Almost 13 million women aged 15–44, accounting for one in five (20.8%) women of reproductive age, were uninsured in 2012, according to a Guttmacher analysis of new U.S. Census Bureau data. Moreover, in that same year, almost four out of every 10 (39.1%) reproductive-age women living below the poverty line lacked insurance coverage. These bleak statistics not only underscore the urgent and ongoing need for safety-net programs such as the Title X national family planning program, they also demonstrate the significant potential gains to be made as the Affordable Care Act’s expansion of public and private insurance coverage gets underway on January 1, 2014.
These new data are especially timely, as October 1 marks the rollout of the new marketplace where uninsured Americans, many of whom will qualify for federal subsidies, can purchase insurance plans (with coverage starting on January 1). All plans sold on these insurance exchanges will meet certain coverage standards, including coverage of a host of sexual and reproductive health-related services that will be covered without out-of-pocket costs. These services include contraceptive counseling and all contraceptive methods prescribed for women; coverage for an annual well-woman preventive care visit; services for pregnant women and nursing mothers; and counseling and screening services for HIV and other STIs, cervical cancer and domestic violence.
The requirements to cover contraception and other preventive services for women without cost-sharing went into effect in August 2012 and are already benefiting millions of women who have private insurance coverage, for instance through an employer-sponsored plan. Making contraceptive counseling, services and supplies—including long-acting, reversible methods (the IUD and the implant), which have high up-front costs—more affordable addresses the fact that cost can be a daunting barrier to effective contraceptive use. Removing that barrier makes it easier for women to use contraceptives generally and the most effective methods in particular, allowing them to reap the health as well as social and economic benefits of contraceptive use.
Another key component of health care reform that will benefit millions of uninsured Americans is the major expansion of Medicaid, which allows states to raise Medicaid income eligibility to 138% of the federal poverty line. As is the case with private insurance plans, those who will be covered by Medicaid will benefit from a robust package of sexual and reproductive health and other preventive services without additional out-of-pocket costs. However, as of mid-September, only 26 states have decided to move forward with expanding Medicaid, potentially leaving millions of poor and low-income Americans uninsured.
For state-level data on the proportion of women who are uninsured, are on Medicaid or have private insurance coverage, please see the Guttmacher Data Center (Insurance Status, under Services and Financing).
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