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How the Affordable Care Act Made Healthcare More Equitable

What the Supreme Court Ruling Could Mean For Access to Birth Control, Prenatal Care, and More

The United States  Supreme Court building in Washington DC, USA.

Editor's Note: We at POPSUGAR recognise that people of many genders and identities, including but not limited to women, may or may not have female sex organs such as uteruses or vaginas. This particular story includes language from government agencies and other organisations that generally refer to people with female sex organs as women.

On Nov. 10, the Supreme Court will hear the latest challenges to the Affordable Care Act (ACA), and the entire law could be at stake. While the ramifications of that decision could be devastating for the estimated 20 million people who gained insurance coverage under the ACA — including more than 2 million young people who have been able to stay on their parent's plan until age 26 — there are also sweeping consequences for every American with health insurance.

One of the most important advances the ACA made was the guarantee of no-cost-sharing coverage of preventive services, which in the past, placed a disproportionate burden on people with female sex organs. These services include prenatal care, mammograms, contraceptives, screenings for cervical cancer, and more — and while they're essential for everyone, expanding access is an important step in tackling the pervasive health disparities that exist for people of colour.

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While it's too soon to predict how the hearing will go on Nov. 10 — after all, the Senate still has an opportunity to confirm Supreme Court nominee Amy Coney Barrett, who's been critical of past decisions upholding the ACA — it's important to know exactly what's at stake. Here are five ways the ACA made healthcare more fair for all.

1. The ACA Banned the Practice of "Gender Rating"

The ACA prevents individual and small group plans from engageing in the practice of gender rating, or charging a person more for the same coverage, based on their sex. The National Women's Law Centre found that gender rating cost women approximately $1 billion more per year than men. Before the ACA, only 14 states had taken steps to limit gender rating for individual plans, and only 17 had done the same for group health plans, making the federal ban even more crucial.

2. The ACA Mandated Coverage For Preexisting Conditions

With few exceptions, insurance companies can no longer refuse coverage or upcharge because of a preexisting condition, which before the ACA, could include pregnancy, past C-sections, breast cancer, irregular periods, and even a history of rape or domestic violence. The list was so exhaustive and discriminatory that, before the ACA was passed, the National Women's Law Centre launched a campaign focussed on the messageing that being a woman is not a preexisting condition.

3. Under the ACA, Preventive Care Is Often Covered at No Cost

The importance of preventive healthcare can't be overstated. It improves life expectancy, reduces the incidence of chronic disease, improves the management of these conditions, and decreases healthcare costs. It's also a key provision of the ACA, which requires a number of vaccinations and screenings — for heart disease, diabetes, sexually transmitted infections, and more — to be covered without a copay or coinsurance, as long as they're provided in-network. The ACA also offers exclusive benefits for women, including mammograms and cervical cancer screenings.

Preventive services are particularly important for people who could become pregnant. According to the Centres For Disease Control, 700 women die of pregnancy complications each year in the US. A healthy pregnancy begins before conception and continues with prenatal care, which includes early recognition and management of complications that may arise. The services provided to pregnant women by the ACA are crucial to lowering that number, particularly for Black and indigenous women, who are two to three times more likely to die from pregnancy-related causes.

4. The ACA Required Insurers to Cover Birth Control

Under the ACA, health insurance plans must cover all FDA-approved birth control methods, without charging a copayment or coinsurance, as long as the patient stays in-network. However, because of a regulation imposed by the Trump administration, employers with religious or moral objections can now opt out of contraceptive coverage. This regulation was challenged all the way up to the Supreme Court, where it was upheld 7-2, with the late Ruth Bader Ginsburg as one of two dissenters.

5. The ACA Expanded Services For Pregnant Women

In addition to preventing discrimination against pregnant women and ensuring they get the preventive care they need throughout their pregnancy, the ACA requires most health insurance plans to provide breastfeeding support, counseling, and equipment for the duration of breastfeeding, including a breast pump.

Image Source: Getty / YinYang
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