Back in medical school, my classmates and I were frequently treated to a very popular, pithy obstetrician who would give OB-GYN lectures and serve as preceptor during our clinical rotations. He cursed freely in class and on rounds and gave us all sorts of memorable one-liners and asides. “Let’s go over conception, or at least the way a baby gets made in my house,” or even more playfully when lecturing on deliveries, “Now remember students, if you drop a baby, fake a seizure.” But as much as his verbal antics were meant to keep our attention, one very simple, sincere thing he said stuck with me the most in shaping my early medical understanding of pregnancy. “Pregnancy is not pathology,” he would frequently say, “This is normal physiology.”
So you can imagine my shock when I later discovered that health insurance companies hadn’t ever gotten that basic lesson. Among the many forms of special treatment women have been long getting under our for-profit health insurance system is exclusion of maternity benefits and even denial of coverage for pregnancy – a pre-existing condition! Indeed, only 13% of individual market plans cover maternity expenses, and, in a whopping 22 states, not one plan covers pregnancy. If there were ever proof of the fundamental flaw in our private insurance model, this is it. (Or as my OB-GYN professor might say, CEOs and their company shareholders don’t give a #@&% about women).
But ladies, it gets worse. 
Pregnancy aside, try to buy health insurance on your own and you will likely find that you are paying higher premiums than your male peers. 42 states specifically allow premium pricing by gender (e.g. women are paying 84% more than their male cohorts in many of these plans). And in general you’ll find it more difficult than a man to find affordable coverage at all. Moreover, being a victim of domestic abuse is legal grounds for rejection of your insurance application if you’re unlucky enough to come from our nation’s capital or one of eight states nationwide.
Fortunately, as HHS Secretary Kathleen Sebelius puts it, “being a woman will no longer be a pre-existing condition,” under the Affordable Care Act. Not only will the most egregious abuses be stopped (i.e. maternity care will be mandatory, rape will not be grounds for denial of coverage, and gender based pricing will be outlawed), but the law comes with a host of other reforms that particularly work to address the inadequate care and coverage women currently suffer from. Preventative health screenings for many diseases including breast and cervical cancer, as well as tests for the BRCA gene and osteoporosis, will be free to the patient. The same goes for aspirin prescriptions for older women, who have historically been forgotten in the fight against heart disease. The ACA will also provide funds for increased breast cancer research and public awareness, as well as grants to help fund organizations that support young breast cancer patients. Health reform even protects nursing mothers by giving them time and space to pump breast milk at work. All this is a big deal for new, working moms and women in general.
So while the new House majority and conservatives across the country seek to further the war on women that the health insurance industry has been waging for decades already, our 1-year-old ACA goes to great lengths to ensure that all Americans are better served by their health insurance (from normal physiology to gross pathology) – with particular attention to an additional 30 million of our mothers, sisters, and daughters who have been systematically discriminated against for so long. So happy birthday, ACA…now hurry up and turn 4 already.