Patient Coverage Protections

Our Position

ACOG is a strong supporter of the landmark women’s health gains made in the Affordable Care Act. Any attempt to reform our nation’s health care system must build upon these advances and not compromise or reduce critical health insurance guarantees and protections.

ACOG advocates for coverage of essential health benefits, including maternity coverage, in all plans. In addition, it is critical to ensure continued coverage of women’s preventive services with no cost-sharing, including the full range of FDA-approved contraceptives, regardless of employer.

ACOG engages with the Center for Medicare and Medicaid Innovation (CMMI) to ensure that proposed health care models include comprehensive coverage for patients and fair payment for physicians. 

The continued prohibition of pre-existing condition exclusions, gender rating, and annual and lifetime benefit caps in all plans are essential to ensure women have access to meaningful health coverage.

The Affordable Care Act is a Women’s Health Success Story

ACOG is a strong supporter of the Patient Protection and Affordable Care Act (ACA), which led to crucial women’s health gains. Ten years after its enactment, the landmark health reform law is in serious jeopardy. ACOG remains committed to preserving, as well as building upon, the critical and now ubiquitous patient protections enshrined in the ACA. The health reform law’s impact on our nation’s women and families cannot be understated. Significant women’s health gains include: 

Unprecedented coverage advances in both private insurance and Medicaid.

• The uninsurance rate for women of reproductive age fell from 20 percent (12.5 million women) in 2013 to 12 percent (7.7 million) in 2018. ¹
• The uninsurance rate for new mothers fell from 20.2 percent in 2011 to 11.3 percent in 2015 and remained relatively stable until 2018. ²

Expanded access to family planning, including long-acting reversible contraceptives (LARCs).

• Prior to the ACA, spending on family planning services and supplies made up to 30-44 percent of women’s total out-of-pocket health care costs. ³
• In 2014, after implementation of the ACA’s contraceptive coverage requirement, the median out-of-pocket cost for all types of prescription contraception decreased to $0, with 91.5 percent of intrauterine device (IUD) recipients and 87.1 percent of implant recipients paying $0 out of pocket. ⁴

Expanded access to maternity care.

• Prior to the ACA, over 60 percent of private health plans sold directly to women did not include coverage of maternity services.⁵
• More than 13 million women have gained coverage for maternity care under the ACA.

Contributions to reductions in maternal mortality.

• Medicaid expansion was significantly associated with 7.01 fewer total maternal deaths per 100,000 live births relative to non-expansion states. ⁶
• When stratifying by race/ethnicity, Medicaid expansion was significantly associated with 16.27 fewer maternal deaths among non-Hispanic Black women relative to their counterparts in nonexpansion states.⁷
• Effects are additionally significant among Hispanic mothers, with Medicaid expansion associated with 6.01 fewer deaths per 100,000 live births relative to Hispanic women in non-expansion states. ⁸

Reduced coverage gaps, or churning on, off, and between health insurance around the time of pregnancy.

• Across three time points (prepregnancy, delivery, and postpartum), Medicaid expansion resulted in a 10.1-percentage-point decrease in churning between insurance and uninsurance. ⁹  

Prohibition on discrimination in health care.

• Prior to the passage of the ACA, LGBTQ+ people faced extreme barriers when accessing health care, including higher patient cost-sharing and discriminatory benefit design.¹⁰
• Under the ACA, it is illegal for most health care professionals and organizations to discriminate against patients for identifying as LGBTQ+.

Decreased racial and ethnic health disparities in health insurance coverage.

• Nationally, the unadjusted Black-White disparity in uninsurance fell by 4.4 percentage points between 2013 and 2017 (a 45 percent change relative to 2013), while the adjusted gap fell by 3.8 percentage points. ¹¹
• Between 2013 and 2017, the uninsurance rate for White individuals fell by 6.9 percentage points in expansion states and by 4.8 points in nonexpansion states. Similarly, the uninsurance rate for Black individuals fell by 12.0 percentage points in expansion states and by 9.0 points in nonexpansion states.

¹ Guttmacher Institute. U.S. Insurance Coverage, 2018: The Affordable Care Act Is Still Under Threat and Still Vital for Reproductive-Age Women. January 2020. Available at: https://www.guttmacher.org/article/2020/01/usinsurance-coverage-2018-affordable-care-act-still-under-threat-and-still-vital#

² Urban Institute. Changes in New Mothers’ Health Care Access and Affordability under the Affordable Care Act. October 2020. Available at: https://www.urban.org/sites/default/files/publication/102984/changes-in-newmothers-health-care-access-and-affordability-under-aca.pdf

³ Becker NV, Polsky D. Women Saw Large Decrease In Out-Of-Pocket Spending For Contraceptives After ACA Mandate Removed Cost Sharing. Health Affairs 2015; 34)7). DOI: https://doi.org/10.1377/hlthaff.2015.0127

⁴ Snyder AH, Weisman CS, Liu G, Leslie D, Chuang CH. The Impact of the Affordable Care Act on Contraceptive Use and Costs among Privately Insured Women. Women’s Health Issues 2018; 28(3): 219-223. DOI: https://doi.org/10.1016/j.whi.2018.01.005

⁵ The Century Foundation. Millions Could Lose Health Benefits If Congress Repeals and States Replace the ACA. April 2017. Available at: https://tcf.org/content/commentary/millions-lose-health-benefits-congress-repealsstates-replace-aca/?agreed=1

⁶ Eliason EL. Adoption of Medicaid Expansion is Associated with Lower Maternal Mortality. Women’s Health Issues 2020; 30(3):147-152. DOI: https://doi.org/10.1016/j.whi.2020.01.005

⁷ Ibid.

⁸ Ibid.

⁹ Daw JR, Winkelman TNA, Dalton VK, Kozhimannil KB, Admon LK. Medicaid Expansion Improved Perinatal Insurance Continuity For Low-Income Women. Health Affairs 2020; 39(9). DOI: https://doi.org/10.1377/hlthaff.2019.01835

¹⁰ Kaiser Family Foundation. The Affordable Care Act and Insurance Coverage Changes by Sexual Orientation. January 2018. Available at: https://www.kff.org/disparities-policy/issue-brief/the-affordable-care-act-andinsurance-coverage-changes-by-sexual-orientation/

¹¹ Buchmueller TC, Levy HG. The ACA’s Impact On Racial And Ethnic Disparities In Health Insurance Coverage And Access To Care. Health Affairs 2020; 39(3). DOI: https://doi.org/10.1377/hlthaff.2019.01394