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Abstract: Women in the United States make approximately 80% of the health care decisions for their families, yet often go without health care coverage themselves. The implementation of the Affordable Care Act provides an historical opportunity for women to gain health care coverage for themselves and their families. The focus of this commentary is on women's leadership roles in the context of health care decision-making and Affordable Care Act education and outreach, and implications for reaching broader health and social goals.
Key words: Women, health care, insurance, health care reform, decision-making, Affordable Care Act.
Four years after the passage of the Affordable Care Act in 2010, and more than two years after the Supreme Court ruling upholding the constitutionality of this law, the prospect of health care coverage for millions of Americans who have been uninsured or underinsured for years is becoming a reality. The focus has turned, in large part, to implementing the law's signature pieces: a Marketplace of affordable private plans that launched on October 1,2013, with coverage that began on January 1,2014. Through the Health Insurance Marketplace available online at HealthCare.gov, individual consumers can compare different health insurance plans and select one based on their income and their needs, as well as determine their eligibility for expanded Medicaid coverage. To date, 27 states and the District of Columbia have opted to expand Medicaid eligibility based on income, household size, and other circumstances. In most cases, individuals without employer-sponsored health coverage must enroll in a health insurance plan for themselves and their families via the Health Insurance Marketplace or, if eligible, apply and enroll in Medicaid or the Children's Health Insurance Program (CHIP). This health care plan decision is one that will fall to women in a large majority of households.
According to the U.S. Department of Labor, women make approximately 80% of the health care decisions for their families and are more likely than men to be caregivers to family members.1-3 Other researchers have also cited this significant decision-making role of women: for example, a 2008 American Academy of Family Physicians (AAFP) national survey found that 90% were responsible for health care decision-making for themselves and/or family members.4 Recognizing this key role that so many U.S. women-particularly mothers-play in their families...