Yesterday marked the one-year anniversary of President Obama signing the Affordable Care Act.  I encourage everyone to become familiar with what the Act has already accomplished, as well as the plans through 2015 (see an interactive timeline online).

Today, I dedicate this month’s column to reflecting on one of the new consumer protections that is scheduled to become effective January 1, 2014, No Discrimination Due to Pre-Existing Conditions or Gender:

Before the Affordable Care Act became law, insurance companies selling individual policies could deny coverage to women due to pre-existing conditions, such as cancer and having been pregnant. 

A WhiteHouse.Gov fact-sheet describes the ways in which, “The Affordable Care Act Gives Womem Greater Control Over Their Own Health Care.”  When I first read it, even as a feminist medical sociologist familiar with health care inequities, a few lines jumped out at me:

Right now, a healthy 22-year-old woman can be charged premiums 150 percent higher than a 22-year-old man.

Less than half of women have the option of obtaining health insurance through a job.

Today, maternity benefits are often not provided in health plans in the individual insurance market.

I appreciate the many positive effects this law has on women, men and children, but I find myself asking: why did the Affordable Care Act not include this provision — to eliminate discrimination to due to gender — among its original 2010 provisions?  A comparable provision was effective as of September 23, 2010 for children:

…health plans that cover children can no longer exclude, limit or deny coverage to your child under age 19 solely based on a health problem or disability that your child developed before you applied for coverage.

Now, don’t get me wrong, I’m all for protecting children’s rights to receiving coverage.  As a mom, I understand the instinct to want to protect one’s child before one’s self.  However, it feels like the policy-makers did not take into account the body of research on the direct correlations between maternal health and child health.  To put it simply, an unhealthy mom is not good for the health of her child — whether or not her child has excellent or poor health care coverage.

For example, a 2005 article in the journal PEDIATRICS documents research findings that,

“Maternal depressive symptoms in early infancy contribute to unfavorable patterns of health care seeking for children.” 

Another 2005 article examined the psychological and physical health of adult caregives of children with cerebral palsy and found that:

The psychological and physical health of caregivers, who in this study were primarily mothers, was strongly influenced by child behavior and caregiving demands…These data support clinical pathways that require biopsychosocial frameworks that are family centered, not simply technical and short-term rehabilitation interventions that are focused primarily on the child.

It’s easy to imagine the ways in which a child’s health might suffer if her/his primary caretaker has poor mental and physical health.  And, solely providing health care to the child did not necessarily improve the health outcomes of the caregiving moms.

One more example along the lines of the effects of maternal depression is the case of pediatric asthma.  A 2007 article in the Journal of Health Economics reports a study which shows:

…treatment of mother’s depression improves management of child’s asthma, resulting in a reduction in asthma costs in the 6-month period following diagnosis of $798 per asthmatic child whose mother is treated for depression.

Our health care system will likely save more money once we end insurance company discrimination on the basis of sex/gender.  Now, I recognize that not all women are mothers, but the overwhelming majority of mothers are women.  So, if the gendered division of labors in most families remains such that moms are primarily in charge of maintaing and protecting the health of their children, then wouldn’t we want these caregivers to have access to affordable, quality health care before 2014? 

That said, I am grateful that this law passed and hope that we will continue to work on ways to strengthen coverage for all Americans.