The Affordable Care Act (ACA), which the Supreme Court upheld in June, has particular benefits for women, especially those who have bleeding disorders or who have children with bleeding disorders. Because most Americans are required to have health insurance starting in 2014, people with bleeding disorders will have more options for coverage than what is currently available, says Ruthlyn Noel, MPA, the National Hemophilia Foundation’s (NHF) senior manager of public policy.
Women-specific Benefits
Under the ACA, women gain access to preventive services without cost sharing—no coinsurance, deductibles or copayments required. As of August 1, 2012, health insurers must cover eight basic preventive health services: HIV screening and counseling; contraception and contraceptive counseling; gestational diabetes screening; sexually transmitted infections counseling; human papillomavirus DNA testing; breast-feeding support, supplies and counseling; interpersonal and domestic violence screening and counseling; and visits for annual checkups and screenings for cervical and breast cancer.
While these services may not relate directly to bleeding disorders, Noel notes that they are important to all women, especially for those with lower incomes. “Women are the caretakers in the home. They’re seeing after the kids; they’re looking after mom and dad,” she explains. “Lowered costs for preventive care mean that women don’t have to worry as much about paying for health visits and may even take more steps to protect their own health.”
Expanded Benefits for Children, Young Adults
The ACA also makes it much easier for children and young adults with bleeding disorders to get insurance. This step eases the worries of mothers concerned about how their children will afford necessary medical care as they get older. It ensures that those under 19 can’t be denied insurance based on pre-existing conditions and that young adults can remain on their parents’ health plans until age 26.
Before the ACA, young adults were the age group least likely to have health insurance, according to the US Department of Health and Human Services (HHS). Further, they were more than twice as likely as older adults to lose private insurance coverage once they had it. And while a year or two without insurance may not be the end of the world for a child without a medical condition, a lack of insurance for a young adult with a bleeding disorder can be catastrophic, says Wendy Chou, vice president of the New York City Hemophilia Chapter. Noel has heard countless stories of young adults with hemophilia and von Willebrand disease without insurance ending up in emergency rooms for routine medical care that could have been managed at home.
But those scenarios are changing. According to a June report from HHS, about three million young adults, including many with bleeding disorders, now have insurance because of the healthcare law. Starting in 2014, even more will gain coverage when affordable insurance exchanges, tax credits and the Medicaid expansion go into effect.
No more lifetime limits
Medications and visits to specialists can be expensive. But two safeguards of the act will directly benefit families with bleeding disorders: Health plans are prohibited from putting lifetime dollar limits on essential health benefits, and most annual limits will be outlawed in 2014, according to HHS. (Benefits categorized as “essential” include preventive care, emergency services, maternity care, hospitalization and prescription drugs.)
“Many of our families have struggled over the years to maintain insurance after a child has hit the lifetime cap, and the plan has stopped paying,” says Noel. “The elimination of lifetime caps is one less burden on these families who are already dealing with so much.”