Life After King v. Burwell: Addressing Ongoing Challenges Under the ACA

Moving forward, however, we have more work to do to ensure that everyone who needs coverage can get it, and that the most marginalized and vulnerable women in U.S. benefit from the ACA’s vision and goals.

In the coming months and years, the National Women’s Health Network (NHWN) and our partners in Raising Women’s Voices for the Health Care We Need (RWV) are gearing up to tackle the more vexing affordability and accessibility barriers that undermine full access to health coverage. Here’s what we’ll be working on:

Closing the Coverage Gap

Twenty-one states, mostly in the conservative South, have not expanded Medicaid to low-income adults who live at or below the Federal Poverty Level (which is $23,850 for a family of 4). This means that at least 3.5 million vulnerable women watch health care reform’s benefits disappear at their state borders — preventing them from accessing comprehensive affordable health coverage and the care they need and deserve. We are working with our RWV Regional Coordinators to build public pressure on state representatives to expand Medicaid coverage and close this coverage gap.

Ending discriminatory cost-sharing and prescription drug formulary restrictions

In clear violation of Federal rules, many insurers continue to force people with life-threatening and/or chronic conditions (i.e. people living with Multiple Sclerosis or HIV) into the highest-priced tiers for the drugs they cover. This makes co-pays and coinsurance rates prohibitively expensive for essential, life-saving medications. Additionally, too many women forego needed care because their out-of-pocket costs and insurance plan deductibles are simply too high to be affordable. And, women who seek care outside of an inadequate or overly-restrictive networks are, too often, faced with astoundingly high medical bills. More work urgently needs to be done to ensure that out-of-pocket costs are affordable and don’t hamper access to health care.

Eliminating Bad Medicaid Waiver Policies

A troubling trend is emerging as a growing number of state legislatures seek waivers to the Medicaid expansion process. Some states are proposing Medicaid expansion that undermines health access, disrupts long-standing consumer protections, and unfairly targets low-income people. For example, some states are trying to add policies to Medicaid services that would burden consumers with excessive premiums, co-pays, work requirements, and/or coverage drop provisions. Legislators are also attempting to place restrictions on necessary services, like non-emergency transportation. More needs to be done to bring women’s unique voices to champion the importance of maintaining consumer protections for millions of families who rely on Medicaid.

Ensuring Protections for Women Purchasing Insurance in Marketplace Plans

Women’s health advocates are working on the state level to create a special enrollment period for pregnancy, so uninsured women who unexpectedly become pregnant can obtain health insurance and gain access to prenatal services when they need it. Currently, many uninsured pregnant women do not automatically qualify for pregnancy-related Medicaid or Children's Health Insurance Program (CHIP) coverage, and can’t access maternity coverage outside of the marketplace enrollment period, because pregnancy is not a qualifying life event that triggers a special enrollment period.   Thus far, the Administration has not granted this much-needed and commonsense accommodation. Additionally, too many working families are currently barred from receiving tax credits to buy health insurance on Exchanges due to the “family affordability glitch.” Under this glitch, low- and moderate-income workers who have employer-based coverage face a quandary if the cost of an employer’s individual coverage is deemed “affordable,” but the costs don't include coverage for their family. The “affordable” designation prevents families from accessing tax credits to help buy insurance for dependents on the Marketplace. We’re working to fix these problems and make health insurance accessible and affordable for millions of Americans.

Defending the ACA and Expanding Other Safety-Net Programs

Despite the recent Supreme Court win, we can expect conservative Members of Congress to continue attacking the ACA for the remainder of this administration. Over the next few months, we also expect Congress to attempt to defund the ACA and attack Federal initiatives that expand eligibility for the ACA. We also expect to see efforts to roll back the rule requiring large employers to provide coverage for full-time employees who work 30 hours/week. (Opponents of this rule want it changed to only cover employees who work 40 hours/week, a shrinking part of the workforce.) And, we expect conservative policymakers to attack other essential safety-net programs (like CHIP and Ryan White), which enable millions of Americans to get comprehensive health care.

Despite these formidable challenges, the NWHN and RWV will continue working with our network of state-based allies to ensure that health care reform becomes affordable and accessible for every woman in the U.S. — no matter where they live or how much they earn.

Coco Jervis, J.D., is a former NWHN Program Director. With a focus on AIDS and HIV, and a law degree from Howard University School of Law, she expertly advocates for sexual and reproductive health. Coco continues her activism today as the Grant Manager for the feminist organization MamaCash.

Read more from Coco Jervis.