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June 20, 2012
A provision in the 2010 health care law requiring contraceptive coverage for women without copays has gotten most of the press.
But much more is at stake for women if the Supreme Court overturns the health care law. Starting in 2014, the law bars insurance practices such as charging women higher premiums than men, or denying coverage for pre-existing conditions that could include pregnancy, a Caesarean-section birth or a sexual or a domestic violence assault.
Even excluding maternity coverage, the National Women's Law Center found that nearly one-third of the most commonly sold insurance plans charged women aged 25 to 40 at least 30 percent more than men for the same coverage (PDF).
"Invariably, non-smoking women are charged more than men who smoke," said Judy Waxman, vice president for health and reproductive rights with the women’s law center.
While about 14 states have already barred insurers from charging women more, such restrictions will be universal in 2014 if the law stands.
On the flip side, women older than 55 are sometimes charged less than men the same age, Waxman said, a difference that will also even out in 2014.
Opponents of the law, including Grace-Marie Turner of the conservative Galen Institute, say the law’s restrictions on charging women more than men distort the insurance market in ways that can affect everyone. Raising costs for some men could result in fewer people overall purchasing coverage, driving up costs for everyone, including women, she says.
Other provisions, including providing contraceptives without a copayment, will also drive up costs, she says, and the rule also affects women business owners.
"Telling Catholic women business owners that they have to cover contraception and sterilization doesn’t give them more choice, it gives them fewer choices and it takes away their religious freedom," Turner says.
In addition, an expected 10 million more women are expected to gain coverage in 2014 as a result of expanded Medicaid coverage to people earning up to 133 percent of the federal poverty level, which is about $14,850, according to an estimate from the National Women's Law Center.
Women are also affected by provisions that require insurance policies sold through state-based exchanges to include maternity coverage, starting in 2014 and that mandate no copays for preventive services such as mammograms to screen for breast cancer.
Those provisions, along with pilot projects aimed at slowing health care costs by changing the way doctors and hospitals are paid, make the law "the most important advance for women’s health in decades," said Kirsten Sloan, vice president of the National Partnership for Women and Families.
She said the law "makes it easier for women and families to buy insurance, keep insurance and afford that insurance."
The court could reject all of the law, uphold it, or just toss parts. If it invalidates the requirement that nearly all Americans carry insurance, the key issue in the Supreme Court case, the Obama administration and opponents have asked the court to cancel related provisions that require insurers to offer coverage to all who apply and to not vary premiums based on gender or health.
If court throws out those provisions, "then we’re back to a situation where not everyone can get coverage, and insurers can charge whatever they want in the individual market, as they do now," Waxman said.
Anticipating the Supreme Court's ruling
→ Supreme Court to rule Thursday on health care reform
→ New consumer protections depend on high court's ruling
→ Court challenge could result in Medicaid cutbacks instead of expansion
→ GOP promises smaller-scale health care agenda if court strikes down law
→ Some health system changes will stay, no matter how Supreme Court rules
→ Obama administration finds 3.1M young adults gained coverage under law
→ What's at stake for Medicare beneficiaries in health reform ruling
→ What's at stake for women if health law overturned
→ Washburn law professor holding to prediction that health reform law will be upheld
→ Even without the individual mandate, health law would still affect millions
The Great Health Reform Debate: Kansas experts weigh in
"The system we have in this country is a failure because people do not have equal access to care," said retired Stormont-Vail HealthCare CEO Maynard Oliverius. He is one of six Kansas experts who weigh in on the health reform debate ahead of the Supreme Court's ruling on the law.
→ Watch the six video shorts here.
Oral arguments before the Supreme Court
Day 1 — Anti-Injunction Act
→ Guide to what happened at the Supreme Court
Day 2 — Individual Mandate
→ Kansas AG Schmidt encouraged by justices' skepticism of health reform law
→ Justices grill Obama administration on health law
→ National media round-up
Day 3 — Medicaid Expansion and Severability
→ Vigorous severability, Medicaid questions
Preview to the Supreme Court oral arguments
→ Schmidt’s pledge to join ACA challenge bolstered candidacy
→ Full interview: Derek Schmidt on the legal challenge of the health reform law
→ The Health Law and the Supreme Court: A primer for the upcoming oral arguments
→ Video explainer: The health care reform challenge before the Supreme Court
→ Kansas rejects $31.5 million for insurance exchange
→ More archived stories and in-depth information on the Affordable Care Act
The KHI News Service is an editorially independent initiative of the Kansas Health Institute and is committed to timely, objective and in-depth coverage of health issues and the policy making environment. Find more about the News Service at khi.org/newsservice or contact us at (785) 783-2529.