The ACA is working for women, especially in states like NY, study finds

megaphoneGuest post by Ann Danforth, Progressive States Advocacy and Policy Manager at Raising Women’s Voices-NY. A recent analysis by the Commonwealth Fund confirms what many women already know — the Affordable Care Act (ACA) has dramatically improved our rates of health coverage and our access to care. The Commonwealth Fund used data from its biennial health insurance surveys to compare women’s health coverage and health care experiences before and after the ACA, and the results make one thing clear: the ACA is working.

The uninsured rate for women in the U.S. is at an all-time low

Thanks to the ACA, the number of uninsured working-age women fell by almost half from 2010-2016, dropping from 20% (19 million) in 2010 to 11% (11 million) in 2016. Low-income women across all races and ethnicities made the greatest gains, while young women ages 19-36 made larger gains in coverage than women in other age groups. After the ACA went into effect, the percent of women reporting difficulty finding an affordable health plan that meets their needs fell by nearly half, the Commonwealth Fund found.

Women in states that expanded Medicaid under the ACA, like New York, have higher rates of insurance than women in states that chose not to expand Medicaid. As you can see in the graph below, the rates of uninsurance among women here in New York, a state that fully embraced Medicaid expansion, are five times lower than for women in Texas, a state that did not expand Medicaid. Commonwealth Fund Chart RWV blog August 2017Women in New York have expanded coverage options, since our state was the first in the country to establish a Basic Health plan called the Essential Plan, as permitted under the ACA. This extremely affordable coverage option for low-income New Yorkers, which HCFANY and RWV-NY successfully advocated for, went into effect in early 2016. As of January 2017, 665,324 New Yorkers have enrolled in New York’s Essential Plan, 54% of whom are women.

ACA consumer protections and subsidies improve access to care

The ACA put in place requirements that insurers cover 10 Essential Health Benefits, including maternity and newborn care, as well as preventive services. Under this requirement, insurers must cover a number of women’s preventive services with no cost-sharing, like contraceptive coverage, cervical cancer screenings and well-woman visits.  Although New York had contraceptive coverage requirements prior to the ACA, the ACA expanded them by prohibiting insurers from charging women co-pays for contraceptive coverage and counseling.

These consumer protections, along with the ACA’s health insurance subsidies, have made it easier for women to find affordable health plans that cover their needs.

New York builds on the ACA’s success by protecting and expanding key provisions of the ACA that impact women

 The Cuomo Administration, responding to requests from RWV-NY and other women’s advocacy groups, recently finalized regulations to keep in place the ACA’s contraceptive coverage protections, even if the ACA is repealed. These regulations require coverage without co-pays for one type of contraception in each of the 18 FDA-approved categories (the federal ACA standard) and allow for the dispensing of 12 months of contraception after an initial three-month allotment.

More recently, the Cuomo Administration proposed a rule that would require insurance carriers offering health plans in New York’s individual and small group market to continue to cover the ACA’s 10 Essential Health Benefits, regardless of what happens at the federal level. The proposed rule also includes a non-discrimination provision, which includes discrimination based on race, color, creed, national origin, sex (including sex stereotyping and gender identity), age, marital status, disability and preexisting conditions. RWV-NY has joined other members of the Health Care for All NY coalition in praising these proposed measures, while urging the addition of sexual orientation to the non-discrimination policy.

 There is still more work to do!

The Commonwealth Fund report adds to overwhelming evidence that the ACA is working for women here in New York and nationwide. But the survey results suggest there is still work to do to make health care more accessible and affordable for women. In the U.S., there are almost 11 million working-age women who are still uninsured and large proportions of women who find it difficult to afford comprehensive health plans. As the ACA faces new challenges, including a hostile Administration that aims to “let Obamacare fail,” it is critical that we inform the public about the ACA’s successes while continuing to advocate for affordable and quality health care for all.

moneybagsNew York’s insurance companies pay more in rebates than insurers in other states, according to new data analyzed by the Kaiser Family Foundation. In New York, insurers are required to spend at least 82 percent of the money they collect from customers on medical care. This is called the medical loss ratio (“medical loss” is the insurance term for money spent on your medical care). If the company’s medical loss ratio is lower than 82 percent (for example, if it only “lost” 70 cents of every dollar by providing medical care) it is required to send rebates to customers. The rest of the money can be used for administrative costs, like salaries and marketing. The average family in New York that got a rebate for 2015, the last year for which we have data, received $149.

