For a PDF of this factsheet with footnotes, please see below.

The Affordable Care Act (ACA) makes historic strides for women’s health and economic security, but is once again under attack. The health care law provides premium tax credits and other financial assistance to help low and moderate-income individuals and families—many of whom are women—purchase health insurance and reduce out-of-pocket expenses such as co-payments and deductibles.  The Supreme Court will soon hear one of several challenges opponents of the law have brought against this core provision of the ACA, and will likely issue its decision by early summer. The National Women’s Law Center (NWLC)’s new analysis of data from the American Community Survey shows what’s at stake for women in King v. Burwell. As the accompanying table and the following highlights illustrate, millions of women – including a disproportionate number of women of color – could lose access to affordable health coverage in states with federally-facilitated insurance Marketplaces.

Millions of women already benefit from the law’s financial help.

We estimate approximately 4.2 million women already receive premium tax credits to purchase health insurance; many of these women also receive cost-sharing reductions, which reduce out-of-pocket expenses such as deductibles and copayments.  In fact, fifty-four percent of enrollees who purchased coverage on the federally-facilitated Marketplaces are women.

New data emphasizes how King v. Burwell threatens women’s access to affordable health coverage.

Our analysis of the American Community Survey illustrates how important the King v. Burwell decision will be for women. In addition to the women already enrolled and receiving financial help, many more are eligible to receive premium tax credits in order to make their monthly premiums affordable. According to our analysis, nearly seven million women, including those already enrolled, are eligible for tax credits in the federally-facilitated Marketplaces. These seven million women are at risk of losing the financial help they need to buy health insurance coverage.

  • The vast majority of women eligible for financial help live in states with federally-facilitated Marketplaces. Across the country, over nine million women are eligible for financial help, but nearly seven million of these women live in states with federally-facilitated Marketplaces.  These women are at risk of losing their access to affordable, comprehensive health insurance just because of where they live.
  • Women of color would be disproportionately affected. Of the nearly seven million women at risk of losing their eligibility for financial help, approximately half (3.4 million) are women of color.
    • This includes 1.8 million Latinas, 1.1 million African American women, 250,000 Asian women, and 106,000 Native American women.
  • Over two million of the women at risk live in just two states.
    • Over 1.2 million women in Texas and over 900,000 women in Florida are at risk of losing access to affordable health coverage.
    • Other states with the largest numbers of eligible women include Georgia, North Carolina and Illinois. 

Health insurance purchased on the Marketplace has important benefits for women.

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. Without financial help, women will lose access to comprehensive health coverage, including:

  • Access to preventive care without cost-sharing: Health plans must now cover certain preventive services such as mammograms, flu shots, and colon cancer screenings with no additional out-of-pocket-costs such as co-payments. All health plans on the Marketplace must also cover certain women’s preventive services without cost-sharing, such as the full range of FDA-approved contraceptive methods and contraceptive counseling, well-woman visits, screening for gestational diabetes, breastfeeding support, supplies, and counseling, and domestic violence screening and counseling.
  • Access to services women need: All health plans offered on the health insurance Marketplaces must cover specified essential health benefits, including maternity and newborn care, mental health treatment, and pediatric services. Prior to the Affordable Care Act, only 12 percent of individual market plans covered maternity care.
  • Continued care for existing medical conditions: If women can no longer afford their health insurance, those who are already enrolled in health plans could lose access to their health care professionals and prescription drugs.

King v. Burwell could destabilize the health care law

The success of the health care law rests on three important principles—reforming the health insurance market, requiring individuals to purchase health insurance, and providing financial help for individuals to purchase coverage. By attacking the premium tax credits that are already available to millions of women, King could destabilize the entire health care law. This financial help makes coverage affordable and ensures broad participation in health insurance Marketplaces; without it, the individual insurance market in these states would fall apart as premiums skyrocket and millions of women and their families have to risk going without health insurance.  King puts in jeopardy the health care law’s advances towards ensuring women’s access to affordable, comprehensive health coverage.


Number of Women at Risk of Losing Access to Affordable Health Insurance

*Factsheet last updated on March 19, 2015*
Published On: February 23, 2015Associated Issues: Health CareHealth Care & Reproductive Rights