Usha Ranji

Health Coverage and Expenses: Impact on Older Women's Economic Well-Being

The health issues women face over the course of their lives, as well as policies that shape Medicare, Medicaid, and other supplemental coverage can affect retired womens economic well‐being. This study uses a nationally representative sample of Medicare beneficiaries aged 65 and older in 2002 to explore gender‐based differences in health and long‐term care use, spending patterns, and the financial burden of health and long‐term care out‐of‐pocket health expenses. Womens health care expenses were higher than mens; older women paid for a greater share of their total spending out of pocket and they faced a greater financial burden by shouldering these out‐of‐pocket costs with less income at their disposal. Low‐income women, those with Medigap or no supplemental coverage, and white women, who are less likely to qualify for Medicaid which covers long term care, faced the greatest financial burdens associated with health and long‐term care costs. The implications of these findings for women in the context of the current health policy landscape are discussed. Controlling health spending and developing options to finance long‐term care are key elements of the policy solutions that will need to be developed to preserve and support economic security for millions of retired women in the United States.

Medicaid at 50: Marking a Milestone for Women's Health

When Medicaid was enacted 50 years ago, no one could have imagined that this relatively modest program would become the backbone of coverage for millions of low-income women. Today, Medicaid provides health and long-term coverage to more than 1 in 10 women. For women inparticular, the program has served as a critical safety net by providing coverage for a wide spectrum of services that other government programs and private insurance did not, from contraceptives and pregnancy-related care to longterm care services and supports. Medicaid’s 50th anniversary is an opportune time to look back at some of the program’s achievements as they have affected women and to take stock of the challenges the program will continue to face in the coming years.

Medicaid and Women's Health Coverage Two Years into the Affordable Care Act

As Medicaid marks its 50th year, the program has unquestionably become the mainstay of health coverage for lowincome women in the nation. Since its inception, its role for women has continued to evolve and expand, but the passage of the Affordable Care Act (ACA) swung open the doors for Medicaid to serve even more low-income women who lack access to private or employer-based insurance. This is because the ACA enabled states to finally eliminate Medicaid’s historical “categorical” requirements, which had essentially shut out women and men without dependent children. The vision of the ACA’s proponents was that eligibility would be extended to all individuals with incomes up to 138% of the federal poverty level (FPL), creating a pathway to coverage for millions who previously could not qualify for the program, regardless of how poor they were. In 2012, a Supreme Court decision effectively made this expansion a state option (Supreme Court of the United States, 2012). As a result, 30 states plus the District of Columbia have opted to broaden eligibility, but 20 states have chosen to maintain historical eligibility categories with income thresholds that are far below the poverty level in many states. Despite this ACA implementation setback, millions of low-income women (and men) have gained coverage since the law was enacted (Office of the Assistant Secretary for Planning and Evaluation, 2015). Nearly 21% of nonelderly adult women and 16% of men now have public coverage, primarily Medicaid. Additionally, 4.8 million women and 3.7 million men have purchased a marketplace plan, with the majority qualifying for premium subsidies (Centers for Disease Control and Prevention, 2015). Considerable questions remain, however, about how to maximize the ACA’s potential to reduce the uninsured count, improve access to care, and how elements of coverage can be strengthened to better serve the needs of lowincome women.

Health and the 2016 Election: Implications for Women

Although all elections matter, it is during the presidential election cycle that the contrasts between candidates and political parties become themost crystalized in the eyes of the public. The differences between the policy approaches to various aspects of women’s health taken by the two presidential candidates, Hillary Clinton and Donald J. Trump, and their respective parties are stark (Democratic Platform Committee, 2016; Republican National Platform Committee, 2016). The Democrats support the continuation and strengthening of the Affordable Care Act (ACA), paid leave for parents and caregivers, and protection of women’s access to the full range of reproductive health care. The Republicans, on the other hand, propose a complete overhaul of the ACA and the Medicaid program to return authority to the states. They also support establishing more federal regulations on women’s access to abortion, but do not address paid leave in their party platform. Health care is a key issue for women voters; however, women are also divided in what they prioritize, largely along party lines (Figure 1). Overall, Democratic womenwho prioritize health care issues rank efforts to reduce the uninsured at the top, whereas Republican women are more likely to favor repealing the law. Reducing health care costs is an area of common concern.