Federal Policy Agenda for Women's Health

 

The federal government can play a major role in improving the health of women throughout the nation.  Through national programs and assistance to the states, the federal government can establish health care policies, fund health and related services to individuals, and fund and conduct public education and outreach campaigns.  Yet for decades, the federal government had taken only limited, incremental steps toward solving problems with our health care system.  

This inaction has had a major adverse impact on women’s health and well-being.  Seven out of 10 women are either uninsured or underinsured, report medical bill or debt problems, or experience cost-related problems accessing the care they need.  The steady growth in health care costs has had a disproportionate impact on women, who have, on average, lower incomes than men and use the health care system more, in part due to their reproductive health needs.  In many instances, discriminatory insurance practices—charging women more for health insurance, failing to cover maternity care or other basic health services—have caused or exacerbated the challenges women face.

The federal government has now taken a major step toward meeting women’s health needs. This year, President Obama signed the Patient Protection and Affordable Care Act into law.  The Affordable Care Act reforms our nation’s health care system, and, when fully implemented, though hardly perfect it holds the promise of dramatically improving the health of women throughout their lives.  

The Affordable Care Act aims to provide all Americans with quality, affordable, comprehensive health insurance.  It includes reforms to ensure that insurance companies will not exclude coverage of individuals or the conditions for which they need care; financial assistance to help individuals with limited income obtain affordable coverage; requirements that a broad range of health care services are covered; new mechanisms to make it easier for uninsured individuals and small employers to shop for, compare, and choose the best insurance to meet their needs in new “Exchanges;” and a significant expansion of Medicaid, the public health insurance program for low-income people.  The law also includes “shared responsibility” requirements, in which both individuals and employers have new obligations to help ensure that all Americans have affordable health insurance.  

The Affordable Care Act makes major improvements in other areas, as well.  The law seeks to address health disparities and discrimination, including by prohibiting most insurance companies, health care providers, and health programs from discriminating on the basis of sex.  The law promotes prevention and wellness, including by requiring new insurance plans to cover preventive health services at no cost and charging a new National Prevention, Health Promotion, and Public Health Council with developing a prevention and health promotion strategy for the country.  And the law takes steps to improve health care quality and access by increasing the number of health care providers and building incentives into the system for providing high quality care.

Though the law makes major improvements in many areas for women’s health, the Affordable Care Act treats abortion care, a key component of reproductive health care for women, differently than all other health care services. The law places new restrictions on some private insurance coverage of abortion, forcing some individuals and health care plans to follow certain administrative requirements if they want to offer or purchase insurance coverage that includes abortion.

The passage of the Affordable Care Act is a major accomplishment, but the work is not over.  Now, the federal government must implement, enforce, and in some cases improve and expand the law so the promise of the Affordable Care Act becomes a reality.  The following recommended federal policies would promote women’s health and well-being:

Women’s Access to Health Care Services

To ensure access to affordable health insurance and comprehensive health care services, the federal government should:

  • Implement and enhance the Affordable Care Act to achieve a health care system that provides comprehensive and affordable coverage for all.
  • Implement and enforce new protections against discrimination on the basis of sex in health care by entities receiving federal funds.
  • Implement and expand the Affordable Care Act to ensure that insurance plans cover the full range of health care services women need, including reproductive health care.
  • Expand access to coverage for all immigrant women and their families, some of whom are currently left out of the Affordable Care Act’s insurance expansions.
  • Continue to improve the affordability of private health insurance by increasing subsidies to help purchase health insurance.
  • Enforce fair insurance industry practices, including requirements that women are not charged more for their health insurance than men.
  • Protect and strengthen the federal Medicaid program so that low-income women have coverage for the full range of services they need.
  • Protect and strengthen Medicare to ensure that it remains available and affordable to older and disabled women and covers the full range of services women need.
  • Invest in outreach, public education, and the development of culturally appropriate materials, to ensure that all women eligible for Medicaid, Medicare, the newly created Exchanges, or other federal programs are informed of their choices and participate in these programs.
  • Continue to support and expand best practices to improve the quality, safety, and efficiency of the health care delivery system.
  • Ensure that the health care workforce and infrastructure is equipped to serve all Americans, including those newly insured as a result of the Affordable Care Act.
  • Remove barriers to quality health care faced by lesbians by identifying and supporting policies and programs that address their needs, including research into lesbian health and strengthening and enforcing anti-discrimination laws.
  • Fully fund and expand provisions of the Affordable Care Act aimed at removing barriers to quality health care faced by women of color and of different ethnic backgrounds, including language barriers. 
  • Require that employers provide or otherwise ensure adequate, flexible, and paid family and medical leave benefits so that employees can take time off to take care of their own health needs or those of family members.
  • Implement and enforce Affordable Care Act provisions that ensure women with disabilities have access to the services they need in the setting they prefer, including support for home- and community-based care and new standards for fully-accessible medical equipment.
  • Expand on improvements to long-term care that began with the Affordable Care Act by providing more financial assistance, expanding voluntary insurance to non-workers, and continuing to ensure quality long-term care by further developing and enforcing appropriate standards.

