Protecting the ACA is Only a Starting Point for Women’s Health Care

Now is the time to make progress in women’s access to health care—not just to hold on to the last decade’s achievements. The ACA gets us some of the way—but there is still much more we must do.

biden, affordable care act, women's health, aca
Joe Biden during a discussion on protecting the Affordable Care Act in Lancaster, Pa., on June 25, 2020. (Adam Schultz / Biden for President)

On Thursday, as part of a series of executive actions related to health care, President Biden signed an executive order to reopen enrollment on the Affordable Care Act‘s HealthCare.gov, the federal health insurance marketplace, from February 15 to May 15—the president’s first move toward keeping his campaign promise to strengthen the landmark health reform law he championed as vice president. In doing so, the president said he is “restoring the Affordable Care Act … to the way it was before Trump became president.”

But while this is a welcome first step to help uninsured Americans get coverage, now is the time to make progress and go further in women’s access to health care—not just to hold on to the last decade’s achievements.

Late last year, the Supreme Court heard oral arguments in a case challenging the constitutionality of the Affordable Care Act. The plaintiffs—a group of 20 states, led by Texas, and two individuals—argued the entire law should be struck down, and with it, the law’s benefits: the health care coverage of 20 million people, protections against gender-based discrimination in private insurance, no-cost contraception, and so much more.

Analysts and pundits seem to think that the justices aren’t buying this argument—which is likely true. The court might get rid of the mandate yet keep the rest of the law intact.

But the fact is we, women who care about feminist politics, can’t stop there. The ACA, if not overturned by the courts, gets us some of the way—but there is still much more we must do. Right now, at a time when women are paying attention and looking forward to a better kind of politics, is not the time to relish in defending ground we’ve already covered. We owe it to ourselves to harness this hard-built momentum and construct a health care system that meets women’s needs.

What would a feminist health care system look like? I envision a world in which when a woman feels sick, she can see a doctor and get the treatment she wants and needs. A world where there’s an appointment available and her wallet is not a factor. She gets the preventive care, the pap smear, the abortion, the blood test, she needs to stay healthy. A world where she just gets health care.

Real progress for uninsured women would be universal coverage. While the ACA reduced the number of uninsured Americans, many millions still lack coverage. The most recent medical expenditure data from 2019 show that about 7.5 million adult women under age 65 had no insurance coverage at all for the full year—about 7.5 percent of us. Without insurance, women are at severe risk of missing life-protecting screenings like mammograms, pap smears, and critical prenatal and contraceptive care. When women do get coverage, studies show a direct link to more equitable access and use of these services.

Progress for women is equitable access to physicians. Medicaid does a great job of meeting the basic health care needs of the nearly 18 million women covered under the program. Medicaid gets you screenings and prescriptions and even hospital and physician care at virtually no cost, or as little as $3 co-payments. This is hugely important for women’s lives and the Affordable Care Act is largely to thank. But even here we have progress to make. Women with Medicaid often have a hard time finding a doctor willing to accept this coverage. This means stretched-thin safety net providers at times unable to provide the quality of care they know their patients deserve.


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Progress for women would be an end to deductibles altogether. Private coverage is considered the gold standard of coverage, and most women have it: 73.6 million women have private insurance (75 percent). Private insurance gets a woman plenty of in-network doctors, as well as screenings and other preventive care at no cost. But should she need any other care, it can get expensive, sometimes prohibitively so.

In fact, 10 percent of women with private insurance avoided getting care within the past year due to cost alone. That’s more than seven million women—about as many women as are uninsured. Progress for women would be finally getting the peace of mind and medical care access that insurance is supposed to offer.

biden, affordable care act, women's health, aca
A Medicare for All Rally in Los Angeles in February 2017. (Molly Adams / Flickr)

A Medicare for All system would make progress on these issues. It would finance health care through progressive income taxes with no deductibles, co-pays, or private insurance premiums. A single-payer system like Medicare for All would cover every woman and would also eliminate narrow networks because all Americans, and their doctors, would be in the same single network.

We can measure every potential reform and every bit of health care news against this yard stick. Can the 7 million women without insurance obtain coverage? Can the 7 million more who have insurance but couldn’t afford it get the care they need? Can every woman find a doctor who will treat her?

We can’t squander this moment. Our eyes are open and we’re all active, paying attention, and ready to make progress on the issues of our lives.

The next round of health care reform must make progress, meaningfully weakening the grip of un- and underinsurance, narrow poor-quality networks, and those pernicious high deductibles.

Court case or not, victory will be when every single woman gets the care she needs.

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About

Naomi Zewde is a fellow at the Roosevelt Institute, and an assistant professor at the City University of New York. Zewde conducts research on how health and social policies in the United States affect households’ economic security and economic inequalities.