Repealing the Affordable Care Act Would Decimate the Social Safety Net for California Women

I was already racked with stress when the organization I had been working for shuttered. My husband was in his last year of graduate school, and I was suddenly unemployed. What was supposed to be exciting news of my first pregnancy abruptly became anxiety when faced suddenly with having very limited and costly health care insurance options.

This was my reality just a few months before the Affordable Care Act (ACA) was enacted, and I was hardly alone.

Today the provisions of the ACA protect women in my situation to ensure that they are not cut off from health care insurance if they become unemployed, and that coverage will include basic health services including maternity and reproductive health care coverage.

What changed for me and millions of women with the ACA were provisions that expanded Medicaid to cover more low-income individuals (known as Medicaid Expansion); created health insurance marketplaces where individuals and families could shop for and purchase health coverage, in many cases with federal subsidies to help bring down the cost of premiums and cost-sharing and provided protections for specific vulnerable groups such as young people, women, and people with preexisting conditions.

California lawmakers and agencies worked hard to make the ACA work for our state. Because of their efforts to fully implement the ACA, California reduced its uninsured rate by more than half, from 17 percent to 7 percent—the biggest drop of any state in the nation. Because of these efforts to provide broader access to high-quality, comprehensive health care, women now make up just over half—54 percent—of the 13.4 million Californians enrolled in the state’s Medicaid program, Medi-Cal.

Medi-Cal covers more than half of all births in the state as well as 83 percent of the state’s publicly funded family planning services. The expansion of Medi-Cal alone provided health care coverage to more than 1.8 million non-elderly adult women. In addition to insuring more people, the ACA has also provided more robust consumer protections against discrimination in health care—something women, communities of color and LGBTQ people have long faced.

Now with its so-called Better Care Reconciliation Act of 2017 seemingly doomed in the Senate, Republican leadership is now vowing to repeal the ACA. We know that a viable replacement plan is unlikely. There are simply too many hard right conservatives in Congress who have stated over and over again that their goal is to “let the ACA fail,” and how better to accomplish that goal than repeal the ACA with no replacement, regardless of the very real on the ground impacts that such repeal would have for tens of millions of Americans?

Repeal of the ACA would disproportionally harm women in California and nationwide. The California Coalition for Reproductive Freedom (CCRF), which I lead, has urged our state’s congressional delegation to stand against any effort to gut Medicaid funding or repeal the ACA. In a letter, we note that if the ACA were repealed, more than 4 million Californians “stand to lose their health care coverage, the California health system would lose tens of billions of federal dollars, consumer protections would be eliminated, and everyone would see increased health care costs.” Moreover, according to the California Department of Health Care Services, by 2027 the state would lose $30.3 billion annually in federal funding. More than 20 state and national groups working to promote reproductive health and health care rights signed on to our CCRF letter.

Access to quality health care is a right for all Californians, not a privilege merely enjoyed by the well-to-do. Politicians pushing or supporting these extreme attacks on Medicaid and the ACA must be called out for attacking the nation’s social safety net. My reproductive healthcare coverage and the coverage of tens of millions of other Californian women should never be a political pawn.

Originally posted at the CCRF blog



Juana Rosa Cavero has dedicated her career to co-creating transformative change with myriad communities that support and advance positive health and well-being. As Director of the Reproductive Justice Coalition of Los Angeles, she has led over 25 organizations in advocacy campaigns for reproductive and sexual health. She is an alum of the Women’s Policy Institute of California and the CoreAlign Generative Innovation Project at the University of California San Francisco.