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Women Will Steer the Fate of Health Care Reform

September 8, 2010
69 Comments

As mothers, daughters, wives and leaders of households, women often steer the health care choices of families. Thus in the coming years, women will also be a major force toward implementing health care reform and the landmark Affordable Care Act.

Whenever we enroll a child into newly available health insurance, whenever we convince parents to get mammograms or colonoscopies that will be free under Medicare in 2011, each time we appeal an insurance company’s denial of care, or when we choose health insurance in new marketplaces beginning in 2014 — we will be helping to shape the future of health care in America. In fact, much of the ACA depends upon the actions and choices of patients, with women often taking the lead.

Many ACA laws are already in effect. For example, nursing mothers in most workplaces are now entitled to time and private space to pump breast milk for a child’s first year of life. Did you ever think the feds would mandate this? It’s a new era.

The ACA’s main goal is for nearly every American to have health insurance. New opportunities are already available, and uninsured members of your family may qualify. If someone in your family has been denied health insurance because of a pre-existing illness, check out the new ‘high-risk pool’ insurance plans available now. Log onto Healthcare.gov to find local options, and get your loved one covered. Medicaid has been expanded, so someone in your family may be newly eligible. By September 23, you can insure your children under your own health plan until they are age 26, and insurance companies will have to accept all children under age 19 with pre-existing illnesses.

Patients (and the women often guiding them), might possibly exert the most influence on health care reform through two important ACA measures — appeals processes that should be in place by Sept. 23, and the new health insurance marketplaces in effect by 2014.

In the words of President Obama, the ACA aims to protect patients against the worst abuses of health insurance companies. The ACA provides many safeguards against insurance companies denying coverage. Yet the devil is still in the details when it comes to holding insurers more accountable toward paying for care. To fight against insurance companies taking our premiums, then trying not to pay for medical care, the federal government is cracking down on fraud, waste and abuse. The ACA eliminates life-time caps on health insurance benefits, while mandating that insurance companies now must spend at least 85 percent of their dollars on medical care, rather than on profit and administration.

We the public can do our part to keep insurance companies honest through new appeals processes which should be in place by Sept. 23 for new insurers. If you feel your new insurer is unfairly denying care, or is stalling on time-sensitive care, you will be able to appeal to the insurer itself, but also to an external review process. The ACA leaves it up to individual states to institute these appeals processes, but the federal government will hear grievances if state processes are inadequate.

These appeals processes will be an all-important aspect of health reform — which will be driven by patients making appeals, and therefore reliant upon all of us.

Another crucial step is that by 2014, we can shop for health insurance in new exchanges offering comparisons between different plans. So if we see an insurance company hiking rates by 70 percent in one year, for example, or if an insurance company has a reputation of not paying for care (yes, this will still happen under the ACA), the new exchanges will offer options. Collectively, by choosing insurance for our families, we’ll determine which insurers succeed or fail, and thus shape the landscape of American health care.

The lady of the house has always had a large role in steering the health care choices of her family. Now with the new Affordable Care Act, the actions of women on behalf of their families will collectively shape the future of health care in America.

Dora Calott Wang, M.D., is Assistant Professor of Psychiatry at the University of New Mexico School of Medicine. A graduate of the Yale School of Medicine and the UCLA Neuropsychiatric Institute, she received her M.A. in English literature from the University of California, Berkeley, and has been the recipient of a writer’s residency from the Lannan Foundation. Her memoir, The Kitchen Shrink: A Psychiatrist’s Reflections on Healing in a Changing World was published by Riverhead Books, The Penguin Group.

Editor’s note: Leave your thoughts and comments below and you could be a lucky winner of Dora’s book “The Kitchen Shrink.”

69 Comments

Thank you so much for this valuable overview to the overwhelming problem...

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This article is very misleading. The new ACA is not all sunshine and roses. Have you tried buying private insurance recently? The options available are fewer and the prices are higher. Beyond the debate of the legality of their action, do any of us really want a health insurance plan that Congress won't even subject themselves to? The ACA is going to cost us a lot, including great doctors. Two of my doctors are going to retire unless the ACA is struck down...

