In order to expand health coverage, increase access to care, and improve health outcomes for all women and reduce racial disparities in health for women of color, state and national policymakers should pursue the following recommendations:
Health Coverage for Women
- Implement the expansion of health coverage through Medicaid in states that have not yet done so. Accepting the federal funds to expand health coverage through Medicaid is the most pressing thing states that have not yet expanded Medicaid can do to address barriers to health coverage for low-income women and racial disparities in coverage for low-income women of color. States that continue to delay the decision to expand Medicaid will leave women who should be benefiting from this expansion out in the cold when it comes to health coverage. Furthermore, state policymakers should avoid experimental provisions that would require approval of a federal waiver, which could slow the timeline for beginning new coverage, undermine standards for quality of coverage, and result in higher costs for enrollees.
- Invest in community-based outreach and health coverage enrollment strategies targeted toward low-income women and communities of color. In order to reduce the overall number of uninsured women as much as possible and to address racial disparities in coverage, states should invest in community-based outreach and enrollment strategies. Ensuring that uninsured women in low-income communities, communities of color, and immigrant communities have face-to-face contact with and support from outreach workers who can assist with the enrollment process will help maximize coverage gains.
- Ensure robust competition in the individual and small business health insurance marketplaces, and strengthen oversight to ensure that all plans are in compliance with the Affordable Care Act’s requirements for essential health benefits important to women. States should actively monitor the level of choice and competition in both the individual/family health insurance marketplace and the Small Business Health Options Program (SHOP) marketplace. Without compromising benefit standards, states should consider a combination of incentives and requirements to increase plan choice and foster competition between insurers to place downward pressure on rates. States should also strengthen oversight to actively enforce provisions of the ACA that require all plans to cover regular preventive care (without cost-sharing) and other health services important to women.
Women’s Access to Health Care
- Establish and enforce strong standards for marketplace health plan provider networks to ensure that all services will be accessible without unreasonable delay, as required by law. With insurance companies’ move toward “skinny” provider networks, there is a danger that people gaining health coverage will not have meaningful access to care because they can’t find an in-network provider or specialist within a reasonable distance from their homes. States should create strong review processes to evaluate the provider networks proposed for marketplace plans, and conduct ongoing oversight to maintain network adequacy. States should also consider adopting maximum travel time and distance to provider criteria (like the criteria used for Medicare Advantage plans) for the networks of health plans to be sold in the state marketplaces. For example, states could set a maximum travel standard of 15 miles or 30 minutes for urban areas and 30 miles or 30 minutes for rural areas, wherever possible.
- Ensure that all women, regardless of income, have access to the full range of reproductive health care and family planning services they need to be healthy. All women, whether they are covered by employer-based insurance, individual private insurance, Veterans Administration health care, Tricare, Medicare, or Medicaid, should have access to the reproductive health services they need to be healthy and to make their own decisions about family planning, including contraception, abortion, and pre- and post-natal care. To improve women’s health, policymakers need to protect and expand women’s access to these services, not restrict it.
- Invest in workforce development strategies that expand and diversify states’ health workforces with more providers who are women and people of color. Health care is among the fastest growing industries by job growth, and these jobs go mostly to women. Expanding health coverage will mean new health care spending and more health care jobs, presenting an opportunity to strengthen diversity in states’ health workforces. States should adopt proactive strategies to diversify the health workforce, such as setting up health career track programs at high schools that serve students of color and lower-income students, increasing funding for community colleges’ health occupation programs, and supporting on-the-job training initiatives.
- Strengthen cultural competency in states’ health workforces. As new populations gain health coverage, states’ success in translating expanded coverage for women into better health outcomes for women will depend on the health workforce’s ability to meet the needs of women with different racial, ethnic, cultural, and linguistic backgrounds. Increasing diversity in the health workforce will help in this endeavor. In addition, states should pursue strategies to ensure access to interpretation and translation services for non-English speakers, and incentivize (or require) cultural competency training for health care providers.
- Address growing health care needs and ease provider shortages by investing in community health clinics, ensuring appropriate scope of practice rules, and creating incentives for new practitioners to locate in previously underserved areas. States should take advantage of funding opportunities created by the Affordable Care Act, such as the New Access Point program, to expand community health clinics and create more primary care delivery sites to serve more low-income women and women of color. Current scope of practice rules often prevent nurse practitioners, physicians’ assistants, and other clinicians from providing specific types of care and services, even when they are trained and qualified to provide this care. As more people gain insurance coverage and seek care, states should ensure that their scope of practice rules are updated to allow qualified clinicians to work to the full extent of their education and training. And, states should prioritize funding for tuition waivers and/or loan forgiveness programs for health practitioners who commit to provide care in previously underserved areas for a defined period of time.
Women’s Health Outcomes
- Invest in preventive care for women. In order for expanded coverage and expanded access to care to produce meaningful gains in health outcomes for women, states will need to encourage a proactive focus on preventive care. This will pay dividends in terms of women’s overall health and wellbeing and also help reduce future health care costs. The Affordable Care Act has advanced critical improvements here, particularly with its requirements that health plans sold in state marketplaces must cover women’s preventive services without cost-sharing. States should actively enforce these requirements. States should also institutionalize their commitment to improving women’s health outcomes by establishing state commissions on women’s health that include a strong focus on preventive care.
- Improve chronic disease management for women. Given the current prevalence of chronic diseases among women and the role of chronic illnesses in driving up overall health care costs, states must incentivize improvements in the management of chronic diseases. Needed improvements include better coordination across providers, more emphasis on early detection and early warning signs, and better education that gives patients the tools and support they need to proactively manage chronic health issues. To support these goals, state Medicaid programs should adopt the “health home” model (a new option created by the Affordable Care Act) for providing services to enrollees with chronic health conditions.
- Improve health data collection focusing on women, with a particular focus on low-income women and women of color. To establish appropriate policy priorities for improving women’s health and reducing racial disparities, policymakers need access to the most current and comprehensive data on trends and gaps in coverage, access, and outcomes. States should collect and publicly report full information on enrollments and target populations for the health insurance marketplace and Medicaid, including data broken down by gender, race/ethnicity, gender identity, income, and geography. They should also strive to improve data collection on measures of health access and outcomes, with the same population and geographic breakdowns.
Adoption of these recommendations will help set states and the country on a path to improve women’s health overall and reduce racial disparities in women’s health, moving toward realizing the promise of quality, affordable health care that gives all women in America opportunities to get the health care they need to lead healthy, happy, and prosperous lives.
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