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Experts to policymakers: Remember women when you're setting up insurance exchanges

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A woman waits outside the mammogram and women's health services area on the first day of the fourth annual free Care Harbor health clinic at the Los Angeles Sports Arena in South L.A. in September 2012. A new report says policymakers should prioritize the coverage of women's health care when they set up state health insurance exchanges, including preventive care services like mammograms and Pap smears.

Statewide insurance marketplaces will be one of the most visible effects of the Affordable Care Act, and a group of experts hope that policymakers remember women when they're setting them up.

Those experts wrote a report, which is a "checklist" of sorts and the result of a joint effort by the Jacobs Institute of Women's Health, the Kaiser Family Foundation and the Brigham and Women's Hospital.

Women, wrote the authors, "should be a key consideration in the planning and design of new systems of coverage under national health care reform" – like the insurance exchanges that will serve as centralized marketplaces for health insurance plans in each of the 50 states. 

The writers add that women tend to use more medical services than men because they tend to have longer life expectancies, need reproductive care and have to contend with a "greater likelihood of chronic disease and disability." Women also "take major responsibility in coordinating care" for their families, and often face more challenges when it comes to the cost and affordability of health care.

Here are some of the questions the report directs to the people organizing state health insurance marketplaces:

On "essential health benefits":

There are 10 essential health benefits all health insurance providers must cover, whether they're within the state marketplaces or not. What the authors want to know: Will that be enforced? Will the health benefits that each state requires of its insurance providers go beyond federal requirements, or simply fulfill them? Do the insurance plans in the marketplace cover a range of services "important to women across the lifespan" – like prevention, reproductive care, mental health and chronic illness?

On maternity care:

Maternity care is one of the 10 categories of essential health benefits – and the report's authors want to know exactly what that encompasses. Does it mean "services ranging from pre- and inter conception to prenatal, delivery, and postpartum care"? In other words, is it comprehensive? Will certain maternity services, like nurse midwives and birth attendants, be covered?

On preventive care:

Under the Affordable Care Act, the cost of services like Pap smears, mammograms and the HPV vaccine must be fully covered by insurance providers. Ask the authors: Will that be enforced? Will women be informed of the available services and what they have to do in order to qualify for them?

On chronic conditions:

Around 35 percent of U.S. women have at least one chronic condition – that means conditions like obesity, depression, high blood pressure, diabetes and eating disorders. The report's authors want to know if insurance plans will provide women with enough resources to address and manage these conditions. They also ask whether coverage of mental conditions that disproportionately affect women – like depression and eating disorders – will meet federal parity requirements. (For insurance plans that cover mental illness treatment, parity protections aim to ensure that their coverage of mental health is generally comparable to their medical health coverage.)

On abortion:

The Affordable Care Act allows for the coverage of abortion procedures, but states can ban private insurers who sell in their marketplace from covering them. Another factor is the Hyde Amendment, which prohibits the federal funding of abortion, except in cases of rape, incest or if the expectant mother's life is threatened. What the authors want to know: Will the exchanges allow plans that cover abortion? Will women have the option of getting abortion coverage? And will women be given "adequate notification" about their abortion coverage options?

On in- and out-of-network care:

A network refers to the group of health providers that a given plan will cover. The Affordable Care Act says networks must provide patients with "sufficient" choice in terms of the types of providers they can choose from, and must include "essential community providers" – providers who serve the safety net, as in a community health clinic. What the authors want to know: How will states make sure insurance providers' networks have a wide enough range to meet the needs of their female patients (e.g. mental health, OB/GYN)?

On making the entire health insurance headache less of a headache for women:

Women are more likely to move in and out of jobs, wrote the authors, creating gaps where they're not covered by an employer-backed insurance plan. Women also "play a central role" in managing their families' health care, and so the authors want to know: Will insurance plan providers play an active role in reaching out to women so they're getting the most out of their plan? Will those conversations be "simple and transparent"? Will the people reaching out be "trained in cultural competency"? Will there be a system to keep those gaps in coverage from happening?

The report also questions whether state exchanges will make affordable health coverage options widely available, and if they'll offer resources to help women and their families "make informed choices" about what tier of plan they should buy.

Enrollment in the state marketplaces is set to begin in October and coverage goes into effect at the beginning of 2014.

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