1. Potera, Carol


Poorest women gain the most.


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The Affordable Care Act (ACA) gives women at every income level better access to health insurance and affordable medical care, according to a recent study. Following implementation of the ACA, the uninsured rate fell from 17% in 2013 to 11% in 2016. Before the ACA, 40% of women with incomes lower than 200% of the federal poverty level were uninsured, compared with only 5% of women with incomes at 200% of the federal poverty level or higher. With the ACA's more affordable options, the uninsured rate for these low-income women fell to 18% in 2016.

Figure. Reprinted fr... - Click to enlarge in new window Reprinted from Gunja MZ, et al. How the Affordable Care Act has helped women gain insurance and improved their ability to get health care: findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016. The Commonwealth Fund, Aug 17.

Because they had insurance coverage, more low-income women visited a physician yearly than before the ACA. Visits for preventive care screenings and inoculations also rose between 2014 and 2017, with more women receiving influenza immunizations, blood pressure and cholesterol screenings, and mammograms, especially low-income women.


Among women with the highest incomes, only 3.5% were uninsured, compared with 27.3% of low-income and 16.9% of middle-income women. About half of women in the lowest-income group were 19 to 34 years of age, according to the study, which followed 105,021 demographically diverse women representing an estimated 41 million women nationally from 2010 to 2017.


Only 46% of women who tried to buy insurance succeeded in doing so in 2010, and 60% said it was very difficult to find affordable coverage. Before the ACA, inequities in coverage deterred about a third of women from buying insurance in the individual market. These included having to pay higher premiums than men; being denied coverage for preexisting conditions, including pregnancy; and lack of coverage for maternity care and contraceptives. After the ACA, the proportion of women who reported having no usual place for care dropped from 18% to 14%.


Overall, the ACA improved coverage for women, especially low-income women. "Efforts to alter the ACA should consider the impact of policy changes on women's health and preventive care," lead author Lois Kaye Lee, associate professor of pediatrics at Boston Children's Hospital, told AJN.-Carol Potera




Lee LK, et al Am J Prev Med 2019 56 5 631-8