Health Care on Life Support? What’s at Stake in the Elections

It’s just days until Election Day, and women’s votes are more crucial this year than ever. We must have not only the will, but also a firm grasp of what we need to hold candidates at all levels accountable for policies that work toward social justice and equity for women.

What’s at Stake is a new bi-weekly series of abbreviated excepts from Ms. money editor Martha Burk’s book “Your Voice, Your Vote 2020-2021.” Using an intersectional approach of gender, race and class to issues ranging from health care to Social Security, violence, pay equity, LGBTQ rights, reproductive rights, the ERA and everything in between, Your Voice, Your Vote is a must for arming activists with the facts for meaningful change. A signed copy benefiting Ms. can be ordered here.

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Rally in support of the Affordable Care Act in front of the U.S. Supreme Court in Washington DC. in March 2012. (LaDawna Howard / Flickr)

Health care is a top issue on the minds of most voters. A great deal is at stake for women—not only because of the coronavirus pandemic, but the looming Supreme Court battle. A case brought by the Trump administration seeking to overturn the Affordable Care Act (ACA) will be heard by the Supreme Court on November 10, and women will lose big if a conservative majority prevails.

There is no single “health care system” that provides insurance coverage for illness in the U.S. There are several (one of which is none—which is the case for 44 million Americans), depending on age, income and job status. 

There are deep disagreements—about who should provide it, who should benefit, how much it should cost, and whether it is a right or a privilege. 

In a nutshell, here’s what we have now:

  • By far the most common healthcare in the United States is privately purchased by employers and individuals from for-profit insurance companies (regulated by ACA rules, some weakened under Trump).
  • Traditional Medicare covers seniors, with the option of purchasing supplemental coverage from private companies for expenses not paid by Medicare.
  • Medicare Advantage (MA) are plans with the same benefits as traditional Medicare, but sold and administered by private insurance companies. Some offer more benefits than traditional Medicare, but choice of doctors, hospitals and specialists is limited.
  • Medicaid is a federal insurance program administered by the states covering very low income people. Rules on coverage vary considerably from state to state.
  • The Children’s Health Insurance Program (CHIP) is a federal program administered by the states for uninsured kids whose families cannot afford insurance, but earn too much to qualify for Medicaid.
  • Veteran’s Administration Health care is the federally run system for current and former members of the Armed Forces. Facilities belong to the federal government, and providers are federal government employees.

Private Insurance and the Affordable Care Act

When the ACA passed in 2010 after much national debate, it brought sweeping changes to the private insurance market which covers the vast majority of Americans. But contrary to red-hot rhetoric, it did not change the basic for-profit structure or in any way convert the system to a “government-run” one. 

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A February 2017 rally in support of the Affordable Care Act. (Ted Eytan / Flickr)

Here are the ACA’s major provisions:

  • Prohibited insurers from denying coverage to individuals due to pre-existing conditions. Before ACA, insurers routinely declared previous pregnancy or miscarriage pre-existing conditions, along with many other conditions.
  • Required insurers to offer the same premium to all applicants of the same age and location without regard most pre-existing conditions (excluding tobacco use).
  • Outlawed “gender rating” in insurance, the common practice of charging women more than men for the same coverage.
  • Prohibited discrimination against LGBTQ people in the health system.
  • Required small group and individual plans to cover 10 essential health benefits, including maternal and newborn care.
  • Required preventive care for women, including approved contraceptives and sterilization procedures (religious organizations exempted).
  • Banned dropping sick policyholders and annual or lifetime coverage caps on essential benefits.
  • Banned co-payments or deductibles for contraception and preventive care, including mammograms, vaccinations and screenings.
  • Allowed states to expand Medicaid eligibility (overwhelmingly women and kids), with the federal government picking up 100 percent of the cost, declining to 90 percent by 2020.
  • Maintained long-standing Hyde Amendment restrictions prohibiting using federal funds for abortions (rape, incest, life endangerment excepted).
  • Maintained federal “conscience” protections for health care providers and facilities that object to performing abortions or sterilization procedures.
  • Allowed states to prohibit abortion coverage in qualified ACA health plans. As of July 2019, 26 states had done so.

If the ACA is repealed, all of the above rules and policies—except the Hyde Amendment—will become moot or disappear.

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President Trump campaigned on repealing the Affordable Care Act throughout 2016. By 2018 the Republican-controlled House had voted more than 60 times to repeal it. A repeal effort in the Senate in 2017 failed by a single vote.

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A rally in support of the Affordable Care Act in March 2012. (angela n. / Flickr)

The Trump administration has systematically weakened the law by repealing the individual mandate, expanding “junk insurance” not subject to ACA requirements, allowed insurers to invoke “conscience clauses” to deny birth control coverage and allowed states to curtail Medicaid coverage.

Trump has said Republicans are planning an ACA replacement that will be “far better than Obamacare” to be revealed after the 2020 election. No doubt as a result of declining poll numbers, he recently signed a completely meaningless executive order stating a “policy” of preserving protection for pre-existing conditions, that has no force of law.

The Looming Health Care Crisis for Women

While all of these problems did not instantly go away with passage of the ACA, the most discriminatory ones for women did. Though the ACA is still the law (though weakened by the Trump administration) it could disappear very soon.

The Supreme Court is scheduled to hear arguments from the Trump administration negating the law on November 10. Justices seated by that date will rule on the challenge. While not a certainty, there is every indication that if Trump nominee Amy Coney Barrett is confirmed by that date, she will vote with the conservative majority to overturn the ACA.

It is imperative that women make their voices heard not only on the nomination, but also at the ballot box.  Though it wouldn’t happen instantly if the ACA is overturned, a new version could be passed if Trump is defeated and with strong pro-woman majorities are elected in the House and Senate.

Health Care-Related Questions to Ask Political Candidates

Here are a few questions to put before candidates seeking your vote:

  • Did you, or would you have, supported the Affordable Care Act?
  • Are you in favor of repealing the ACA, and if so, what would you replace it with?  Please be specific.
  • If the ACA is repealed, we will lose protection from being dropped or excluded for pre–existing conditions, and once more face arbitrary caps and cessation of coverage by insurance companies.  What would you do about that?
  • If the ACA is repealed, insurance companies will be allowed to go back to charging women more than men for the same coverage.  Do you think this is okay?
  • Do you think birth control and mammograms should be covered without co-pays or deductibles?  What about Viagra-type drugs?


Martha Burk is money editor at Ms.