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In the past year, we saw significant changes for women’s access to health coverage. In the first year of the full implementation of the Affordable Care Act (ACA), millions of Americans newly enrolled in affordable, comprehensive health insurance. Women make up more than 50 percent of enrollees on the new health insurance Marketplaces, which is no surprise given that the ACA protects women from discriminatory health insurance practices, makes health coverage more affordable and easier to obtain, and improves access to many of the health services women need.

Here are just a few of the major changes for women’s health insurance coverage this year:

  1. Access to affordable health insurance: Over four million women [PDF] signed up for health insurance with coverage beginning on January 1, 2014. On average, women in most states now receive $264 per month [PDF] to help make health insurance more affordable.
  2. The end of gender rating: Prior to 2014, health insurance companies on the individual market could discriminate against women by charging them more than men for the same health coverage, a practice known as gender rating. Ninety-two percent of plans practiced gender rating before the ACA took full effect, but this is now prohibited in the individual market.
  3. More Medicaid coverage: Twenty-seven states and the District of Columbia expanded Medicaid eligibility to cover all low-income individuals, providing them with access to free or low-cost health coverage. One more state will start expanded eligibility as of January 1, 2015, and several additional states are expected to accept Federal funding to expand coverage through Medicaid in the coming year.
  4. Access to health services women need: All plans offered on the individual market are required to cover essential health benefits including preventive care, maternity and newborn care, mental health services, and prescription drugs. Before this year, health plans often failed to cover the services women needed most; for example, only 12 percent of individual market plans covered maternity care.
  5. Preventive services without cost-sharing: This year, 30 million women [PDF] had access to preventive services without cost-sharing. This includes access to critical women’s health services such as birth control, well-woman visits, and breastfeeding support and supplies. At the end of the year, Congress also added breastfeeding supports and supplies to health coverage for military women and women in military families.

In short, 2014 brought many far-reaching improvements for women’s access to health insurance, particularly for low-income women and women who purchase health insurance on their own.  

However, 2014 also brought important set-backs for the coverage of women’s reproductive health  – most notably the Supreme Court’s Hobby Lobby decision, which allows certain employers to opt out of law’s requirement that they cover comprehensive birth control.  This decision allows employers to impose their religious beliefs on their employee’s personal health decisions.  A bill to overturn this decision was blocked in the U.S. Senate by anti-birth control Senators. 

Looking forward to 2015, the ACA must withstand new challenges to ensure that the law’s achievements in women’s health can continue to flourish.  These include further litigation on the application of the ACA’s contraceptive coverage requirements to non-profit employers, and the Supreme Court’s review of King v. Burwell, which examines whether the Federal government can offer premium tax credits to individuals who live in states that do not operate their own Marketplaces.

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