Challenges to accessing healthcare are not new for women; however, in the past year, several new roadblocks have hindered women’s access. These roadblocks span the gamut from the COVID-19 pandemic to policy changes that have impacted the fabric of women’s healthcare access. Also looming are significant changes to federal and state policies that threaten to roll-back the access women have gained to healthcare over the past decade as well as a pending lawsuit before the Supreme Court that could decimate access for millions of people.
Passage of the Affordable Care Act (ACA) in 2010 resulted in significant improvements to equitable access to healthcare for women. When the ACA was implemented in 2018, just 11% of women (10.8 million) were uninsured, whereas prior to ACA, 18% (~20 million women) were uninsured.[1] Not only did women gain insurance coverage rights with ACA, women were no longer charged higher premiums just for being women, pregnancy coverage denials were ended and women’s preventive health services were now included in basic coverage. Yes, you read that correctly, women in the past have been denied insurance coverage for basic care including pregnancy.[2] These positive strides under the ACA are threatened today due to recent and upcoming Supreme Court rulings.[3]
The COVID-19 pandemic also poses a major obstacle for women seeking comprehensive health care. According to the University of Southern California’s ongoing coronavirus survey, job losses, additional childcare duties and mental distress have all disproportionately affected women since the start of the pandemic.[4] Furthermore, job loss as a result of the pandemic has led to loss of health insurance for many women. For Black women and other women of color, the effects of COVID-19 have been even more damaging, further highlighting the inequities in the healthcare system.[5]
As already noted, even with the ACA in effect, 10.8 million women remain uninsured in the US. But 2020 has been rapidly rolling back the number of women able to get access to insurance and medications. On July 8, the Supreme Court ruled to uphold the Trump Administration’s regulations allowing employers and insurers to decline providing contraception coverage because of religious or moral objections. Implementation of these rules will immediately and significantly decrease contraceptive access for 70,500 to 126,400 women.[6]
In November, the Supreme Court will hear a case that has the potential to overturn the entire ACA and with it critical provisions for women’s health. This would have far reaching impacts on women’s access to care, with an estimated 68 million women with preexisting conditions and the approximately six million women who become pregnant annually excluded once again from healthcare insurance and therefore affordable access to healthcare.[7]
As of May 2020, an estimated 27 million people across the U.S. lost health insurance because of COVID-19.[8] For women, losing insurance could mean losing their ability to affordably access healthcare including well women visits, cancer screening, pregnancy care and essential reproductive healthcare services like birth control. Access to family planning is even more important during the coronavirus pandemic since pregnant women have been found to experience more severe complications from COVID-19.[9] No matter the unique situation, all women should feel confident in their ability to access healthcare, no matter their race, income, disability or health need.
We have an urgent need to address health disparities arising from race, disability and income levels. Racism is a public health issue that has been brought to the forefront by COVID-19. Due to inequitable care in the healthcare system, people of color often experience increased negative health outcomes.[10] Specifically, disparities between white women and women of color exist when it comes to birth control use, caused by barriers such as cost, structural racism, and cultural stigma.[11] This is evident in the rate of unplanned pregnancies: Black women are almost two and a half times more likely to have an unplanned pregnancy than white women, even after controlling for differences in income level.5 We need changes across our healthcare system to ensure that women of all races and socioeconomic status can access birth control.
Additionally, people with disabilities are often erased from conversations about birth control. We’ve seen that self-reported cognitive disabilities (“serious difficulty concentrating, remembering, or making decisions”), as well as physical disabilities, are significant predictors of birth control choices.[12] In fact, use of the pill is less common among people with physical disabilities. Women living with disabilities need to be visible in the conversation about reproductive health and access to birth control.
One positive trend is a rapid increase in the use of telehealth services. In April of this year, telemedicine visits accounted for 69 percent of all appointments.[13] Telehealth medicine can be particularly useful for people whose work and/or family schedules make it difficult to get to doctors’ offices and/or pharmacies during normal business hours. This form of access will continue to be important even as public transportation, daycare centers and offices fully reopened.
