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Rev. Debra Haffner Headshot

Sex and the Affordable Care Act

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The Supreme Court affirmation of the Affordable Care Act (ACA) is a moral victory -- and a victory for sexual and reproductive health and rights. As a religious leader, I believe that access to health care is a fulfillment of the Biblical mandate to take care of all of our neighbors. Jesus reminded his followers to take care of the sick, especially those most in need (Matthew 25:36-40). The ACA means that tens of millions of people in the U.S. will have new access to health coverage by 2014 if not sooner. I am celebrating that the ACA provisions especially benefit low-income women, people of color and lesbian, gay, bisexual and transgender (LGBT) persons.

The ACA expands access to sexual and reproductive health services in stunning ways. Most preventive sexual and reproductive health services will now be available without co-pays. The new requirements for coverage of contraceptive counseling and methods without cost-sharing have perhaps received the most media attention -- and the most opposition by the Roman Catholic hierarchy -- and indeed should be celebrated as a major advance for reproductive health. These required preventive services now also include mammograms, Pap smears, HIV and other sexually transmitted infection testing, intimate-partner violence screening and annual well-woman visits. Reproductive and sexually health services broadly defined are now to be understood as preventive health services that should be available to all.

The ACA improves health care coverage for women and LGBT persons in many ways. Insurance coverage will no longer be allowed to use "gender rating" which has meant that women are often charged up to 150 percent more for identical health insurance coverage. Strikingly, the state health care exchanges, to be implemented in 2014, are explicitly forbidden from discriminating on the basis of sexual orientation or gender identity in any of their activities, even if the state's law would allow such discrimination.

The ACA does not allow insurers to deny coverage for pre-existing conditions, which has particular significance for sexual and reproductive health. People with HIV or AIDS will be able to obtain health insurance. Individuals going through gender transitions cannot be denied health care coverage. Women with histories of post partum depression, sexual violence or mental health illnesses -- often considered pre-existing conditions -- can no longer be excluded from coverage.

The ACA is not a panacea, and many people -- including myself -- still believe the U.S. needs health care reform not just health insurance reform. The Supreme Court did strike down the "major expansion of the joint federal-state Medicaid program," leaving "a potentially sizable hole" in "access to affordable coverage." Further, it would be naïve to believe that the political pressure to negate the Supreme Court's ruling will ease any time soon.

Even so, as a religious leader with a faith based commitment to health care, including sexual and reproductive rights, I am celebrating this historic Supreme Court decision -- and committing to ensuring its provisions to take care of the most marginalized and the most vulnerable. The words, "Truly I tell you, just as you did it to one of the least of these who are members of my family, you did it to me" should remain in our hearts and our actions.