten of the 20 states with the lowest female uninsured rates in the country were in states with their own marketplace. These states include Vermont (3.2%), Rhode Island (3.9%), New York (4.4%), Maryland (5.0%), Connecticut (5.6%), Pennsylvania (6.1%), Maine (6.1%), Minnesota (6.5%), and Kentucky (7.8%) – along with the District of Columbia (3.0%). In comparison, among the 20 states with the highest female uninsured rates, only four are represented by states that have established their own exchange.
Now state exchanges have a once-in-a-lifetime opportunity to improve health insurance marketplaces and keep insurance rates affordable.
The 2021 American Rescue Plan, which increased premium subsides at all income levels for health plans sold in public marketplaces, also earmarked funds to modernize public facing IT services, allowing more states to automate, streamline, and reduce manual interventions. The goal is to make it easier to get public benefits and more affordable health insurance. States are responding by seizing this support to build state-based marketplaces that fit the unique needs of their residents.
As states continue to build marketplaces, government can leverage private market cloud-based software platforms that will improve the user experience and overall efficiency of enrollment, process claims faster, and allow residents to easily compare their options online. It’s incumbent on all of us to make sure state governments make those improvements and push Congress to continue subsidies that make insurance affordable for all. The health care of all of us, particularly women who are at higher risk of chronic disease, is at stake.
Heather Korbulic is the Senior Policy and Strategy Lead at GetInsured, where she engages local, state, and federal health care policy leaders in developing strategies for technology-driven improvements to the provision of health care and other public benefits. She was previously the executive director of Nevada’s health insurance marketplace, the Silver State Health Insurance Exchange.
