For the first time in a generation, the Affordable Care Act promises help to rural communities and in particular to the women who live there. It is unfortunate that fallacies about the ACA , repeated until they are accepted truths and inaccuracies used for political ends are now widespread in this election year.
I am a Certified Nurse Midwife in Calais, providing full-scope women’s health (obstetrics and gynecology) since 1992. I service women and their families spanning the ages of 10 to 80 in Washington County.
Studies, as well as my own professional experience, show unequivocally that women are disproportionately affected by the shortcomings of our health care system. As a Certified Nurse Midwife, I see these deficiencies daily. Women simply do not have access to good primary care or maternity care, sometimes leading to tragic individual results. The Affordable Care Act includes several provisions benefiting women and families in providing high-quality, cost-effective care to the millions of Americans who currently lack adequate health insurance coverage.
Since 2006, Medicaid has covered 42 percent of women’s childbirth-related hospital stays across the nation. Before implementation of the new health care reform provisions, many uninsured young women have not been eligible for Medicaid or other insurance coverage until becoming pregnant. Over the years, I have cared for women that become pregnant every 12 to 18 months, just to be eligible for Medicaid and have the opportunity to access health care that they would otherwise not be eligible to receive.
Three ACA provisions will dramatically change this situation. First, whereas previously states were required to cover uninsured pregnant women with incomes up to 133 percent of the federal poverty level, beginning in 2014 they will be required to provide at least minimal essential health services to all uninsured persons in this income range. This provision has the potential to add coverage for up to 8.2 million women younger than 65 years (when they become eligible to the Medicare program), or half of those without insurance.
Second, also beginning in 2014, uninsured women with low and moderate incomes (100 percent to 400 percent of federal poverty level) will have access to subsidies for purchasing health insurance through state insurance “exchanges,” with discounts ranging from two-thirds to one-third of the cost, depending on income level. Up to 41 percent of uninsured women, or an additional 7 million women under the age of 65, will be eligible for this provision.
Third, access of young adults to health insurance will be increased. This population segment has been especially vulnerable to losing health insurance when reaching the age of 19 or graduating from high school or college, resulting in high rates of being uninsured, which in turn, affects access to health care, reduced well-being and increased medical debt. The new law has already helped many young women in my practice and in our community gain access to women’s health care that they would otherwise not be able to afford.
In 2014, again thanks to the ACA, access to maternity care, primary care and well-woman exams will be greatly improved through a market reform that prohibits exclusion of coverage for preexisting conditions or other discrimination based on health status. More recently, some insurers have deemed women who had previous cesarean sections to be ineligible for maternity care coverage, and there are anecdotes of similar practices, such as excluding coverage of pelvic floor problems among women who have had an episiotomy. Such practices will be illegal in 2014.
The ACA, passed by congress in 2010 and upheld by the U.S. Supreme Court, is long overdue. I heartily applaud this decision as a woman, a community member and a health care provider in Washington County.
Sen. Kevin Raye from Washington County is running for Congress. He recently made statements in the Calais Advertiser regarding the ACA that showed a misunderstanding of the act and its potential benefits to people who are his constituents. Mr. Raye is an alarmist spreading inaccuracies aimed at creating fears in voters for his own political gain.
I invite Mr. Raye to enter into a dialogue with me, and-or spend one day with me, in order to see how those of us “in the trenches” deal with the reality of rural health care and how we try to provide safe, professional care to hard-working but uninsured and underinsured families in Washington County.
Washington County has so little and is likely to have even less if proposed financial cuts from Federal and State governments are imposed.
Nancy Green, CNM, MSN, is a Certified Nurse Midwife in Calais, providing full-scope women’s health (obstetrics and gynecology) since 1992.