To Improve Women’s Health, We Must Protect the Foundation Laid by the ACA

We’ve all heard the saying, “An ounce of prevention is worth a pound of cure.” As a board-certified physician trained in preventive medicine, I have spent my life’s work fighting for increased access to life-saving preventive care for everyone, especially women and minorities.

Whether serving as the former chief medical officer for the Office of the Assistant Secretary for Health or leading quality-improvement initiatives at some of New York City’s leading hospitals, I have witnessed the devastating effects of women not seeking timely and appropriate preventive care. For this very reason, I always urge my friends, family members, coworkers and patients to take advantage of the preventive care services available for women under the Affordable Care Act.

However, I am also a patient — one who, despite my clinical training and professional experience, must contend with the unease that my physician may one day find “something” like a lump or an irregular lab result. I empathize with women who share these fears but know unequivocally that my training and experiences have proven the importance of seeking proper preventive care services for the good of myself and my family.

I also recognize that, historically, American families have been burdened by the costs of preventive health care. Financial costs of preventive care and any further treatment may have limited some women from seeking appropriate services prior to the passage of the ACA in 2010. Having increased access to health care for millions of Americans, the ACA’s impact has been significantly positive for women; not only is the rate of uninsured women at an all-time low, the ACA also ensured that the vast majority of women of all ages have better access to preventive care than ever before.

Now, most private health insurance plans must cover women’s preventive services without additional out-of-pocket costs to women, including well-woman visits, contraception counseling and follow-up care, sexually transmitted infections counseling, interpersonal and domestic violence screening, cervical cancer screening, gestational diabetes screening, HIV screening, breast cancer screening, and breastfeeding services and supplies. These services were established using evidence-based scientific review and assessments of which services are shown to provide most benefit and value to women’s health and lives.

Women’s use of preventive services is on the rise, according to a recent survey conducted by the Kaiser Family Foundation. Eighty-one percent of women have had a well-woman visit in the past two years, and most women have had cancer screenings in the past year, including 71 percent of women receiving a mammogram and 66 percent receiving a Pap test.

Yet, despite this important progress in overall women’s use of preventive services, data continue to show disparities in women receiving preventive care. Why is this? It’s a combination of financial means, social and cultural aspects and knowledge of these services.

One important factor is insurance status and the financial costs of seeking health care in general. Rates of preventive screening tests are higher among women with insurance. For uninsured women, health care costs are a significant barrier to care. Forty-seven percent of uninsured women postponed preventive services because of cost.

We cannot ignore that low-income women, black women and Latina women are more likely to be uninsured and thus are less likely to receive care. Similarly, American Indian and Alaskan Natives have gained health coverage from the ACA, particularly through Medicaid expansion, but in 2016, a quarter of this population remained uninsured and also less likely to receive care.

And, recent data reported the numbers of uninsured patients are growing. With all the uncertainty in health care, patients are more likely to slip through the cracks, especially those who find themselves without coverage.

But barriers still exist among women with insurance. One in five women reported paying out-of-pocket costs for a recent Pap test, 13 percent for a mammogram and 7 percent for a colon cancer screening. Twenty-three percent of women with private insurance paid out of pocket for a Pap test, as did 16 percent for a mammogram. There is still much work to be done to build off the foundation laid by the ACA.

Looking ahead, to continue to build a health care system that is equitable, affordable and accessible, we must prioritize a patient-centered system that meets patients where they are. Successful health care systems should address all types of barriers preventing women from receiving the care they deserve. There is a lot of innovation going on in the country, both in the public and private sectors, where we can improve women’s health care services and delivery.

As history teaches us, the voices of women of all races, ethnicities, socioeconomic statuses and backgrounds will be needed to secure the care that keeps us healthy for our families. As recognition to April as National Minority Health Month, let’s celebrate the progress we have made but also work together to achieve a system where all women can receive the care they deserve.

Dr. Karen Scott is principal consultant at Health Management Associates and previously served in the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Health, as chief medical officer and deputy chief medical officer for the New York City Health and Hospitals Corp., the nation’s largest municipal public hospital system, where she developed the first system-wide quality improvement program.

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