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Ruth Robertson, M.Sc.

Senior Research Associate
Affordable Health Insurance Program
The Commonwealth Fund
New York, NY

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Health Care Reform Changes Affect Low-Income Women

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How do the new health reform laws affect low-income women?


The Patient Protection and Affordable Care Act, a federal health reform law approved in 2010, will significantly benefit women with low incomes who are not currently eligible for Medicaid or employer-based health insurance. While parts of the law do not come into effect until 2014, some of the reforms are already helping women.

Women have greater health care needs than men, especially during their reproductive years, and play an important role in coordinating the health care of family members. Their incomes are typically lower than men's, meaning they experience higher rates of poverty, especially minority women and female heads of households. More than half of women with incomes of less than 133 percent of the federal poverty level (equivalent to income of $14,856 for an individual or $30,567 for a family of four) were uninsured in 2010 and more than three of five had delayed or gone without needed health care in the past year because of its cost.

Medicaid is a joint federal-state program that provides health insurance to nearly 60 million adults and children with low incomes and people with disabilities. Women make up two-thirds of the adult Medicaid population, and these are mainly pregnant women and mothers. States must provide Medicaid coverage to pregnant women with incomes up to 133 percent of the federal poverty level throughout their pregnancy and for 60 days after delivery. Some states extend this to women with higher incomes. Many states cover parents but, in general, only those with low incomes. Medicaid also provides services for vulnerable seniors, including nursing home coverage for low-income elderly people. Childless adults are rarely eligible for Medicaid unless they have disabilities or qualify for nursing home coverage.

Starting in 2014, Medicaid coverage will be extended to all those under 65 who earn up to 133 percent of the federal poverty level. For example, poor women without dependent children earning up to $14,856 will be eligible for Medicaid. As a result, millions of parents with low incomes and non-disabled adults who do not currently qualify for Medicaid will become eligible in 2014. For little or no premium contribution (this varies by state), women with low incomes will gain access to comprehensive health care benefits with only limited cost to them. Also, starting in 2013, the Affordable Care Act calls for increasing federal funding to encourage state Medicaid programs to cover preventive care services like mammograms and Pap tests without any cost sharing.

In addition, people who do not qualify for Medicaid and are not eligible for employer-based coverage will be able to buy insurance plans through new state health insurance exchanges starting in 2014. Plans sold through these exchanges will be subject to new market rules, which will mean insurers can no longer charge women a higher premium because of their gender or health status and can no longer deny people coverage. All plans sold through the exchanges (as well as plans sold to individuals outside of the exchanges) will cover a comprehensive set of essential health benefits. Importantly for women, these will include maternity and newborn care, which are rarely included in plans sold to individuals today.

Women with low and moderate incomes will qualify for a tax credit to help toward the cost of premiums for plans bought in the exchanges. Individuals with incomes below 400 percent of the federal poverty level—a yearly income of $92,200 for a family of four – will have their premium contributions capped at a percentage of their income. The cap ranges from 2 percent of income for people earning 100 percent of the federal poverty level ($23,050 for a family of four) to 9.5 percent of income for people earning just under 400 percent of the federal poverty level. There will also be cost-sharing caps to limit yearly out- of-pocket spending; these will vary depending on income.

Some parts of the health care reform law are already helping women with low incomes.

  • Young women up to age 26 can now stay on or enroll in their parents' health plan if it offers dependent coverage, regardless of their income or family status.
  • Women with a non-grandfathered private insurance plan can now get preventive care tests such as mammograms and Pap tests without paying any co-pay, coinsurance or deductible. Beginning August 2012, the list of covered services will expand to include all forms of FDA-approved contraception, among other services.
  • Women who are nursing and employed by companies with 50 or more employees are now entitled to breaks from work to express breast milk, and employers must provide them with a private place in which to do this for the first year after birth.
  • The Medicaid program now covers smoking cessation support for pregnant women and covers care provided in free-standing birth centers.
  • The new law makes it easier for states to expand their Medicaid family planning services.

To find out more, you may want to read:

Major Changes With Health Care Reform

More Options for Purchasing Insurance
Insurance Regulation Changes That May Affect You
Challenges to the Health Care Law
A Perspective on Women and Health Care
Preventive Services Covered Under the Affordable Care Act
Timeline for Health Care Reform Changes
Health Care Reform: Where to Learn More
Ask the Expert: How does the new health care reform act affect older women?

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