15 December 2010

Court Challenge to Health Care Reform Shouldn't Slow Us Down

We knew this was coming. Ever since a slew of November election campaigns were run on a platform to repeal the Affordable Care Act (or as some people would have it, Obamacare), we’ve been anticipating an active and concerted health care reform backlash. And this Monday the battle lines were drawn. A Federal District Court judge in Virginia ruled that one of the primary aspects of the law is unconstitutional -- the provision requiring that uninsured Americans obtain health insurance. This  cornerstone of the legislation would extend coverage to almost all of today’s 30 million uninsured Americans. Although this ruling will have no effect on health care reform’s rollout -- the judge refused to require that the act’s implementation be suspended -- it does reveal the growing activism of the anti-reform cohort.

The ruling came on the heels of two new reports by Ms. Foundation grantees -- one by the National Women’s Law Center and one by the National Asian and Pacific American Women’s Forum -- demonstrating the continued threats to women’s overall health presented by income inequality and lack of insurance coverage. According to the NWLC report, women who have access to private insurance are often denied access to basic reproductive health: “In 2010, only seven states have recognized the importance of access to comprehensive maternity care -- including prenatal, birth, and postpartum care -- by requiring that these services be covered in all individual and group health plans.” Furthermore, the racial disparities in insurance coverage are staggering; “nationwide, 37.6% of Hispanic women, 32.0% of American Indian/Alaska Native women, and 23.4% of Black women do not have health coverage, compared to 13.9% of White women.“

It is obvious that our health care system, as it stands, does not provide adequate care to even a fraction of the nation. While there is much to cheer about the new legislation -- according to the NWLC report many of the 2010 improvements in health for women can be attributed to the first roll-outs of the Affordable Care Act, including mandatory private insurance coverage of preventive services (such as Pap smears, mammograms, and osteoporosis screenings) [see their report on the "Promise of the Affordable Care Act"] -- but much work remains. We must continue to make sure implementation is prioritized and provisions that secure the health of women and families are highlighted.

For the attacks will keep coming. Two previous court decisions have upheld the law, several other lawsuits have been dismissed and a major ruling in Florida -- brought to court by the Republican Attorney Generals of 20 states -- is set to be heard tomorrow. It seems unlikely that the attack through the courts will subside until a decision is made at the Supreme Court level. In the mean time, incoming House leaders have promised to ramp up the rhetoric calling for repeal.

For all of their posturing, though, a full repeal is extremely unlikely. As Austin Frakt and Aaron Carroll of Kaiser Health News argue, there is simply not enough support within Congress or among health care interest groups (who actually have a significant amount to gain from the new health care law), and the President would certainly veto any attempt at repeal. So, while anti-reform rhetoric isn't without impact -- it already served to mobilize a powerful electoral base -- it has its limits. And it shouldn't intimidate. We must continue to fight for fair and equitable implementation, and make sure the provisions that will make a difference in real people’s lives are included in the full legislation.

In truth, this is a fight that will be measured in incremental gains and losses, regarding the exchanges, Medicaid, and other aspects of implementation. Ms. Foundation grantee the National Latina Institute for Reproductive Health has focused on this unheralded side of health care reform and is passionately advocating for rights that will ensure quality access for low-income women and women of color. They are fighting to make sure that: contraception is universally covered as preventative care; the voices of impacted communities are heard before any changes to Medicaid provisions are made; and that women’s reproductive health care, language access, and children’s health are reflected as “essential health services” -- services that will be the backbone of all insurance coverage plans.

So as the anti-reform rhetoric picks up even greater steam, let's not lose sight of the need to remain vigilant in our efforts to ensure that the health care law (with all of its imperfections -- it excludes millions of immigrants and undermines women's reproductive rights, remember?) does its best to extend health care justice to those who need it most: women, low-income people and people of color. We knew the backlash was coming; now its time to gird ourselves and stand stronger than ever to improve the health of our families, our communities and our country.

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