The medical loss ratio is one of the ways in which New York State ensures that customers get value from insurance companies. It creates a small incentive for insurance companies to spend money on actual medical care. It also helps reduce the incentive insurance companies have to avoid or drop sick customers. There is a limit to how much money they can avoid spending on care. It’s a great consumer protection that the entire country now benefits from, thanks to the Affordable Care Act.

The medical loss ratio can also help regulators in their quest to keep premiums at reasonable levels. New York’s Department of Financial Services is currently deciding what insurance companies will be allowed to charge in 2018 (see our explanation of the rate review process here). Kaiser’s analysis shows that in New York’s individual market, Affinity, Fidelis, and MVP all had to pay big rebates for 2015. Each of those companies has asked for and received hefty rate increases over the past few years (see the chart below).

Premium Increases for Insurers Paying Medical Loss Ratio Rebates in 2015
Insurer 2016 2017 2018 (requests)
Affinity 6.6% 22.4% 23.5%
Fidelis 4.7% 11.6% 8.5%
MVP 10.2% 6% 13.5%

In 2015, when these companies were making their 2016 requests, they estimated that their medical costs were going to go up so much that they needed customers to pay higher premiums to make ends meet. Now that we have real data instead of estimates, we know that they actually spent less on medical care than expected in 2015. These companies should either have to make an especially strong case that they need higher premiums to cover customer care in 2018, or they should be told that their requests are too large.

Gavel-CreativeCommonsWe have been talking a lot about the ACA Cost Sharing Reductions or CSRs in the last couple of months. CSRs are crucial subsidies that help make out of pocket health care costs, like deductibles and copayments, more affordable for people who earn incomes up to 250 percent of the Federal Poverty Level (about $61,000 for a family of four or $30,000 for an individual). CSRs are even more important in New York because they are a major source of funding for the Essential Plan, which provides low-cost insurance with no deductible and low copayments to more than 665,000 New Yorkers earning incomes under 200 percent FPL (about $49,000 for a family of four or $24,000 for an individual).

In 2014, the House of Representatives sued the Obama administration, alleging that the CSR payments were unconstitutional because the funds to pay for them were not appropriated by Congress. In 2016, a federal judge ruled in favor of the House, and the case is currently on appeal. U.S. Secretary of Health and Human Services, Tom Price, has not provided clarity on whether or not he will pursue the appeal, and President Trump has not provided consumers or insurance companies clarity on whether or not he will continue CSR payments in the meantime. An analysis from the Kaiser Family Foundation estimates that insurers would have to raise premiums nearly 20 percent to compensate for the loss of CSRs.

However, according to an article in the Washington Post, a federal appeals court issued a ruling earlier this week that could help keep the CSR payments in place. The U.S. Court of Appeals for the District of Columbia Circuit ruled that a coalition of 16 state attorneys general, including New York Attorney General, Eric Schneiderman, could intervene in the pending appeal and defend the CSR payments. As the article points out, this ruling could make it more difficult for President Trump and the House of Representatives to end CSRs without a fight in court.

Yay BlogAccording to an analysis from the Georgetown University Health Policy Institute’s Center for Children and Families and the American Academy of Pediatrics, a historic high of 98 percent of children in New York have health insurance. This is thanks in large part to New York’s progressive policies on Medicaid, Child Health Plus (CHP), and the Affordable Care Act (ACA).

Medicaid and CHP together cover more than 2.8 million children in New York State and account for 38 percent of the state’s total Medicaid and CHP enrollment. This includes 84 percent of children living in or near poverty, 47 percent of infants, toddlers, and pre-schoolers, 39 percent of children with special health care needs, 51 percent of newborns, and 100 percent of children in foster care. An additional 11,000 children in New York have coverage through the New York State of Health Marketplace. Because of New York’s leadership in health care and health coverage, all children are eligible for health insurance regardless of immigration status.

Children enrolled in Medicaid and CHP do better in school, are more likely to graduate from high school, are more likely to attend college, grow up to be healthier adults, and earn higher wages. Continued investment in Medicaid and CHP and outreach to the remaining uninsured is needed to ensure that all of New York’s children and families have the opportunity to reach their full potential. This is especially important in the face of the current federal threats to these crucial sources of coverage.

You can view the full New York State fact sheet here.