When Elizabeth Barry of Bethlehem was pregnant with her son Nolan, she didn’t have to make co-pays for her obstetrician visits.

After Mariah Gring of Salisbury Township gave birth to her daughter Penelope last year, she received a free breast pump, a device that can cost hundreds of dollars but makes it easier for women to leave their babies in the care of others, whether it be to run errands or go to work.

Barry and Gring, both of whom have health insurance through employers, are among millions of women who have seen the impact of the Affordable Care Act, and its mandated maternity coverage, firsthand.

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“It was nice I didn’t have to pay a co-pay because you visit every month, and toward the end [of the pregnancy] every week. That could have gotten expensive with co-pays,” said Barry, a first-time mother.

Women in particular have benefited from Obamacare, whether they have private insurance or buy coverage on exchanges. It requires all but small companies to offer preventive care such as yearly mammograms, cervical cancer screenings and well visits without out-of-pocket costs. It mandates prenatal and deliveries coverage with no co-pays. Birth control, including intrauterine devices, and breast feeding supplies are free.

The law also bans a previously common practice in which women were charged more than men on the individual market.

The idea behind mandating benefits was to make sure pregnant women get early care to avoid complications to them and their babies, catch cancer and other diseases early enough to be treated and prevent unwanted pregnancies and the societal problems that go with them.

The number of women with insurance coverage also grew under the law, with 20 percent of women ages 15 to 44 uninsured in 2013. Two years later that number dropped to 13 percent, according to data from the Guttmacher Institute, a research and policy organization committed to advancing sexual and reproductive health and rights.

President Donald Trump and Republicans who control Congress have sworn to repeal and replace the ACA, but a proposal has not yet been revealed so it is not known how women’s care would be affected. Early ideas floated range from offering tax credits to allowing states to continue insurance exchanges on their own with the mandates they want.

When the issue of maternity coverage came up at a recent Senate Finance Committee meeting, Seema Verma, Trump’s pick to run the Centers for Medicare and Medicaid Service, said it should be optional for patients, The Associated Press reported. She said patients — not the government — should determine the insurance benefits they need.

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Before the ACA, some women had private insurance that covered preventive and maternity care. Still, the potential loss of such benefits was among the reasons women and men in the Lehigh Valley joined marches in Bethlehem, Philadelphia and Washington, D.C., in January. It also was on the list of grievances aired at the Tuesdays with Toomey rally outside U.S. Sen. Pat Toomey’s Allentown office on Jan. 31.

Among those at the rally was Christine Bainbridge, an Allentown resident and breast cancer survivor. Doctors discovered her cancer after her first mammogram at 41. Even though she was on employer-provided insurance and doesn’t think the health care law directly affected her, she fears that the loss of a free mammogram could put more women at risk.

“I’d hate to see that change and women not being screened because if you’re screened frequently and early your cancer is more easily treated,” Bainbridge said.

Janel George of the National Women’s Law Center in Washington, D.C., said while many people recognize the value of women having access to preventive and other services for free, others forget what women’s advocates describe as discriminatory pricing policies. Before the ACA, women also paid about $1 billion more than men each year for identical health plans in the individual market, according to a study of plans by the National Women’s Law Center.

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“Those are very important provisions, but again it’s these consumer protections that prevent insurance companies from treating women differently,” George said. “At the law center we had a saying, ‘Being a woman is not a preexisting condition,’ because a lot of insurance companies would deny women health coverage for conditions like having a Cesarian section or having a prior pregnancy or being treated for domestic violence or sexual assault.”

She said she’s concerned new plans for health care could reduce the number of women covered under Medicaid, discourage plans covering abortion and leave states to determine essential benefits.

The Kaiser Family Foundation has put the average bill for doctors’ fees and hospital charges at $9,700 for a normal delivery and $12,500 for a Cesarean section. Before the ACA, Kaiser said, many plans sold on the individual market to women did not include maternity coverage.

George also noted that changes don’t need a repeal of the ACA. Birth control coverage, which is considered a preventive service, or other services like breast pumps, could be ended administratively by Trump rather than legislatively by a vote in Congress.

Free birth control has been a popular part of the ACA.

Kim Chiz, executive director at the Allentown Women’s Center, said her health center saw a big drop in women coming there for reduced-price birth control once the ACA went into effect. A 2015 study at the Perelman School of Medicine at the University of Pennsylvania found women nationally saved $1.4 billion per year in out-of-pocket birth control pill costs because of the ACA.

Melissa Reed, executive director for Planned Parenthood Keystone, a Pennsylvania branch that covers 37 counties, said women have saved millions across the country by not having to pay for preventive services out of pocket.

“Even a $20 co-pay can be the difference between someone being able to put gas in their car or food on their table,” she said. “They will put off health care to do those essential things.”

Not everyone thinks the benefits afforded women under Obamacare are a win-win. Barry’s husband, Dan, said the word “free” as in free breast pump is a relative term. Since 2010, he said his annual deductible has gone from hundreds of dollars to thousands a year.

The Commonwealth Foundation, a free-market think tank in Harrisburg, said the ACA is forcing benefits, and extra costs, on people who may not want them.

Elizabeth Stelle, the foundation’s policy analysis director, said the organization wants people to have more choices so they don’t have to pay for services they’re not going to use.

For example, she thinks women should be allowed to choose if they want preventive services and birth control covered under their plans.

She noted the cost for services haven’t declined, but have been spread to other areas. She said the reason women were paying more for health care before the ACA is because they require more health care.

“The alternative, under the ACA, which I think is extremely unfair, is we then asked single men, for example, to essentially pay for maternity coverage that they had no intention of ever using. I don’t think it’s fair to ask somebody to pay for coverage they’re never going to use,” Stelle said.

ACA advocates say women are worried about what the future holds. Chiz said there’s been an increase in requests for IUDs since Trump was elected, something she attributes, at least in part, to fears that an ACA repeal could be accompanied by a lack of access to contraception. Her observations were mirrored by Planned Parenthood, which nationally said it saw a 900 percent increase in women requesting IUDs in the wake of the election.

THE ACA AND WOMEN

• In 2010 required insurers to cover mammograms, cervical cancer screenings, flu and pneumonia shots and regular well-baby and well-child visits without out of pocket costs.
• Starting in August 2012, most plans had to cover well-woman visits, gestational diabetes screening, HPV DNA testing for women age 30 and older, sexually-transmitted infection counseling, HIV screening and counseling, FDA-approved contraception methods and contraceptive counseling, breastfeeding support, supplies and counseling and domestic violence screening and counseling without cost-sharing.
• Maternity-related services had to be covered, including anemia screening for pregnant women, folic acid supplements for women who may be pregnant, Hepatitis B screening for pregnant women, Rh incompatibility screening, syphilis screening and tobacco use screening.

Source: U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation

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