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No one knows what's in this 2,000+ page bill, even Pelosi said "we have to pass the bill to find out what's in it", that is one of the MOST amazing statements a person pushing this can make. We need major changes in our healthcare system however the way that Obama pushed this through was wrong. Aren't you at all suspicious of why Obama is putting this bill into effect until 2014, AFTER he maybe nominated for a 2nd term...

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I am trying to understand all this. Affording high Quality medical insurance for low/reasonable cost...It seems that the amount of options are fewer..even with the state's medicaid plan's....
I pray that God will help our leaders make the right choices for us....

Wow, you girls are scared- this health reform is just what we needed to shake things up a bit! Insurance companies have had the control on this for long enough. Now we have a more constringent set of rules that all of the private and Multi-plan companies will have to play by! I think it is great!

I have to say I am a little surprised at all of the fear of "big bad government" that is going on here. It might be time to replace watching television and reciting the talking points of the day with actually doing the/some research. To question the "legality" of the actions of an overwhelmingly elected and people supported governing body, a body that was elected because of its promises to its people, one of which was to pass this bill specifically, is a little ridiculous...

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My daughter has cancer. She was diagnosed the last week of July while visiting family in Australia. Australia has national health care. I am with my daughter now in Australia. If my daughter had fallen ill in America, before certain clauses of ACT were able to go in force, our insurance company in America would have done nothing for her because she had taken a gap year from college. We are waiting for these parts of ACT to pass before my daughter comes back to her homeland. Have a heart...

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Yes, the only problem with the health care bill is that the "fear mongers" caused it to be watered down so that it is not as effective as it could have been. Actually, I know many people who are disappointed that we didn't get a plan more like the rest of the first world has. And while there are some Doctors who are ignorant of the good effects of reform, there are many others who would have supported a true national health care plan...

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I am annoyed that I'm reading this pro-government health care article in a forum about mommy-related issues and advice. The previous topics and discussions have always been free of political undertones. This article was extremely one-sided and insulting to my husband. He is involved in the decison-making on our healthcare just as much as I am, and we have both decided that we don't want the Government to have any part in our healthcare. They haven't proved themselves effective in other areas...

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I, too, agree that this article is misleading and one-sided. Everyone is entitled to their opinions on the matter but the fact is that this massive spending bill is going to bankrupt our country and put our children in a position worse than they are in now. This bill did nothing to address the torts system and did nothing to lower insurance costs, while giving the government further ability to meddle in our lives...

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I find this article patronizing and unrelated to the forum. My husband and I are equally involved in our healthcare decisions. We do not need another expert telling us what the new healthcare plan will be; we are perfectly capable of seeing that for ourselves. I second what Amanda Smedley said!

Here is another site that I have always enjoyed turning political. I wouldn't have a problem with this if the article would have been about both sides of the issue not praising one. I have read the majority of this healthcare bill and after having done so I want absolutely no parts of it. I have also worked in healthcare for over 10 yrs and am thankful that I took time off to raise my daughter...

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@The quite but powerful contingency!
(did you mean quiet?). Your care did not cost $1000. Someone had to cough up the rest. I don't know how much you pay in federal taxes. Maybe you are among the almost half of citizens who pay none, but remember it is on the b ks of taxpayers that you get your expensive care for cheap or "free."

I am not fearful of the Healthcare bill. I am disgusted. The only thing that this bill will do is limit my healthcare choices. We have insurance through our city government. Once this gets going we will have no other choice than to be on Obama care. If you think fighting an insurance company is hard. Try fighting government. This makes me sick!

So sad you have joined with AARP with all their liberal friends. And nothing is free. In the bill it says we will have to pay for drug treatment even if we have never smoked pot....I have a friend on Medicare that now will have to pay for things she never paid before. She went to a meeting of AARP explaining it will only cost so much for a colonoscopy--she was getting hers free. Plus other treatment will only cost so much. SAD-SAD-SAD

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