“Repeal and replace.” That has been the refrain of many conservatives who opposed the Obama Administration’s landmark health reform law, the Patient Protection and Affordable Care Act (ACA), passed exactly two years ago today. Never mind that we haven’t seen much by way of exactly what the ACA will be replaced WITH. For now, in true can-do fashion, the conservatives’ focus seems to be on “repeal.”
On Monday, the Supreme Court will hear arguments about the constitutionality of the ACA with a specific focus on the individual mandate and Medicaid expansion parts of the bill. The individual mandate element is getting is getting the bulk of the media attention, as it would require everyone to have health insurance coverage. This is a policy position that is based on the assessment that if we all had insurance (rather than just the sickest folks) it would be dramatically cheaper for everyone involved. It’s a solid economic principle, and when it’s coupled with strong regulations of the insurance industry, it can be very effective in keeping costs down. We see it at play in many other arenas of social protection: income tax and car insurance, for disparate example.
The idea is that if you get to participate in a society that protects your rights, you ought to be required to contribute something to it as well. Now, given the fact that we did not achieve federalized, universal health care through the ACA (would have been my personal preference), and we are maintaining the participation of private insurance companies in health care, we have to ensure that we make it possible for everyone to participate.
Republican lawmakers fought tooth and nail against this bill, and they are still fighting hard to try and prevent it from being implemented. White House Deputy Chief of Staff, Nancy-Ann DeParle isn’t worried about the challenge, though, stating, “We feel great about our Supreme Court argument and we feel great about where we are on implementation [of the ACA].”
So, why should we care? Three reasons why the ACA should be protected:
1) What it’s already done;
2) What it will do; and
3) What it could do.
So first, what has the bill already done, that a repeal will undo? Well, there are a ton of great provisions in the law here are some greatest hits:
- The Medicaid expansion is at the very top of my list. More poor people will get health care that they can’t afford right now, because they make too little to afford health care but just too much to qualify for Medicaid.
- Preventive care for one and all without co-pays. The list of required benefits is long, and includes: mammograms; cancer screenings, domestic violence services, HIV and sexually transmitted diseases; lactation and breastfeeding support and equipment; well-woman visits; and all FDA-approved contraceptive options. The contraceptive coverage came after a big fight, as you might remember. (Full list of all covered services.)
- Every health care plan must include maternity coverage. Plain and simple.
- No more “gender rating.” Insurance companies can’t charge women more for being women. They can’t deny them care if they’ve been pregnant before or if they’ve experienced domestic/intimate partner violence. Yes, this was legal before.
Secondly, there’s the matter of what the law will do once fully implemented. The biggest deal happens in 2014. Starting in 2014, if your employer doesn’t offer insurance, you will be able to buy it directly in an Affordable Insurance Exchange. An Exchange is a new transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Think of it like Expedia or Orbitz for health care – compare and contrast different plans that all meet quality control and cost standards. One of my favorite things about this is that in 2014, once the exchanges are operationalized, all Members of Congress will be getting their health care insurance through the Exchanges.
Thirdly, what is the potential within the ACA? This isn’t a question that we ask often. Here I offer you an important caveat to all this optimism about the ACA: the bill does not treat abortion like a valuable health service. In fact, states can choose not to offer abortion in their exchange plans, and there are roadblocks to private insurance coverage of abortion in the exchanges. Further, in most states Medicaid does not include abortion – so the gap in access to abortion care will not be directly addressed by the ACA’s Medicaid expansion.
I say this in the same moment that I talk about what the bill CAN do because while I believe that it’s offered a blow to reproductive health and I think it’s also afforded an opportunity. We’ve seen this happen in fight for contraceptive coverage.
We have to push back against the silos in this moment – abortion coverage in Medicaid and in private insurance should be mentioned in the same breath as contraceptive coverage. We can’t make these distinctions in fighting for access to the full range of reproductive health services, because our opponents certainly aren’t. For them, challenging abortion and contraception in federal health care plans is as important as challenging it in private insurance plans. We have to respond in kind.
This big, bold policy makes the argument that our government should help us get health care and make sure that we can afford it. We have to keep making the case that it ought to include the full range of women’s health care needs – preventive care, birth control, cancer screenings and yes, abortion.
So, let’s celebrate this moment. Two years ago, Congress said yes, health care is a right. Everyone should have it regardless of whether they are rich or poor. Now, we keep pushing to make sure that it’s not selective. We keep pushing to make sure it’s complete.