Ask Cheasty: Women’s Health, the ACA, and Angelina Jolie

In yesterday’s New York Times, Angelina Jolie got the world talking about breast cancer. Having been diagnosed with a “faulty” BRCA1 gene, and knowing she stood an 87 percent chance of getting breast cancer, Jolie decided to take preventive action by having a double mastectomy before any cancer had ever appeared. Her courageous decisions – first, to have the procedure, and second, to write about it publicly – have gotten people talking about the options available to women in the realm of cancer prevention, detection, and treatment.
Breast cancer kills almost half a million women each year, and those numbers are heavily tilted toward low- and middle-income demographics. In other words, poor women (or women in poor countries) die of breast cancer a whole lot more frequently than wealthy women in wealthy countries. The reasons for this aren’t complicated. Poor women have a lessened ability to afford medical treatment, they tend to put off problems because of the expense of seeing a doctor, and when they finally do get diagnosed, the cancer is often advanced. This is a huge problem, but here in the United States, the Affordable Care Act has taken some important steps toward ensuring more egalitarian access to prevention, treatment, and counseling for women dealing with breast cancer.
As of August, 2012, women with insurance have had access to free “well woman” care. What used to cost at least a co-pay (generally between $15 and $80, depending on the insurance plan) is now covered by the cost of your premium. Women have access to a great many preventive services under this general category – birth control, pap smears, testing for sexually transmitted diseases, and, of course, breast cancer preventive care.
Specifically, the ACA provides coverage for the following three breast cancer-related services:

  • BRCA counseling about genetic testing for women at higher risk
  • Mammograms (regular screening) every 1 to 2 years for women over 40
  • Breast cancer chemoprevention counseling for women at higher risk.

These preventive services are not a cure-all for the problem of unequal access to medical care for women dealing with breast cancer. In fact, the test that Jolie did to diagnose her faulty BRCA1 gene is not covered under preventive services. She notes that, “the cost of testing for BRCA1 and BRCA2, at more than $3,000 in the United States, remains an obstacle for many women.” She is correct, and that is hugely problematic for women at high risk. However, the provisions listed above go a long way toward ensuring that women with insurance have equal access to basic breast cancer prevention services.
The ACA hasn’t fixed everything: access to affordable health care is still not guaranteed in this country, despite health reform’s best efforts. Compounding those problems, states that don’t expand their Medicaid program to cover low-income adults are complicating those problems by concentrating the lack of access to care for the poorest among us.  But step by step we’re getting there.
Women are now free to pick any primary care provider or OB-GYN in their health plan’s network without a referral, and insurance companies can no longer charge women 50 percent more than men for insurance because (and no, this isn’t me trying to be funny) being a woman will no longer be a pre-existing condition. Sit and mull over that one for a little bit.
Angelina Jolie took a courageous step in writing about her medical choice. Similarly, the United States Congress took a courageous step in 2010 by passing the Affordable Care Act and ensuring that millions of women have enhanced access and increased affordability to well woman care, including breast cancer preventive care. Thanks, Obamacare.

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