Turning Back the Clock on Women's Health in Medically Underserved Communities

Abstract

The Affordable Care Act (ACA) represents a watershed for women’s health policy in the United States. Among its many advances, the ACA establishes coverage of women’s preventive health services without cost-sharing as a near-universal standard for public and private health insurance. All contraceptive methods approved by the U.S. Food and Drug Administration are part of this coverage standard, which is also integrated into Medicaid (U.S. Department of Health and Human Services, Health Resources and Services Administration, 2011; 42 U.S.C. x300gg-13; 42 CFR x147.130; 42 U.S.C. x1396). But the struggle continues in the ongoing effort to turn promise into reality, and unfortunately, poor women have been a main casualty during 5 long years of crushing implementation battles. The most prominent battle, perhaps, has focused on the ACA’s Medicaid expansion. The poorest residents of 20 states, including close to 1.9 million women of childbearing age, remain without the law’s promised reforms, because their state refuses to participate in Medicaid, an option made possible by the United States Supreme Court’s decision in 2012 in National Federation of Independent Businesses v. Sebelius (Salganicoff, Ranji, & Sobel, 2015).1 Although Alaska and Montana have recently moved to expandMedicaid, bringing total participation to 30 states and the District of Columbia, the states that continue to hold out probably will not elect to participate any time soon. The struggle extends beyond Medicaid. Had the United States Supreme Court not turned back a lethal challenge to the ACA’s insurance expansions in King v. Burwell (2015), millions more