About 850,000 additional adult women of reproductive age (19 to 44) will be uninsured in 2023 if the enhanced premium tax credits (PTCs) passed under the American Rescue Plan Act (ARPA) are allowed to expire at the end of 2022 as they are slated to under current law. Uninsured women are at higher risk than insured women of having an unintended pregnancy due to more limited access to free or low-cost reproductive health services, including the most effective forms of contraception. Further, many of these additional women who will be uninsured live in states that tightly restrict or plan to tightly restrict access to abortion. In the wake of the Supreme Court’s elimination of the constitutional right to an abortion, uninsured women who are facing an unintended pregnancy and living in certain states are now at a higher risk of being denied access to the full range of reproductive health services, including abortion, than at any time in recent decades.
The Affordable Care Act (ACA) vastly improved access to health benefits for women in the nongroup market by prohibiting gender rating of premiums and coverage exclusions due to preexisting conditions. Under the ACA, qualified health plans must offer 10 essential health benefits, including maternity care and mental health benefits. Moreover, preventive care services must be covered without cost sharing. For women, this means well-woman visits and reproductive health services, including contraception and cancer and other screenings, are free.
Though state laws are changing rapidly, we estimate that 2.5 million uninsured adult women of reproductive age live in states with the most restrictive or very restrictive access to abortion. If the enhanced ARPA PTCs were extended, 384,000 fewer adult women of reproductive age in these states would be uninsured, and most would instead have free access to contraception and other reproductive health services through Marketplace plans to help avoid an unintended pregnancy. They would also have access to comprehensive health insurance benefits that would cover the necessary services to support a healthy pregnancy and delivery and ongoing maternal health and well-being.