Editor's Note, 3/27/12: Melissa finished this post on her trip to the White House Affordable Care Act roundtable last week with a call for you to weigh in and share your story. As the Supreme Court hears arguments on the constitutionality of various aspects of the act this week, we want to keep the BlogHer roundtable going. What's your insurance situation? How do you feel about the legislation? Share your story in the comments below. -- Julie
Today, I attended a small roundtable discussion with 11 other women in the Roosevelt room at the White House. We talked about the Affordable Care Act and how it is playing out in the actual lives of women. Leading the discussion were Deputy Chief of Staff, Nancy-Ann DeParle, and Deputy Assistant to the President for Health Policy, Jeanne Lambrew.
Before I left, I studied up on the ins and outs of the Affordable Care Act -- as well as the many different ways people see this legislation. If you don't know a lot about it, you can learn more at Healthcare.gov -- including the full law, key features, and the timeline for when different aspects of the law will be rolled out.
It's a broad law that will be rolled out in small increments over 10 years, so I focused on the parts that apply to women or families:
- Certain, common preventative care must be covered without cost sharing (in other words, no co-pay for preventative care visits that fall under the parameters -- including mammograms and wellness visits).
- Insurance plans that are job-based or individual can no longer refuse to cover treatment or charge more due to pre-existing conditions.
- You can no longer be dropped from an insurance plan due to a condition.
- If your job does not provide insurance, starting in 2014, you'll be able to purchase insurance at a rate that matches those of job-based insurance plans.
- You will no longer need a referral for primary care physicians, pediatricians, or OB/GYN practitioners. You may choose any doctor who participates in your plan.
- Women cannot be charged differently from men for the same insurance. According to the Healthcare.gov site: "Before the law, women could be charged more for individual insurance policies simply because of their gender. A 22-year-old woman could be charged 150% the premium that a 22-year-old man paid. In 2014, insurers will not be able to charge women higher premiums than they charge men."
- In most cases, a child can remain on their parents' insurance plan until the age of 26.
I went into the meeting with both an open mind and a critical ear. Personally, I firmly support measures to ensure that all women receive adequate health care, which I believe includes everything from Pap smears to birth control. But I also researched the arguments against the Affordable Care Act while I looked at the benefits that are accessible two years into the new law.
Arguments against the plan include those from religious institutions, such as the United States Conferences of Catholic Bishops, who protest the inclusion of contraceptive coverage even after the Obama administration compromised to ensure that there is no direct involvement of religious organizations. Others find fault with the idea of a penalty against those who are uninsured, which will go in effect in 2014.
Those in favor of the new plan believe the benefits outweigh the drawbacks. Lambrew stated today that 45 million American women had access to free preventative care last year. How much could that have saved taxpayers overall by finding medical issues at an early stage, when the treatment is less expensive and invasive than down the road? One million women who didn't have health insurance at all prior to this point now have health insurance, which brings the ability to get a yearly wellness visit.
I asked DeParle and Lambrew what criticisms of the Affordable Care Act they thought were the most important to address. DeParle said,
That it does nothing to control cost. We know, for example, with Medicare that Medicare spending is the lowest it has ever been, it part because of all the reforms that went into the Affordable Care Act that medicine is well underway in implementing ...
Another one I find irritating is a lot of people think that the so-called individual mandate is a huge, new imposition on their liberty based on what they heard, when in fact, for most Americans nothing is going to change. You'll just check a box that says, "Yes, I have insurance." They are lucky enough, many of them, to be with a large employer. For them, nothing will change except that over time, the cost for their plan should decline, and they should have protection for life of no annual limits, no lifetime limits, coverage of preventative benefits such as contraception.
Somehow I think people have this notion that the requirement that they have insurance is some big imposition on them and that's unfortunate.
A representative from the Huffington Post asked whether insurance companies and pharmaceutical companies stand to benefit most from this legislation. DeParle responded that it doesn't need to be an either/or situation:
"To the extent that everyone is getting coverage, there are new customers for insurance companies, new paying customers for pharmacutical companies although the pharmacuticals and the hospitals argue -- and we'll see what the results are -- that they may actually lose money because if you're uninsured right now and you show up at the hospital, they can charge you the full amount ... I think in the end, they will gain something, but I think people gain a lot."
Lambrew and De Parle also answered questions about the recent debate over contraception coverage, saying that contraception saves money for the general public by lessening the need for the public to pay for maternal health care for unwanted pregnancies or the children who are born as the result of those pregnancies. Covering contraception, they said, is not just the desire to give women something they want; in the view of the administration, it is a cost-saving measure looking at long-term goals in regard to medical spending.
I walked out of the roundtable with a better understanding of the purchasing clout individuals will now have in shopping for an insurance plan; something held prior to this point only by large businesses who negotiated the insurance. I also learned what steps the administration believes will ensure that the 21 million women and children still without insurance have access to a medical plan by the time the law is fully implemented. As a woman, I was hopeful to hear about the plan to do away with gender rating, discrimination in insurance plans with women paying more for the exact same insurance as a man with a similar profile.
We also discussed the reality that this legislation may not remain in place. It could be overturned if there is a shift in party control with this next election, especially when we take into account the voting record to bring the Affordable Care Act into law, as well as states that are refusing grant money in order to show their lack of support for the new plan, such as Florida, Oklahoma, and Kansas, another aspect of the discussion today when we looked at the act state by state.
Legal challenges are also a factor. The U.S. Supreme Court will also hear arguments challenging various aspects of the Affordable Care Act starting March 26, with a decision expected in late June. It could overturn some, part, or none of the law. Today, the court struck down part of a provision of the Family and Medical Leave Act, a decision the Los Angeles Times said some see as "a bad omen for President Obama's healthcare law."
To be frank, as much as it helped me to understand the Affordable Care Act to talk about it with the administration, I would love to hear YOUR story, how changes in insurance and medical care have affected you on a personal level. Are you now covered differently? Are you more likely to go to a wellness visit now that co-paying for preventative care isn't required? Are you opposed to the Affordable Care Act because you've seen a negative change in your health care plan over the last two years?
What's on your mind? Talk to us in the comments section.
Photo Credit (Official Photograph): Deputy Chief of Staff Nancy-Ann DeParle and Deputy Assistant to the President for Health Policy Jeanne Lambrew hold a roundtable discussion on the Affordable Care Act and how health reform is benefiting women with representatives from leading women’s online publications in the Roosevelt Room of the White House in Washington, D.C., March 20, 2012. (Official White House Photo by Sonya N. Hebert)
All other photos by Melissa Ford.
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