Women’s Health Policy Indicators
States continue to make some progress in adopting policies to advance women’s health. As in the 2007 Report Card, for 2010 the policy most consistently improved among the states is the provision of Medicaid coverage for smoking cessation—15 states have made progress in this area. Fourteen states have raised their excise tax on cigarettes—a well-characterized measure to reduce smoking rates—bringing to 23 the number of states with a tax of $1.50 or more per pack. (See Chart 1 for policies most widely improved.) The most widely improved policies target smoking, which is one of the most widely improved health status indicators. In fact, in the 2010 Report Card, more than three-quarters of states (42) experienced reductions in the percentage of women who smoke.
While the health policy improvements are positive, it is notable that progress has slowed—and in some cases stagnated—at a time when states still have a long way to go. States achieved an average of just three health policy improvements since the last Report Card was published; the District of Columbia and Maryland made the most progress, with each improving on nine policies overall. Of the 68 policies that were assessed for the 2010 Report Card, only two policy goals are met by all the states: Medicaid coverage for breast and cervical cancer treatment, and participation in the Food Stamp Nutrition and Education Program. Only 17 policy goals are met by a majority of states, including supplementing the Social Security Income (SSI) grant (46 states), external review in managed care plans (46 states), and requiring private insurance plans to include diabetes supplies and education as part of general coverage (43 states). Nine states meet a majority of the policy indicator goals (35 or more indicators each), with California (44), New Jersey (43), Massachusetts (40), and New York (39) meeting the most indicators. The average number of policy indicators met across all states is 25.
Unfortunately, the progress states have made is diminished by the weakening of other key policies. Seven states sustained a net loss of one to three policies (net loss being defined as the total weakened policies minus total improved)—fewer states than in 2007. On average, states diminished just one policy, though Colorado and Maine had the largest declines, with each state weakening four health policies since the Report Card was last published. While the specific targeted policies varied among the states, 15 additional states failed to establish a minimum wage that allows a family of three to reach the federal poverty threshold (Chart 1). Notably, policy assessments for this indicator are based on the current federal minimum wage, which has increased from 2007—as a result states whose minimum wages have remained constant since 2007 may receive a lower policy rating not because they have actually reduced their minimum wage but because they do not keep pace with the new federal minimum.
In addition to the net declines displayed in Chart 1, it is important to note that nearly a quarter of the policy indicators (16) were met by only five states or fewer. No state met the policy indicator of passing “clinic access” legislation to protect women and health care providers from violence and harassment at reproductive health centers. The four states that meet the fewest policy indicators are Mississippi (10), Idaho (11), South Dakota (11) and Alabama (12).
Overall, the policy indicator findings show more improvement than deterioration; on average, states improved three policies and weakened only one policy. Yet progress has been plodding and inconsistent. The policy landscape, however, is shifting. The federal health care law enacted in March 2010 (the Patient Protection and Affordable Care Act or ACA) requires states to make improvements in many of the areas addressed in the Report Card policy indicators, and many of the policy goals examined in the Report Card will be realized as the ACA is implemented. For example, four Medicaid eligibility and enrollment policy goals will be accomplished when new Medicaid eligibility rules take effect in 2014. Several of the Report Card’s policy goals for private insurance coverage of preventive services (such as Pap smears, mammograms, and osteoporosis screenings) were achieved when a provision of the law which requires all new health plans to cover recommended preventive care with no cost-sharing took effect on September 23, 2010. Details of the ACA and its implications for specific Report Card policy indicators are described in a special supplement to the 2010 Report Card, “The Past and Future in Women’s Health: A Ten-Year Review and the Promise of the Affordable Care Act and Other Federal Initiatives.”