New Survey Documents Women’s Health Care, Coverage and Early Experiences with the Affordable Care Act

A comprehensive survey released today by the Kaiser Family Foundation provides a snapshot of women and their health coverage and care during a time of transition as important Affordable Care Act insurance market changes began to take root.   These include many changes that affect women including a prohibition on using gender in setting premiums, as well as broadening access to a more comprehensive range of preventive services benefits without cost sharing.

The Kaiser Women’s Health Survey, conducted from Sept. 19 to Nov. 21, 2013, provides a national overview of women’s health experiences regarding health care coverage, access, and affordability among nonelderly women (ages 18 to 64) in the United States more than a year after the ACA requirements for preventive and contraceptive coverage affecting women took effect and shortly before the coverage expansions in the law took full effect in January 2014.

Key findings include:

• Among women ages 18 to 64, more than a quarter of women (26%) delayed care in the past year because of cost, compared to 20 percent of men. About one fifth of women also reported skipping recommended tests or treatment (20%), forgoing or skipping prescription medicines (22%), higher rates than men (14% and 12%, respectively).  And 28 percent of women say they had problems paying medical bills, compared to 19 percent of men.

• While most women (82%) report a recent checkup or well woman visit, 6 in 10 know that insurance plans must now cover check-ups at no out-of-pocket cost, and 57 percent know that mammograms and pap tests are covered without cost sharing. Most women (70%) report discussing diet and nutrition with a provider in the past 3 years, but rates are lower for talking  to a provider about smoking (44%), alcohol or drug use (31%), and mental health (41%).

• Coverage under a parent’s plan is now the leading way that women under age 26 get their coverage, with 45 percent of women ages 18-25 reporting that they were covered on a parent’s plan as a dependent. According to the survey few women in this age group are aware that private insurers can send documentation to the primary policy holder (often a parent) that details the services they have used, raising privacy concerns for young adults who want their use of health services to be confidential.

The survey also provides a deeper look at reproductive health and other issues affecting women of childbearing age, defined in the survey as those ages 15 to 44. Key findings for this age group include:

• Nearly one in five (19%) sexually active women ages 15-44 who say they do not want to get pregnant report that they are not using contraceptives. Eighty-six percent of women ages 18 to 44 have heard of emergency contraceptive pills, while 5 percent have used or bought the pills, which became available without a prescription in 2009.

• Among reproductive age women who used birth control and have private insurance (through an employer or an individual policy), 35 percent say their plan covered the full cost of contraception, while 42 percent report that insurance covered part of the costs and 13 percent say they did not have any coverage for birth control. The ACA required that contraception and other preventive services be covered without cost sharing in most non-grandfathered health plans starting with the first plan or policy year beginning on or after August 1, 2012.

• Fifty percent of women of reproductive age (ages 15 to 44) say they had a recent conversation with a provider regarding sexual history, 34 percent reporting one about HIV and 23 percent saying they talked to a provider about intimate partner violence.

The survey is the latest in a periodic series begun in 2001. The complete 2013 survey report, including a discussion of methodology, can be viewed online. The findings were to be discussed this morning at a public briefing in the Barbara Jordan Conference Center in the Foundation’s Washington D.C. office. Materials from the briefing, including an archived webcast, will be available online later today.

Methodology

The 2013 Kaiser Women’s Health Survey was conducted from September 19 to November 21 among a nationally representative random digit dial telephone sample of 3,015 women ages 15 to 64 living in the U.S. Telephone interviews conducted by landline and cell phone were carried out in English and Spanish. A shorter companion survey with a nationally representative sample of 700 men ages 18 to 64 was conducted using similar RDD landline and cell phone methodology.  The margin of sampling error is plus or minus 3 percentage points for the full sample of women and plus or minus 4 percentage points for men. For results based on subgroups, the margin of sampling error is higher.

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