There are excellent resources for those seeking birth control and other reproductive healthcare services. Here at Medicines360, we developed a three-part webinar series to provide information on the birth control options, the best ways to get birth control and the policy considerations that could impact access.
- Birth Control for All: Amid COVID-19
- Birth Control for All: The 18 Methods
- Birth Control for All: Understanding Your Rights & Options
The fight for women’s healthcare access, including birth control access, will take a collective effort on all levels. To make this a reality for all, we need policy solutions that will:
- Defend gains for women’s health under the ACA, including coverage expansions and no-copay preventive services like birth control and protecting pregnancy coverage;
- Preserve and build on innovative solutions to expand access for underserved women, like increased flexibility for telehealth; and
- Invest in policies and programs designed to address the root causes of systemic inequality in our health system, especially as they relate to women of color, women with low incomes and women living with disabilities.
Women must have the right and ability to equitably obtain and afford healthcare throughout their lives. Women must have the right to choose if and when they want to get pregnant and be able to get quality care when they are pregnant.[14] Policies on women’s health – both existing and newly created – should uphold these basic human rights. We’re dedicated to supporting the fight to protect access to healthcare for all women.
[1] https://www.kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage-fact-sheet/
[2] Waxman HA, Stupak B. Coverage denials for pre-existing conditions in the individual health insurance
market [Internet].Washington (DC): US House of Representatives; 2010 https://oversight.house.gov/sites/democrats.oversight.house.gov/files/documents/Memo-Coverage-Denials-Individual-Market-2010-10-12.pdf
[3] https://www.npr.org/sections/health-shots/2020/09/21/915000375/the-future-of-the-affordable-care-act-in-a-supreme-court-without-ginsburg
[4] USC News, COVID-19 has hit women hard, especially working mothers, https://news.usc.edu/171617/covid-19-women-job-losses-childcare-mental-health-usc-study/
[5] Essence.com, ESSENCE Releases ‘Impact Of COVID-19 On Black Women’ Study, https://www.essence.com/health-and-wellness/essence-covid-19-black-women-study/
[6] Department of the Treasury, Religious Exemptions and Accommodations for Coverage of Certain
Preventive Services Under the Affordable Care Act; Final Rule, https://www.govinfo.gov/content/pkg/FR-2018-11-15/html/2018-24512.htm
[7] https://www.americanprogress.org/issues/healthcare/news/2020/06/24/486768/health-care-repeal-lawsuit-strip-coverage-23-million-americans/
[8] Garfield R, Claxton G, Damico A, & Levitt L. Eligibility for ACA Health Coverage Following Job Loss, https://www.kff.org/coronavirus-covid-19/issue-brief/eligibility-for-aca-health-coverage-following-job-loss/
[9] Ellington S, Strid P, Tong VT, et al. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–June 7, 2020. MMWR Morb Mortal Wkly Rep. 2020 Jun 26; 69(25): 769–775. doi: 10.15585/mmwr.mm6925a1
[10] https://www.americanprogress.org/issues/race/news/2020/05/04/484339/workers-color-disproportionately-risk-serious-complications-coronavirus/; Gee GC, Ford CL. Structural Racism and Health Inequities: Old Issues, New Directions. Du Bois Rev. 2011;8(1):115-132. doi:10.1017/S1742058X11000130
[11] Gunderson A, Reducing Racial Disparities in the US by Increasing Contraception Coverage. Chicago Policy Review (Online). 2017. https://search.proquest.com/docview/1977984017?fromopenview=true&pq-origsite=gscholar
[12] Mosher W, Hughes RB, Bloom T, Horton L, Mojtabai R, Alhusen JL. Contraceptive use by disability status: new national estimates from the National Survey of Family Growth. Contraception. 2018;97(6):552-558. doi:10.1016/j.contraception.2018.03.031
[13] Ross C. Telehealth grew wildly popular amid Covid-19. Now visits are plunging, forcing providers to recalibrate. STAT. 2020. https://www.statnews.com/2020/09/01/telehealth-visits-decline-covid19-hospitals/
[14] https://www.cdc.gov/nchs/maternal-mortality/index.htm
