By Carolyn Mullen
Associate Director, National Center for Health Reform Implementation, AMCHP
Maternal health is important to assuring healthy outcomes not only for women but also infants and children. Preconception and interconception care – health care services and supports that are provided prior to a pregnancy – are designed to assure that women are healthy before conception in order to improve pregnancy-related outcomes. The Patient Protection and Affordable Care Act (ACA) provides state MCH programs and their partners (e.g., local health departments, community health centers, Medicaid programs, providers) with a significant opportunity to improve the health care delivery system overall; ensure that women, children and families have access to quality health care; and to improve health outcomes. Health care coverage expansions, investments in prevention, including the Prevention and Public Health Fund, and programs, such as the Maternal, Infant and Early Childhood Home Visiting Program, provide new tools and resources for states and communities to improve the health of women before they become pregnant and between pregnancies.
One of the most notable accomplishments of the ACA relative to improving women’s health occurred on Aug. 1, 2011 when the Health Resources and Services Administration issued guidelines to ensure that women have coverage for eight preventive health services identified by the Institute of Medicine (IOM) as critical gaps, as well as measures to further ensure women’s health and well-being. The guidelines require new health insurance plans beginning on or after Aug. 1, 2012, to cover these services without charging a co-payment, co-insurance or a deductible. According to an article in CQ Healthbeat, in 2011, "an estimated 31 million people in new employer plans and 10 million people in new individual plans will benefit from the new prevention provisions under the Affordable Care Act." These eight health services are:
- A well-woman visit
- Screening for gestational diabetes
- Human papillomavirus (HPV) DNA testing for women 30 years and older
- Sexually-transmitted infection counseling
- Food and Drug Administration approved contraception methods and contraceptive counseling
- Breastfeeding support, supplies and counseling
- Human immunodeficiency virus (HIV) screening and counseling
- Domestic violence screening and counseling
Specifically, the IOM recommended coverage for at least one well-woman preventive care visit annually for adult women to obtain the recommended preventive services, including preconception and prenatal care. The committee also recognized that several visits may be needed to obtain all necessary recommended preventive services, depending on a woman’s health status, health needs and other risk factors. As part of the list of preventive services to be obtained during well-woman preventive visits, the IOM recommended that the preconception component of the visit include an opportunity for the health care provider to conduct, "evidence-based tests, procedures, and screening for nonpregnant women to optimize reproductive outcomes and prevent or optimize treatment for chronic conditions, as well as topics for counseling and guidance for preconception health."
As implementation of the ACA moves forward, it is important to keep in mind that this law has afforded many opportunities to greatly improve the health of women and, ultimately, improve birth outcomes. The ACA has thus far moved the dialogue and practice forward to promote health throughout the life course as opposed to treating a person according to their sickness. It is imperative that we work in collaboration with our partners to promote the aforementioned valuable investments in preventive care. AMCHP will continue to work with our members and the states leveraging these initiatives to increase maternal and child health leaders’ effectiveness and capacity to optimize implementation of the ACA to address preconception health, adolescent health and reproductive health.