Health-care reform and women


    The Affordable Care Act, which was signed into law in March 2010 and is being rolled out in phases through 2015, has already begun to change the way our health-care system functions. Much has been written and debated about the politics of the legislation, but for those of us who work as providers — particularly in the community-health setting — there can be no doubt that the Affordable Care Act represents a major step forward for women’s health in the U.S. The ACA reforms are particularly welcome for lesbian, bisexual and transgender-identified women, who face many health disparities — such as difficulty accessing insurance, denial of coverage for preexisting conditions, lack of knowledgeable providers to name a few.

    Effective this month an estimated 47-million women have access to eight new prevention-related health care services, free of charge. These services include annual check-ups (or “well woman” visits), pap smears, mammograms, any FDA-approved form of birth control, domestic-violence screening and counseling, counseling and support for breastfeeding and screening for diseases such as gestational diabetes, HPV and HIV. The new law requires any health plans starting after Aug. 1, 2012, to cover these services without charging women deductibles or co-pays. We know this is important because according to a June 2012 Kaiser opinion poll, more than 60 percent of U.S. women reported they had delayed or avoided accessing health care in the past year because of costs.

    For lesbian and bisexual women, who might be at a greater risk for breast cancer, having access to mammograms is a critical component of preventive care. In addition, several studies have reported higher incidence of obesity, tobacco use and alcohol use by lesbian or bisexual women. These factors may increase the risk of type 2 diabetes, lung cancer and cardiovascular disease, respectively. Higher rates of heart attack have also been reported in lesbians. Given these increased risks, it is especially important for lesbian and bisexual women to stay on top of preventive health care, with routine office visits that include counseling for weight control and smoking cessation, as needed, as well as screening for cardiac risk factors, for diabetes and lipid status as appropriate for the patient’s age and medical history.

    As additional elements of the Affordable Care Act are rolled out in the months to come, there is even more to be glad about. In the past women seeking to purchase health insurance would nearly always pay more than a man (in some cases, as much as 80-percent more, according to a March 2012 article in The New York Times). Starting in 2014, the practice known as “gender rating” will be prohibited by the ACA, so women will no longer have to pay more than men to receive the same insurance coverage.

    Transgender-identified women (and men) often have difficulty accessing preventive-health screenings, since insurance companies typically limit their coverage to health issues linked to their gender at birth. With the arrival of Health Benefit Exchanges in 2014, whereby individuals and families can compare and purchase health-care plans at an affordable price — and where discrimination on the basis of sexual orientation or gender identity will be forbidden — transgender individuals should benefit greatly.

    In 2010, there were approximately 19-million American women (one in five, ages 19-64) who were uninsured, according to the National Partnership for Women and Families. Many LGBT individuals have lacked access to insurance coverage because their employers didn’t offer it or their partners’ employers did not extend coverage to same-sex relationships. By 2014, the new regulations will provide coverage for nearly all of these folks by expanding Medicaid eligibility, making private plans more affordable and eliminating discriminatory practices that have long kept women and small businesses out of the private market.

    Pre-existing conditions have long presented barriers for women on any number of health issues, from breast cancer to pregnancy, as well as treatment for domestic violence or chronic conditions like high blood pressure or diabetes. Consider the implications for victims of sexual abuse and assault, who were sometimes denied coverage for mental-health treatment related to their abuse, when their insurance company would label it a “pre-existing” condition. (Staff from Mazzoni Center’s Open Door counseling program have had to file appeals for clients over this very issue, and those appeals have always been denied.) Once the ACA takes full effect in 2014, insurers will no longer be able to deny coverage on this basis.

    And if you care about evidence-based, medically accurate, comprehensive sexuality education, you’ll be glad to know that the ACA provides $75 million per year for five years to the Personal Responsibility Education Program, a state grant program to fund comprehensive approaches to sex education. It doesn’t do away with abstinence-based programs, but it does address the need for a more comprehensive approach, so that more young women across the country have access to the information they need to avoid pregnancy and stay safe.

    There is much good news here for members of the LGBT community and for women throughout the U.S. To expand the availability of LGBT-friendly care across the country, the new law includes funding to help build and train a more diverse and culturally competent health-care workforce. The U.S. Department of Health and Human Services has also begun the process of developing and adding sexual-orientation and gender-identity questions to national health surveys to better understand and address the health issues that impact LGBT individuals and communities.

    Whether you have private insurance through an employer, or are searching for coverage on your own, HHS recently introduced an online tool that lets same-sex couples identify health plans that offer coverage for domestic partners through the “Health Plan Finder” at

    Community health centers such as Mazzoni Center have a key role to play in implementing the ACA over the next several years. Insurance plans will be required to contract with what are called “essential community providers” or ECPs, including women’s health centers, HIV/AIDS clinics, community health centers and public hospitals that serve medically under-served and low-income populations. This is good news for individuals who have come to rely on their community health center for accessible, consistent care — and in the case of a place like Mazzoni Center, a culturally competent model of service with staff who understand the particular needs and concerns of LGBT patients.

    Whoever your care provider is, I would advise all women to take advantage of this good news: Schedule a well-woman visit, a pap smear or a mammogram if you are due. Let your friends know these changes impact them, too. Find an LGBT-friendly provider, if you don’t have one already, and take the necessary steps that will allow you to preserve optimum health, now and for the future.

    Nurit Shein is executive director of Mazzoni Center, the only LGBT health center in the Philadelphia region. Mazzoni Center Family and Community Medicine, 809 Locust St., accepts patients with or without insurance; or 215-563-0658.