On June 28, 2012, the Supreme Court, in a 5-4 decision, ruled that the historic Affordable Care Act (ACA) was constitutional. This means that starting January 2014 nearly 2 million Georgians and potentially 16 million Southerners will receive comprehensive health coverage through either Medicaid or a state health exchange.
For women, this also means coverage for a wide range of preventive reproductive health services without additional out-of-pocket costs, including Pap tests, STI screening and counseling, prenatal care, and the human papillomavirus vaccine (HPV); as well as obstetric and gynecologic care without preauthorization or referral. It also means that insurance companies can no longer charge women higher premiums than men nor can they exclude coverage for people with pre-existing medical conditions. Health insurance plans would also have to support maternal, infant and early childhood home visiting programs, which are designed to improve prenatal, maternal and newborn health, including pregnancy outcomes, childhood outcomes and reduce disparities among women of color.
While overall, women will receive better coverage and more choices in their health care, the Court also dealt a potentially serious blow to the Medicaid expansion portion of the health care law. Under the ACA, states would have been required to expand eligibility under Medicaid to all Americans with a family income up to 133% of the federal poverty level beginning in 2014 or risk losing their current Medicaid funding. Unfortunately, the court ruled that states’ participation in the expansion must be optional and that the government could not penalize those states that decide not to do the expansion.
Currently, most state Medicaid programs, particularly in the south, cover pregnant women and children within state specified thresholds. Expansion would allow individual adults, many of whom are parents, the ability to participate in the Medicaid program. If a state “ops out” of the expansion,, poor women, especially women of color, who cannot afford to buy into the state exchanges or do not qualify for a subsidy, will be in a “healthcare limbo.”
Our mission as a southern-based reproductive justice organization is to not only increase awareness about the health benefits that women gained under the ACA, but to also raise alarms about the potentially harmful impact the Court’s decision about the Medicaid expansion could have on poor women. As policymakers in Georgia and throughout the South implement the ACA, we must be vigilant to ensure that all women and their families receive affordable, quality health care, regardless of their income.