Addressing Wellness and Prevention

To help promote good health and prevent disease among women, the federal government should:

  • Ensure that preventive services of particular importance to women’s health, including  mammograms, Pap smears, family planning, and screenings for osteoporosis, sexually transmitted diseases, and domestic violence are provided without cost sharing in health plans, and enforce these new coverage requirements.
  • Develop a national strategy on prevention that addresses women’s needs and key health risks.
  • Target investments in public health and wellness at programs and organizations that serve women and focus on addressing women’s health needs.
  • Increase investment in programs that support physical activity, assist women in getting nutritious food, and educate women about nutrition.
  • Investigate gender-based barriers to girls’ and women’s participation in physical activities and enforce applicable civil rights laws when violations are found.
  • Expand federal efforts that support and encourage women not to smoke and enforce current tobacco regulations.
  • Ensure that all women are able to access treatment for substance abuse by enforcing and expanding current laws that require coverage, providing child care in federally-supported programs, and addressing substance abuse by women who are victims of violence or in prison.
  • Eliminate federal funding for abstinence-only programs that promote gender stereotypes and fail to provide information about contraceptives.  

Key Conditions, Diseases and Causes of Death for Women

To help address specific health conditions, diseases and causes of death faced by women, the federal government should:

  • Increase funding for women's health research, including research on cardiovascular disease, stroke, lung cancer, breast cancer, diabetes, HIV/AIDS, arthritis, violence against women, sexually transmitted diseases, depression and eating disorders. 
  • Ensure that government-supported health care programs are collecting data on patients’ race, ethnicity, sex, and primary language as required by the Affordable Care Act, expand the bases on which data is collected, and set standards to make sure the data is provided to the public in an easily accessible format that allows comparisons across these dimensions. Read more about the importance of data collection to address health disparities among women.
  • Increase funding for programs to prevent and treat the diseases, causes of death and conditions that constitute key health risks for women. 
  • Increase investments in mental health services that are community-based and coordinated with primary care services.
  • Expand and invest in federal programs that provide family planning; require all FDA-approved contraceptive drugs and devices to be covered as a preventive health services without cost sharing; make infertility treatments more affordable; and, increase funding for comprehensive prenatal and post-partum care.
  • Protect and expand women=s access to abortion services by removing restrictions on coverage of and payment for abortion in health plans, including in federally-funded health plans, eliminating restrictions on abortion services provided at federal facilities, and enacting legislation to codify the principles of Roe v. Wade.
  • Invest in surveillance and research on effective strategies to combat domestic violence and sexual assault, and support programs that address the health, financial and other needs of victims of these violent crimes.

Living in a Healthy Community

To ensure that all communities promote women’s health and well-being, the federal government should: 

  • Require that adequate funds are raised in a fair and equitable manner through the federal tax system to address the health needs of women.
  • Expand programs that provide financial assistance to low-income women and their families, and help the working poor and other low-income women attain economic security. 
  • Enact new prohibitions against discrimination on the basis of sexual orientation and domestic violence and actively enforce the anti-discrimination laws already in place.  
  • Expand gun violence prevention efforts, including regulating the design, manufacture, distribution and sale of firearms and ammunition, and requiring standardized licensing and registration systems.  
  • Require better monitoring of diseases that may be caused by environmental factors, fund more research to address the relationship between the environment and disease (e.g., cancer and reproductive problems in men and women), and more strictly regulate those toxins and other substances that are related to health problems.
  • Actively enforce current federal requirements protecting health in the workplace and ensure that occupational health rules adequately protect women.
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