Womens Health Insurance Coverage, 1999

1
Womens Health Insurance Coverage, 1999
Total Women 84 million (ages 19 to 64)
SOURCE Kaiser Family Foundation estimates,
based on Urban Institute analysis of the March
2000 Current Population Survey.
2
Importance of Ob/Gyn Services for Women

• U.S. Preventive Services Task Force recommends
  that women receive routine cervical and breast
  cancer screening, pelvic exams, as well as
  counseling for STDs
• Access to ob/gyns increases likelihood women will
  receive preventive reproductive health services
• Women who see ob/gyns more likely to receive
  recommended preventive gyn services, such as
  pelvic exams and pap tests, than women who see
  other doctors
• Ob/gyns often provide more extensive counseling
  about family planning, STDs, and HIV/AIDS

3
Key Features of Ob/Gyn Access Laws

• Some eliminate referral requirement from primary
  care provider (known as direct access)
• Some allow women to designate ob/gyns as primary
  care provider
• Additional protections include
• ensuring that the number of annual visits is not
  limited
• requiring that women receive notification of
  their options
• restricting surcharges or added co-pays for
  ob/gyn visits

4
Ob/Gyn Access Laws, 2000
ME
WA
ND
MT
MA
MN
OR
NY
WI
ID
SD
MI
PA
OH
NE
IN
MD
IL
NV
WV
UT
VA
CO
MO
CA
NC
SC
OK
NM
AZ
GA
AL
MS
LA
TX
FL
Direct Access to Ob/Gyn and Ob/Gyn as Primary
Care Provider (13 states DC)
Direct Access to Ob/Gyn Only (25 states)
Ob/Gyn as Primary Care Provider Only (3 States)
SOURCE Compiled from state statutes, NCSL Health
Policy Tracking Service, 2000 and American
College of Obstetricians and Gynecologists, 1999.
5
Health Plan Coverage of Contraceptives, 2000
Percent of covered workers in plans that provide
Note Percent excludes firms reporting they did
not know whether plan covered benefit. SOURCE
Kaiser Family Foundation, HRET Survey of Employer
Sponsored Health Benefits, 2000.
6
Key Elements of Contraceptive Coverage Legislation

• Guarantees insurance coverage of all FDA-approved
  contraceptive drugs and devices
• Some states have more limited provisions
• Requirements that only apply to the small group
  and individual markets
• Limitations on types of contraceptives covered
• Conscience clauses have been a major issue
• Exemption of employers or insurers whose
  religious beliefs conflict with the use of birth
  control

7
States with Contraceptive Coverage Laws, 2000
VT
ME
WA
MT
OR
RI
CT
MI
WY
NV
UT
WV
CO
CA
KY
NC
GA
TX
FL
AK
HI
Comprehensive contraceptive coverage law (13
States)
Limited contraceptive coverage law (9 States)
SOURCE Compiled from NCSL Health Policy Tracking
Service, 2000 and National Womens Law Center et.
al, 2000.
8
Womens Health Insurance Trends, 1987-1998
Employment / own name
Percent of women 18-64
40.1
37.2
Employment / dependent
32.4
26.4
Uninsured
18.5
13.9
8.3
7.6
Medicaid
SOURCE Employment Benefit Research Institute
Issue Briefs 1997-2000, based on Current
Population Survey.
9
Womens Access to Care and Use of Health Care
Services, 1998
Note Of women 18-64 years of age. SOURCE
Commonwealth 1998 Survey of Womens Health.
10
Medicaids Role for Women

• Covers over 12 million low-income women
• Eligibility limited to
• pregnant women, mothers, seniors, or disabled
• Provides coverage for a wide range of services
• Physician and hospital care, prenatal care,
  mammograms, pap smears, family planning, STD
  testing and treatment, prescription drugs and
  long-term care
• Improves access to physicians and preventive care
• Pays for over one-third of all U.S. births
• Women on Medicaid more likely to get regular
  care, mammograms, pap tests than uninsured women
  and as likely as privately insured low-income
  women

11
Medicaid Family PlanningExpansions for Women

• Extends Medicaid coverage for family planning to
  low-income women ineligible for full Medicaid
  assistance
• 1115 waiver used to make this expansion
• Family planning covered at a 90 federal match
• States have extended coverage to women who
• lose Medicaid coverage at the end of the
  postpartum period
• lose Medicaid for any reason or
• are low-income

12
States with Medicaid Waivers to Extend Coverage
of Family Planning Services, 2000
OR
NY
IL
SC
AZ
AR
NM
AL
AL
MS
LA
FL
Women losing Medicaid for any reason (1 State)
Women on basis of income (5 States)
Women losing Medicaid after post-partum (6 States)
Note AL currently operates an expanded family
planning program in Mobile County. SOURCE
Schwalberg et al., 2000.
Writing or have submitted a waiver proposal to
HCFA
(6 States)
13
Expanding Full Medicaid Coverage to Low-Income
Women

• Section 1115 Research and Demonstration waivers
• Allow states to waive certain Medicaid rules
• States have used approach to extend coverage to
  categorically ineligible populations and other
  low-income groups
• Section 1931
• A new eligibility category created when Medicaid
  and cash assistance were de-linked
• States can extend coverage to categorically
  eligible adults and are no longer restricted to
  cash assistance income thresholds

14
State Medicaid Expansions to Parents
SOURCE Center on Budget and Policy Priorities,
2000.
15
Uninsured Women, by Poverty Level and Family
Structure, 1999
Total Uninsured Women 14.9 Million (ages 19 to
64)
SOURCE Kaiser Family Foundation estimates,
based on Urban Institute analysis of the March
2000 Current Population Survey.
16
Health Policy Priorities for Women
Percent responding it is very important for
elected officials to address
Helping uninsured people to get health coverage
Requiring plans to allow women to see ob/gyns
without referrals
Funding family planning for low-income women
Requiring insurance plans to pay for birth control
SOURCE Kaiser Family Foundation/SELF Magazine.
A National Survey on Women's Health Policy
Priorities and Election 2000, 2000.
17
Issues and Challenges

• State reforms have resulted in important
  expansions in access to and coverage of ob/gyn
  and contraceptive services for women
• Employers and insurers have not always been able
  to fill gaps
• Federal action on these issues has stalled
• However, state reforms have limitations
• Considerable variation in policies from state to
  state
• ERISA limits the reach of state legislation
• Major challenge assuring that women have
  meaningful coverage that meets their health care
  needs