On November 10th, just one week after the presidential election, the U.S. Supreme Court will sit down for the hearing on the future of the Affordable Care Act (A.C.A., also known as Obamacare) for the third time. This is because challengers in Texas claim with the elimination of the tax penalty in 2017, the mandate is unconstitutional without any tax to enforce it. Now that the SCOTUS is predominantly conservative—thanks to Amy Coney Barrett’s confirmation that occurred on Monday, October 26th—the outcome isn’t expected to go well, especially since she made it clear that she was not in favor of the A.C.A. in a 2017 law review essay.
In fact, there’s a fear that, despite there not being a cohesive backup plan, the A.C.A. will be completely abolished with a 6-3 conservative majority, leaving more than 20 million Americans without coverage. Let’s also keep in mind that despite being one of the richest countries in the world, we sure do a terrible job when it comes to taking care of our people. So much so that the A.C.A. is up for debate during a global pandemic. It really doesn’t get much crueler than that.
An early October 2020 CNN poll found that 61% of Americans favor Obamacare and only 32% want to see it overturned. But, in his never-ending hope to abolish all Obama-related bills, acts, and laws, President Trump has wanted to gut and abolish the A.C.A. since he was voted into office. One of the most prevalent aspects that the Democrats are afraid to lose is the guarantee of pre-existing conditions being covered by the A.C.A. Even though President Trump claims this won’t occur, he hasn’t yet provided exactly how this will be done.
Although many will be affected by a complete abolishment, it’s women who will lose the most. For them, the A.C.A. hasn’t been just a lifesaver in the metaphorical sense of the word but in the actual sense of the word.
"The A.C.A. is the difference between a $7,000 and a $20,000 hospital bill for an uncomplicated birth,” says Emily Sauer, who’s not only a women’s health expert and patient advocate but also founder and CEO of Ohnut, a sex-positive company that creates products to reduce painful sex. “It’s the increased likelihood of life over death when preventative cancer screenings no longer require a copay and, therefore, become more accessible to the BIPOC women who need them most.”
As Sauer explains, before the Affordable Care Act, insurance companies often deprived women of health care. Women paid more than men for the same health coverage, and benefits like maternity care and contraception weren’t covered. In fact, before 2012, when Obamacare first started going into effect for women's coverage, charging women more than men for the same insurance was costing women about $1 billion a year, as there was no protection requiring insurance companies to charge men and women the same price. These were called “gender-based premiums.” According to the National Women's Law Center, 60% of insurance plans charged less for men who smoked but more for women who were nonsmokers, a fact that doesn’t make any sense at all.
“In some cases, insurance providers have even excluded coverage for certain ‘pre-existing conditions,’ like pregnancy, sexual assault, and domestic partner violence,” says Sauer. “Without the A.C.A., women will once again be subject to a sexist and exploitative insurance marketplace, with BIPOC women most vulnerable."
When pregnancy is regarded as a “pre-existing condition,” then we really need to look at our healthcare system and fight for it to protect others. Although some 67 million girls and women have a pre-existing condition, as the ACLU pointed out in a 2017 article, just being a woman is a pre-existing condition in itself based on what the GOP wanted to repeal and revoke in the Affordable Care Act.
But that’s just the beginning. Here’s what you need to know about the impact the Affordable Care Act has had on women and what they'll lose should it be gutted, overturned, or just completely thrown out the window tomorrow, November 10th.
What the Affordable Care Act has done for women
It has created equality
In charging women and men the same amount for the same services, as mentioned above, equality has been created—at least on the financial front. According to the Commonwealth Fund, “The A.C.A. brought about sweeping changes in insurance for women. Because of the law, women who buy coverage on their own are no longer charged higher premiums than men in their own age group, can no longer be denied coverage because of pre-existing conditions, and must be covered for essential services like maternity care." This is because tax credits have helped made individual plans affordable for women, especially those with low to moderate incomes. According to the same Commonwealth Fund article, this has made millions of women become eligible for Medicaid. And according to a 2015 study, the A.C.A. has collectively saved privately insured women about $1.4 billion out of pocket per year on contraception alone.
