August 1 is a great day for women. It marks the roll-out of the Affordable Care Act (ACA) package of preventive and diagnostic care that must now be included without co-pays or deductibles as a part of every policy provided to employees by their employer. But while we celebrate, a note of caution is in order, because opponents of the new law have vowed to continue to do everything they can think of to dismantle health care reform.
First, the good news is that the new benefits mean that women can now get a free well-woman visit every year to obtain standard preventive services, and additional ones as needed. Pregnant women can be screened for gestational diabetes as appropriate, and women 30 or older can get testing every three years that can help reduce the prevalence of cervical cancer. Sexually active women can access free counseling regarding sexually transmitted infections (STIs) and obtain free HIV/AIDS testing -- critical since women have suffered a 15 percent increase in AIDS cases from 1999-2003 (dramatically more for women of color), while cases among men rose only one percent.
Family planning is an essential service that improves maternal health and leads to healthier babies. Starting August 1 under ACA, women, with the limited exception for those working for pervasively religious employers, will have access to all contraceptive methods approved by the Food and Drug Administration as well as to sterilization procedures and to related patient education. And pregnant and postpartum women will have access to the counseling and equipment needed for breastfeeding -- one of the most effective ways mothers can protect both their children's health and their own.
Finally, the ACA will ensure coverage of screening and counseling for interpersonal and domestic violence. One-quarter of women report that they have experienced intimate partner violence during their lifetimes. Screening has proved effective in the early detection of such violence and leads to effective interventions to increase the safety of abused women.
That's the good news. The bad news is that there are still committed opponents of health care reform -- dead-enders -- who want to prevent, undercut, or dismantle nearly all of what health care reform has to offer. The House of Representatives has voted at least 33 times to repeal the Affordable Care Act, the latest instance being July 11. Now House Republicans have proposed to delete all funding for the law from the 2013 fiscal year budget, and they even propose to rescind current funding for several of the law's programs.
At the state level, opponents are fighting the expansion of Medicaid in 2014 that will insure up to 17 million more poor and working class people, a majority of whom will be women. In fact the majority of women who will be newly insured when ACA takes full effect in 2014 will gain coverage through an expanded and improved Medicaid program that states can opt into. It will be funded primarily by the federal government and administered by the states. But, according to the recent Supreme Court ruling, states don't have to take the new money, and several governors have announced that they won't, leaving millions still without access to adequate affordable health care.
And the contraception controversy has not gone away. Despite the administration's fix that will allow insurance companies to pay for contraceptive coverage -- taking religiously affiliated employers out of the process-- the issue is still alive in the courts. While one lawsuit seeking to overturn the law, filed by Nebraska, Florida, Michigan, Ohio, Oklahoma, South Carolina and Texas, was just tossed out by a federal district court judge, 12 others have been filed by 43 Catholic organizations (and now one evangelical college). The plaintiffs include several dioceses, social services providers, and educational institutions that contend the contraceptive requirement violates their conscience as employers. NCJW and many others believe that women employees should not have their health care decisions dictated by their employers' religious beliefs.
So we celebrate August 1 with some trepidation. The new package of care for women without extra out-of-pocket cost represents a huge step forward. But the ongoing, relentless campaign against health care reform continues unabated. The debate before the Supreme Court and elsewhere rarely mentions those without health care and the misery, suffering, and economic ruination that results from out of control medical costs. Those of us who believe in this law must exercise unrelenting vigilance to keep it alive. Literally millions of women are depending on us.
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