6. INSURANCE REFORMS
The ACA banned many of the long-standing discriminatory practices in the individual insurance market that translated into higher cost burdens for women. While the AHCA maintains the gender-rating ban and the dependent coverage expansion, it could allow states to permit insurers to charge higher premiums to individuals with health problems if they have a lapse in coverage.
DEPENDENT COVERAGE
A popular element of the ACA is the provision that requires private health insurers that offer dependent coverage to children to allow young adults up to age 26 to remain on their parents’ insurance plans. This provision was the first in the ACA to take effect, and it increased the availability of insurance to an age group that historically had a high uninsured rate (Table 1). In 2015, 39% of women ages 19 to 25 reported that they were covered as a dependent.11
Table 1: The ACA Made Many Insurance Reforms Affecting Women | ||
Before the ACA | ACA Provision | AHCA Provision |
Many employer plans did not offer coverage for adult dependent children.
|
Requires plans to extend dependent coverage up to age 26 | AHCA does not change |
Many individual plans used gender rating to charge higher premiums to women for same coverage as men
|
Bans gender rating | AHCA does not change |
Insurers could charge more or exclude those with pre-existing conditions including:
|
Bans pre-existing condition exclusions | Retains pre-existing condition ban, but would charge those with coverage gaps 30% higher premiums for 1 year upon resuming coverage or state could request a waiver to permit insurers to charge higher rates to those with pre-existing medical conditions for 1 year. |
GENDER RATING
Prior to the ACA, non-group insurers in many states charged women who purchase individual insurance more than men for the same coverage, a practice called gender rating.12 Yet, plans sold on the individual market often did not cover many important services for women, such as maternity care, mental health services, and prescription drugs.13 An estimated 6.5 million women purchased coverage on the individual insurance market in 2011, and many of these women paid higher rates than men. Prior to the ACA, most of the women in this market were of reproductive age, working, and had incomes below 250% FPL.14 The ACA bans gender rating and the AHCA would not change this.
PRE-EXISTING CONDITIONS
One of the most popular provisions of the ACA has been the ban on pre-existing condition exclusions. In the years before the ACA was passed, insurance companies often denied or would not renew coverage to individuals with a “preexisting condition,” which included several conditions common among women such as pregnancy, breast cancer, or a prior C-section. The AHCA would not re-instate this practice, but individuals who do not maintain continuous coverage would be charged a penalty when they try to obtain health insurance after having a coverage gap. The penalty could be in the form of higher premium rates (30%) for one year. Alternatively, states could obtain a waiver to allow insurers to again engage in medical underwriting for one year, charging people with health problems higher rates. This would have the effect of raising premiums for people with pre-existing conditions such as pregnancy, prior C-section, or clinical depression.
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