The fight for health equity goes on

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More than 6 million people in 34 states, including a majority of women, finally could breathe a sigh of relief when the Supreme Court ruled in King v. Burwell. Once again affirming the constitutionality of the landmark Affordable Care Act (ACA), the court upheld the law’s financial assistance for all eligible individuals and families, ensuring they would not lose coverage based on where they live.

This ruling should put to rest any doubt that the ACA is the law of the land. Five years in, it is woven into the lives of women, children and families. who cannot afford to go back.

Prior to the ACA, women often delayed or sacrificed getting the care they needed at greater rates than men. Women faced legal discrimination in insurance rates and exclusions based on pre-existing conditions, which could have included surviving intimate partner violence or giving birth via C-section.

For women of color, who face disproportionately lower wages and higher uninsurance rates than white women, these obstacles were even more deeply felt.

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Today, thanks to the ACA, an estimated 55 million women no longer face cost barriers to birth control, cancer screenings and other critical preventive care. Vital services, including care before and after giving birth, are now guaranteed. These and other protections ensure that millions more people can get the care they need without jeopardizing their economic security.

As Jews, we believe that everyone — regardless of race, income, gender or any other factor — should be able to care for their health without risking their financial future or basic needs, like housing or food. If each of us is of equal worth, created b’tselem Elohim (in the divine image), we should have equitable access to quality, affordable health care. And if we are committed to tzedek (justice) for all, we cannot stand by while barriers to care threaten our neighbors’ health, economic security or true self-determination.

While King was a strong victory, we must resist complacency. There is still much to do to ensure coverage is affordable and comprehensive.

In the District of Columbia and Maryland, local legislators have chosen to expand Medicaid, an ACA provision whereby state governments can use federal dollars to extend affordable coverage to low-income individuals and families earning up to 138 percent of the federal poverty level, or just over $33,400 for a family of four. Medicaid expansion is critical for those too poor to qualify for the financial assistance upheld in King, but not poor enough to meet pre-expansion guidelines. But in Virginia and 20 other states, politicians have refused this improvement, leaving millions without coverage. We must urge lawmakers in these states to adopt Medicaid expansion.

Affordable coverage also still remains out of reach from many immigrant women and families. Congress has preserved several restrictions imposed by the 1996 welfare reform law, denying coverage to millions of immigrants — despite being authorized to live and work in the United States and paying taxes.

Barriers include a five-year waiting period before lawfully present immigrants can access Medicaid, the Children’s Health Insurance Program (CHIP) and the health insurance marketplace. Women make up the majority of U.S. immigrants and are more likely to be young, in low-wage job and uninsured. We must urge Congress to pass the Health Equity and Access Under the Law (HEAL) for Immigrant Women and Families Act (HR 1974) —  to remove arbitrary, inhumane obstacles to care and restore affordable coverage for all lawfully present immigrants.

Additionally, we must improve access to quality coverage that includes abortion. Politicians in Congress have imposed bans like the Hyde Amendment, withholding abortion coverage from women enrolled in Medicaid and other federal health plans. While some states cover abortion with state Medicaid dollars, Congress has  barred D.C. legislators from ensuring eligible low-income residents can access care. An ACA restriction also allows state legislators to interfere in private plans, banning abortion coverage in many marketplaces.

Bans on abortion coverage harm women. They force one in four poor women seeking an abortion to carry an unwanted pregnancy to term and increase her risk of falling into poverty. However we personally feel about abortion, politicians should not be allowed to deny a woman access to care just because she is poor. In addition to harming her health and security, this interference erodes her moral autonomy. Respecting every person’s equal worth and her religious liberty means ensuring each woman can make personal health decisions, in the context of her own religious beliefs and circumstances.

Millions of women and families still lack adequate and affordable coverage. They are counting on us to push forward.

Amy Cotton is senior policy manager at the National Council of Jewish Women.

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