The Senate has just made it easier to repeal the Affordable Care Act (ACA). According to the New York Times, a Republican majority worked last night "approving a budget blueprint that would allow them to gut the health care law without the threat of a Democratic filibuster." This does not mean the ACA has been repealed, but it is a strong political signal that warns it will be.
Janel George, the director of Federal Reproductive Rights and Health at the National Women's Law Center, says that last night's hearing was preemptive, but that a budget reconciliation process will later determine exactly which provisions of the ACA are going to be repealed. If such a repeal occurs, George says that the results would be devastating to the progress made for women's health and the health of LGBT Americans.
For instance, before the ACA was made law, "the health market place was a discriminatory place," George explains. Prior to the passage of the ACA, it was legal for insurance providers to deny coverage based on pre-existing medical conditions, which negatively impacted women. Pre-existing conditions "can range from anything from prior pregnancies [to] trans individuals who've undergone transition surgeries," George explains. Without the ACA, insurance companies are allowed to "indiscriminately deny coverage."
"Women were routinely charged more than men for insurance coverage; one study found this cost women $1 billion in one year," George says. She adds that such coverage was insufficient despite its high cost: "Most plans did not even include maternity coverage for women," she says. The ACA, conversely, requires maternity benefits.
She also cites the significance of mental health care. Under the ACA, mental health coverage expanded, which is crucial for LGBT youth in particular, George says, adding that it has been historically difficult for LGBT people to receive care at all, as they were often denied treatment or treated differently than straight people.
The ACA has also expanded coverage to people of lower income, those who didn't qualify for Medicaid prior to the ACA but who couldn't afford private health insurance. Because the ACA expanded Medicaid coverage, more low-income women and LGBT Americans gained health care coverage. "Thanks to the Affordable Care Act, 20 million Americans have gained health insurance coverage," says Kimberleigh Joy Smith, senior director of community health planning and policy at Callen-Lorde Community Health Center in New York City. Smith highlights the significance of preventative care in lowering healthcare costs overall as well as in keeping people well before their health is at its worst, which would require a costly visit to the emergency room.
Thanks to the Affordable Care Act, 20 million Americans have gained health insurance coverage.
If the ACA is repealed, George worries that our society would return to "the battle days" for health care, where people lack coverage and fight against discrimination in obtaining care.
Even Republicans are concerned about undoing the ACA without having an alternative plan in place. According to ABC, Sen. Susan Collins, a Republican from Maine, worries about "people falling through the cracks or causing turmoil in insurance markets."
One provision of the ACA may represent the urgency of this situation most clearly: Section 1557, the Nondiscrimination in Health Programs and Activities rule. This provision of the ACA that broadly protects against discrimination. Section 1557 has been the subject of controversy—inciting reactionary lawsuits by opponents to legal equality—because it provides protections for transgender people seeking medical health coverage. But Section 1557 is bigger than trans issues. It is a broad, sweeping provision that protects many people from discrimination: "for women, on the basis of sex, but also race, color, national origin, age, disability, gender identity, and sex stereotypes," George explains, underscoring the landmark nature of the ACA.
This was the "first broad federal prohibition against this kind of discrimination in the health sector," George says. "This was huge in the health sector."
"[Section 1557] covers things like pap tests for transgender men with a cervix. Basic healthcare for Americans that should be protected under the law to help bridge the gap in health disparities that we know exist for LGBTQ people," Smith explains. "Disruption or repeal of the Affordable Care Act not only jeopardizes the healthcare for the millions who depend on it but has the potential to reverse the progress we've made towards achieving health equity in this country."