Whether or not you realize it, every time you go to the doctor, the A.C.A. also empowers and supports women. Over twenty million people have access to the A.C.A., creating affordable care that allows women to get cancer screenings, gives them the opportunity to have access to any insurance they prefer, and guaranteeing that if they have a pre-existing condition, they can’t be turned down by insurance companies.
It has been a gift to the underprivileged
“There's no question that the Affordable Care Act or Obamacare has completely changed our healthcare system for the better,” says Jolene Caulfield, senior advisor for Healthy Howard, a nonprofit organization that advocates for healthy living. “The A.C.A.’s focus on helping women and those who can't afford health plan coverages took our whole healthcare system to the next level. It's a monumental gift to millions of underprivileged Americans, and wiping these rights away is a disgrace to the name of public service.”
According to the Commonwealth Fund, “Women with low incomes have made particularly large gains: Uninsured rates for those with incomes below 200 percent of the federal poverty level ($23,760 for an individual or $48,600 for a family of four) fell from 34 percent in 2010 to 18 percent in 2016. The findings are similar for low-income women of all races and ethnicities.” That’s almost a 50% increase in the number of women who now have insurance.
It has been essential for mothers
Raising a baby is no walk in the park for anyone. And for those who rely on the A.C.A., that walk in the park is even more difficult—meaning it’s no walk at all but rather a persistent struggle.
“The Affordable Care Act is integral to the support and protection of breastfeeding mothers,” says Jennifer Jordan, director of Mom & Baby at Aeroflow Breastpumps, a company that accepts insurance for the breast pumps they sell. “[The A.C.A.] provides coverage for breastfeeding supplies [and] support and services that make it possible for new moms across the country to receive the tools they desperately need in order to feed their babies.” These services include maternity coverage throughout the entire pregnancy and after the baby is born as well as making employers provide time and space for new mothers who are breastfeeding to express milk for up to a year after their baby is born.
“For the first time, working mothers no longer have to choose between breastfeeding and going back to a workplace where they could pump in a safe environment,” says Jordan, who also calls access to this equipment “groundbreaking,” especially as it resulted in a national dialogue about breastfeeding and the normalization of it. For example, although it was technically “on the books,” according to Reuters Health, that women had a private space to express their milk, it wasn’t until the A.C.A. that it was enforced in all companies.
"The results are clear: Since the Affordable Care Act was signed into law in 2010, instances of breastfeeding have increased each year as well as the average duration of breastfeeding," says Jordan. "As a working mother whose breastfeeding journey took place prior to the A.C.A., watching these positive impacts evolve over the past ten years has been beyond inspiring.” And being backed by the law on the topic has given women the chance to speak up and further empower each other.
It has offered preventative care for free
“The Affordable Care Act is expansive and has many sides to it,” says Arlene F. Schwartz, the managing director of Impact Tax Policy. “The A.C.A. requires that women’s preventive health care is covered for free. This includes reproductive health services such as mammograms, screenings for cervical cancer, prenatal care, and other benefits. While coverage for birth control can be denied for religious or moral objections by employer-provided insurance in all states, a general requirement of the A.C.A. is that contraceptive methods that are prescribed by a woman’s doctor must be covered in full.”
A woman without insurance or the A.C.A. wouldn’t have access to necessary screening that could possibly save her life. Health care, for many, is a matter of life and death and should not now or ever be something that only the privileged can access.
What women will lose if the A.C.A. is abolished
Millions of women will suffer physically and financially
With millions of people becoming uninsured, there will be an increase in delayed medical treatment. Not having access to preventative health care, like screening for cancer—cervical and breast included—is a devastation for which there are no words. As the Center for American Progress reports, the A.C.A. enables low- and moderate-income people to be insured “through a combination of measures that ensure more widespread insurance coverage, reduce costs, raise the standards of what insurance companies need to cover, and subsidize millions of lower-income and moderate-income people.”
