Women’s Awareness of ACA Preventive Services Remains Low Amid Ongoing Legal Challenges

Although the Affordable Care Act (ACA) was passed over 14 years ago, many women remain unaware that it mandates most private health plans and Medicaid expansion programs to fully cover recommended female health care services, like annual checkups, mammograms, and contraceptives.¹

Many women remain unaware that the Affordable Care Act (ACA) mandates cost-free preventive services; however, ongoing legal challenges threaten the future of this coverage. | Image Credit: Syda Productions - stock.adobe.com

KFF conducted the 2024 KFF Women’s Health Survey to understand how many women know that the ACA covers female-specific preventive services. It was conducted between May 13 and June 18, 2024, both online and by telephone, among a nationally representative sample of 6246 adults between the ages of 18 and 64 years, which included 3901 women between the ages of 18 and 49.

Most women surveyed (71%) knew that the ACA’s preventive services requirements cover annual check-ups for women without cost sharing, but about 3 in 10 women (29%) did not know or believe they do not.

Unawareness of this benefit was more prevalent among those aged between 18 and 25 years compared with those aged 50 to 64 (52% vs 77%). Similarly, knowledge of the ACA requirement to cover routine mammograms was high among women over 40 (73%), but 1 in 4 are unaware (26%).

Additionally, despite most women using contraceptives, less than half of reproductive-age women (43%) and contraceptive users (47%) knew that their insurance should cover the full costs of all FDA-approved prescription methods. In terms of race/ethnicity, a higher share of Black women (49%) were aware of this requirement than White, Hispanic, or Asian or Pacific Islander women (42% of each).

As for insurance type, less than half of women with private insurance were aware of this requirement despite it applying to them (44%). Consequently, some may have paid out-of-pocket costs for their contraception as recent Congressional investigations found that some health insurers have continued to charge for contraception that is supposed to be fully covered.

Because of this, the federal government continues to release guidance that clarifies and reiterates the ACA health plan requirements. However, limited awareness may reduce the number of women accessing recommended preventive care. Also, the future of these requirements remains uncertain due to ongoing ACA legal challenges, including Braidwood Management Inc. v Becerra, which could eliminate the coverage requirement for certain preventive services.²

The ongoing lawsuit argues that the ACA’s preventive services requirement is unconstitutional, alleging that the US Preventive Services Task Force (USPSTF) lacks the authority to mandate cost-free preventive services in the commercial market. Therefore, the plaintiffs claimed that this violates the Appointments Clause, which requires that officials performing certain duties be appointed by the president, confirmed by the Senate, or appointed by a Cabinet secretary.

Additionally, the plaintiffs argued that the requirement violates the Religious Freedom Restoration Act as it demands they cover services they morally object to, causing religious harm.³ They also claim economic harm from paying more for a health plan that includes services they do not want or need.

As ongoing legal challenges threaten the ACA, providers are urging their peers to prioritize coverage of preventive care services to ensure patients, especially women, can access essential health services without financial barriers.²

References

1. Frederiksen B, Salganicoff A. Gaps in awareness of insurance requirements to cover preventive services among women. KFF. October 18, 2024. Accessed October 21, 2024. https://www.kff.org/womens-health-policy/issue-brief/gaps-in-awareness-of-insurance-requirements-to-cover-preventive-services-among-women/
2. Joszt L. Covered preventive services at risk: V-BID Summit breaks down the Braidwood v Becerra case. AJMC^®. March 20, 2024. Accessed October 21, 2024. https://www.ajmc.com/view/covered-preventive-services-at-risk-v-bid-summit-breaks-down-the-braidwood-v-becerra-case
3. Sobel L, Ranji U, Pestaina K, Dawson L, Cubanski J. Explaining litigation challenging the ACA’s preventive services requirements: Braidwood Management Inc. v. Becerra. KFF. May 15, 2023. Accessed October 21, 2024. https://www.kff.org/womens-health-policy/issue-brief/explaining-litigation-challenging-the-acas-preventive-services-requirements-braidwood-management-inc-v-becerra/#:~:text=In%20the%20current%20case%2C%20Braidwood,RFRA)%20(Table%202).