An Important Victory Includes Shadow of Uncertainty

Last week, in a 5-4 ruling, the Supreme Court declared that the Affordable Care Act (ACA) is constitutional. As one of the most contested issues of our time, this decision is a huge victory for the nearly 50 million uninsured Americans and represents a tremendous financial gain for women. While the Court agreed that the Commerce Clause did not grant the federal government power to impose an individual mandate (the ability to impose a financial penalty on those who could and did not purchase health insurance), the Court decided that the federal government certainly has the authority to levy taxes on Americans, meaning the federal government could impose a select tax on individuals who did not buy health insurance.

The decision may seem like a bunch of confusing, constitutional and political maneuvering (and the national media have certainly enjoyed dissecting the electoral implications of the decision and the the penalty v. tax debate), but we cannot forget or ignore that this decision, by preserving the ACA (since the four dissenting justices would have thrown out the whole law), is a vital victory for women across the country.

The ACA ensures a great many protections for women. One of the legislation’s greatest achievements is the elimination of a practice known as “gender rating”, or when insurance companies charge women more than men for comparable coverage simply because they are women. The National Women’s Law Center recently reported that in states without a “gender rating ban” over 90% of the best selling plans charged women more than men, and only 3% of them even cover maternity services. Eliminating this practice will save women and their families over $1 billion dollars-and we’re still debating the presence of gender inequity? In addition to that billion dollars saved, much of women’s basic preventative care will now be covered without copays including contraception, Pap tests, mammograms and domestic violence screenings. The ACA also parses out what constitutes as a “preexisting” condition. Insurance companies have been able to deny women coverage or charge a higher premium solely because of their gender, or if they were pregnant, a survivor of sexual abuse and assault or even previously given birth through a Caesarean section. These practices are now prohibited. The list of successes continues on as the ACA grants maternity care, mandated breaks for nursing mothers, and a private place to breastfeed in the workplace.

The Court’s decision was not all positive news though, as the majority decision limits the federal government’s power to rescind Medicaid funds if states do not expand coverage to low income families, as the ACA prescribes. The ACA aimed to expand the eligibility level to those with incomes up to 133% of the poverty line, extending coverage to 17 million Americans. Administration officials are confident that states will not drop out of the program because the federal government will pay for the entire cost of the expansion from 2014-2016 and then almost 90% of the costs thereafter. Unfortunately, the number of states who have said they might opt out is increasing. The Washington Post’s infographic shows who would be at risk if states opt out of the expansion. This prospect is certainly disconcerting as the expansion of Medicaid was a very significant element in ensuring universal coverage.  If states walk away, this will leave millions of individuals at risk without needed coverage. Check out this interactive map to see how your state would fare if they declined the expansion.

The Court’s decision, in effect, passes responsibility for ensuring this expansion to all of us. Although the ruling is a substantial gain for millions of Americans and especially women, the uncertainty surrounding Medicaid expansion should cast a shadow over our collective excitement. We cannot allow politicking to interfere with the right to decent and affordable health care. We need to let our representatives and governors know that not participating in the expansion is a short-sighted decision that will impose significant harm on vulnerable families.

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