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Patient Protection and Affordability Care Act (PPACA)

On March 23, 2010, President Obama signed the historic Patient Protection and Affordability Care Act (ACA) or HR 3590. It is currently being implemented despite some controversy. Several portions of the PPACA are intended to benefit women, including insurers are required to cover maternity care, which will eliminate previously reported pregnancy discrimination.

According to a survey released by the Centers for Disease Control and Prevention (CDC), 46.3 million Americans, or 15.4%, do not have health insurance coverage. Nearly 60 million, or one in five, have gaps in insurance coverage over the course of a year. These figures include 6 million children under the age of 18. When fully implemented in 2014, healthcare will expand to cover 32 million uninsured Americans.


Supreme Court Upholds ACA Health Care Law

On June 29, 2012, in a mixed Supreme Court decision the High Court largely upheld President Obama's health care law. The law put into effect a nationwide insurance system that will sharply reduce the number of Americans without coverage and extend coverage to over 30 million people, slow the growth of health care costs and insurance premiums, and curtail insurance practices that have prevented people from receiving health care and insurance coverage.

Women and the Affordable Care Act of 2010

One of the goals of the ACA is to improve women's health and decrease the discrimination women have faced in the insurance market. The ACA ends "gender rating," namely, charging women more money than men for the same services, and this practice will no longer be legal as of 2014.

For years there has been major discrepancies with regard to maternal health insurance coverage. In the current insurance market, coverage of maternity care is often excluded with only 12 percent of insurance plans offering maternity care coverage. It is estimated that the ACA will extend coverage to approximately 8.7 million women and newborns. Under ACA insurers are required to cover maternity care, eliminating previously reported pregnancy discrimination. Currently in many states, not only could women be charged a higher premium if they sought maternity coverage, but pregnant women could be denied coverage altogether for maternity care if they sought care after they became pregnant. In addition, those women who have had previous cesarean sections (1 in 3 women) could be denied coverage altogether, or charged a much higher premium.

Considering the fact that our country has one of the highest infant mortality rates among developed nations, and our maternal mortality rates are unacceptably high and steadily climbing, we have a critical need to address maternity care reform and discrimination in premium pricing.

Simply Being a Woman is No Longer Considered a “Pre-existing Condition”

It is common in today's health insurance market for companies to refuse to cover women due to gender-based "pre-existing conditions," such as Cesarean section, breast cancer, or having been a victim of sexual assault or domestic violence. 

A recent article by the Commonwealth Fund forecasts “over the next decade, the Affordability Care Act (ACA) is likely to stabilize and reverse women’s growing exposure to health care costs.” 

Childbirth Connection, a maternity care quality improvement organization since 1912, has identified key healthcare policy components to addressing health and well-being of women and infants across the lifespan as well as reforming the system that cares for mothers and infants in the childbearing year (Resource # 5 below.)


  1. How Much Does PPACA Really Benefit Women?
  2. PPACA Preventative Care Measure Benefit Women
  3. Maternity Care and Healthcare Reform
  4. Realizing Health Reform’s Potential: Women and Affordability Care Act of 2010
  5. Health Care Reform Priorities for High Quality, High Value Maternity Care: An Essential Component of Women's Health Care Across the Life Span,
  6. Guide to Effective Care in Pregnancy and Childbirth is an overview of results of the best available research about effects of specific maternity practices. The full text of the current edition (Oxford University Press, 2000) is available on this website courtesy of the authors: Murray Enkin, Marc J.N.C. Keirse, James Neilson, Caroline Crowther, Lelia Duley, Ellen Hodnett and Justus Hofmeyr.
  7. Health Care Reform: Seven Key Principles, American College of Nurse-Midwives,