With Liberty and Access for Some: The ACA's Disconnect for Women's Health

Abstract

The ACA denies to women the "basic security" of providing insurance for a procedure that statistics show one in three women will need during their reproductive lifetime. On one hand, the access-enhancing elements of the ACA are likely to help women, who earn lower wages, need more medical care, and live longer than men, to gain access to preventive and regular healthcare and to keep the insurance that they have. On the other hand, poor women and women of color will lose ground in access to abortion, because the ACA prevents insurance payment for abortions through both public and private insurance. This new set of federal funding limits contradicts and undercuts the access enhancing goals of the ACA. Further, by inviting state lawmakers to limit insurance coverage of abortion, the ACA amplifies existing barriers to women’s reproductive care and further detaches abortion from holistic treatment of women’s medical needs.

The ACA is likely to exacerbate the class divide in abortion services. Women with private health insurance who historically have had health plans that cover abortion will likely continue with this coverage. But the millions of women who will rely on Medicaid and tax subsidies to pay for private insurance in the Exchanges will be subject to the Hyde Amendment with no alternative but to sacrifice life necessities to access a legal, non-experimental medical procedure. The decision in NFIB v. Sebelius contained federalism-enhancing language that may protect states that buck the anti-abortion tenor of the ACA, but it may also protect those states that have increased their abortion restrictions by preventing private insurance coverage of abortion. Whether such state limitations will give rise to additional access problems remains to be seen. In the meantime, women’s sexual health remains a political football.

Keywords: ACA, health, women, spending, abortion, NFIB v. Sebelius