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Opinion: Protecting California women’s access to affordable care

March 23 marked the one-year anniversary of the enactment of the Patient Protection and Affordable Care Act (PPACA). In recent months, some states have become engrossed in the politics of congressional repeal efforts and the legal reasoning underlying federal judicial opinions. Meanwhile, in California, we are committed to maintaining an aggressive pace in implementing the federal health care law.

Even as there is uncertainty over the law’s implementation, by moving forward with policies that remove antiquated barriers to adequate health care coverage, California will remain well-positioned to advance long-sought goals regarding coverage expansion, affordability, and health status improvements. Although the people of California will realize the greatest benefits from the expansion and improvement of coverage beginning in 2014, several PPACA provisions have already been implemented and will provide important transitional support. Many of these early provisions particularly benefit women.

PPACA makes important advances for women’s health. The law offers many opportunities to improve access to care and coverage for California women of all ages, ranging from insurance system reforms, to lowering out-of-pocket costs, and securing comprehensive benefits packages that address women’s health needs across the course of their lives.

This landmark legislation would expand access to affordable coverage in several ways by 2014, but, if the law is repealed, California women will be further obstructed from obtaining timely, cost-effective care and preventive services. Because of challenges associated with enacting major changes to the health care system, it is shortsighted fiscal policy to curtail investment in preventive programs with long-term cost saving benefits. Furthermore, California’s rising healthcare spending has reached a tipping point. Implementing the law is a critical step towards curbing the Golden State’s skyrocketing medical costs and making health care truly accessible and affordable for the women of California.

Much of the work required to successfully implement effective strategies for promoting value in California’s health care spending requires advance planning. A prime example of a proactive solution to the financing and delivery of health care is the recent introduction of ACOG-backed legislation to ensure that women receive equitable access to comprehensive maternity health coverage in California. While PPACA mandates maternity coverage in all new policies sold to individuals as of 2014, if the law is repealed, plans will not be required to include coverage of comprehensive maternity care services. Equal access to affordable maternity coverage is vital to obtaining prenatal care, which is essential to ensuring the health of women and their pregnancies. A lack of prenatal care negatively impacts public health costs.

The implementation of PPACA is likely to stabilize and reverse California women’s growing exposure to health care costs. Even though the challenge of high health care costs is not exclusive to the Golden State, the health care needs of California’s women coupled with the state’s intricate health care landscape mandate that California continue to forge ahead with implementation.

The health care needs of women require specific attention, especially during their reproductive years, which leaves women more vulnerable to problems resulting from an inability to obtain coverage. Estimates peg the aggregate number of uninsured California women (ages 18-64) at nearly 3 million. Of these uninsured women, 92 percent are projected to qualify for federal assistance under PPACA.  Despite the fact that the new law provides a major opportunity to advance a culture of coverage and improve the health of California women, successful implementation of PPACA in California will be shaped by several of the state’s distinctive features.

California is home to some of the world’s best hospitals and health care providers, but also has the largest total number of uninsured citizens – more than 7 million — of any state. California’s large size means that health care is organized, delivered, and financed differently throughout the state. Barriers to timely, cost-effective care present an enormous challenge to the state, particularly among California’s less populated and underserved regions. Even where health care services are readily accessible, financial barriers may delay or prevent low-income California women from receiving timely, cost-effective care.

In a state as complex as most countries, California’s aggressive push forward is necessary to take full advantage of opportunities to improve state health care programs vital to women’s health and to obtain federal funds to help carry out the numerous PPACA provisions that will benefit millions of California women.  The imperative to move forward comes at a time of continued state fiscal distress and state and federal political transition. The California Legislature is in the process of implementing tough budget cuts – further decreases in federal health care funding would truly be catastrophic to California’s women.

If California is successful in its implementation, the Patient Protection and Affordable Care Act holds the potential to transform access to comprehensive, quality reproductive health care and accomplish other reforms that will strengthen the state’s existing health care system’s ability to serve millions of women.


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