But while millions are currently benefiting from the A.C.A., if the A.C.A. is shut down, the wealthy will see tax cuts, as it was largely financed by the taxes of the wealthiest Americans and companies in the healthcare industry. And not only will millions of patients suffer, with people unable to pay for their care, that financial loss will trickle down to doctors and hospitals, meaning they’ll lose necessary revenue that—especially right now, as we’re smack dab in the middle of a pandemic—would be devastating. Uncompensated care, according to the Urban Institute, would increase by $50.2 billion, resulting in the possible closure of facilities that cater to low-income families who need health care. It means local healthcare providers and the state government would be left with a bill that’s over $1 trillion, a bill for uncompensated care that will take eight years (or more) to pay off.
So we’re looking at lack of coverage, closure of medical facilities, and uncompensated medical care. It is, in a word, a disaster, especially for women. As the Commonwealth Fund reports, there are multiple reasons why women use the healthcare system more than men, including but not limited to this: “Not only do women have relatively greater healthcare needs during their reproductive years, [but] they also often serve as family caregivers and play a central role in coordinating the healthcare needs of multiple generations of family members, including children, spouses, and aging parents.”
It would be a profound setback to women’s health care, especially for women of color
Considering everything listed above, if the A.C.A. were to no longer exist, its impact on women’s healthcare would be absolutely detrimental in so many ways. But while others will suffer, it will be women of color especially who will suffer the most.
Although all women have benefited from the A.C.A., the Center for American Progress found that “coverage for women of color grew at more than twice the rate of women overall between 2013 and 2015.” This is extremely important, considering how certain illnesses affect women of color disproportionately compared to white women.
For example, Black women between the ages of 45 and 64 have the highest rates of breast cancer, and Latina women have the highest rates of cervical cancer. Because the A.C.A. automatically offers coverage for these screenings, to no longer have this can be a death sentence for some women—a death sentence that would be prevented if the A.C.A. stays intact.
“If all of [the] A.C.A.'s protections are abolished, it would take the way women receive health care decades back to when discrimination was prevalent in the medical field,” says Caulfield. “This repeal is a direct attack on women's rights for fair healthcare costs and provisions. This politically-motivated repeal is an assault that only puts women, especially women of color, in a devastating position, when the Act has already guaranteed millions with anti-discriminatory access to healthcare coverage and even just consumer rights.”
The LGBTQIA community will also suffer immeasurably
One of the most important aspects for the LGBTQIA community under the A.C.A. is nondiscrimination protection. With this, doctors and medical facilities can’t turn away patients based on their gender identity or sexual orientation. For people in this community, nondiscrimination is paramount not just to receiving the health care they deserve but to having a safe space, free of judgment.
Before the Affordable Care Act went into effect, 34% of LGBTQIA people were uninsured and made less than $45,000 a year. That was in 2013. By June 2020, thanks to the A.C.A., the rate of uninsured LGBTQIA individuals dropped to 16%—a sign that the A.C.A. does work and is making lives better. Repealing the A.C.A. could take all of that away, especially with Justice Amy Coney Barrett on the bench, who has been linked to anti-LGBTQIA hate groups.
So what can we do?
In a country run by old, cisgender white men, many of whom have zero understanding of how the female anatomy even works, it’s easy to see why abolishing the A.C.A. isn’t a big deal to them. They don’t have to see the repercussions, and they don’t have to see the physical and financial suffering and deaths that will come if the A.C.A. is taken away.
So while we may not be able to show up to the hearing on November 10th and vote, we can contact our state representatives, either by phone or by letter, and let them know our thoughts. We can educate our family and friends about the Affordable Care Act, how it saves lives, and what people stand to lose without it. Then, we can ask them to contact their representatives, too. Although they often forget and tend to go rogue, politicians work for us; we are their bosses. So let’s get in their faces, via phone and letters, and let them know that abolishing the A.C.A. isn’t just wrong—it's deeply inhumane.