(WOMENSENEWS)--The Supreme Court upheld the gist of the Affordable Care Act Thursday, reported the Los Angeles Times, including the individual mandate requiring everyone to have insurance or face a penalty. Those who purchase insurance individually can qualify for subsidies to help with the cost, according to Kaiser Health News, if they make less than 400 percent of the poverty level, which was about $43,000 in 2011.
That requirement ensures that the system's savings from covering healthier people who need fewer services help pay for those who need more medical attention. Those with pre-existing conditions have long been unable to buy insurance because insurance companies claimed it was too expensive.
The preservation of the individual mandate is a victory for President Obama, Democrats and women, said Karen Davenport, director of health policy at the Washington-based National Women's Law Center.
In an interview Wednesday, on the eve of the ruling, Davenport said upholding the entire law "would be best for women" because of the myriad ways it benefits women.
Steven R. Shapiro, ACLU legal director, also said in a statement Thursday, "The ACLU welcomes today's decision . . . The decision is especially welcome for disadvantaged minorities, who are more likely to be uninsured, and for women, who are more likely to suffer gaps and discrimination in their health care coverage.
The court ruled that the individual mandate is constitutional, but not under Congress' ability to regulate commerce--as argued by the administration--but because of Congress' ability to impose taxes. The court upheld the individual mandate because the penalty for not purchasing insurance was in the form of a tax.
However, the court gave states leeway not to expand Medicaid, the current health program for low-income Americans. To qualify for Medicaid, low-income individuals also had to have an additional financial burden – having children or being pregnant, for instance. The expansion allows all low-income people, or those under 133 percent of the poverty line, to qualify, according to NPR.
The potential limiting of Medicaid expansion -- which has not received as much attention as the individual mandate -- could be of concern, especially to low-income women.
Medicaid expansion was one of the most important aspects of the law, Davenport said, because it would insure over 10 million more women. "Half of coverage gains" are through Medicaid expansion, she said.
The court found Medicaid expansion constitutional and said states must comply if they accept funds to expand Medicaid, according to C-SPAN. The federal government would be paying about 90 percent of the cost of the expansion, according to Davenport. But the court also ruled that Congress cannot "penalize States that choose not to participate in that new program by taking away their existing Medicaid funding."
Although the federal government would take on the financial burden of expansion, states with ideological objections could turn down the extra funding.
In the 5-4 decision, Justices Elena Kagan, Sonia Sotomayor, Ruth Bader Ginsberg and Stephen Breyer were joined by conservative-leaning Chief Justice John Roberts, Jr., the crucial fifth vote.
According to the National Women's Law Center, the Affordable Care Act enacted a number of provisions to ramp up women's health care.
For instance, it requires insurance companies to cover individuals with pre-existing conditions, which can include a previous Caesarean section, pregnancy while seeking coverage, and receiving treatment for domestic or sexual assault.
Under the law, women cannot be charged higher premiums than men of the same age. In states where it is legal – 14 states ban or limit "gender rating" on the individual market – 90 percent of the best-selling plans charge a 40-year-old woman more than a 40-year-old man. Even when insurance is obtained through an employer, in fact, organizations that employ mostly women face higher premiums.
Health reform also requires plans in the individual insurance market to cover maternity care, which only about 13 percent of such plans did in 2009.
In a nod to the ongoing partisan controversy over health reform, Davenport said, "No matter the outcome, we will certainly be talking about this through November."
The ruling drew fighting words from Republicans.
"Today's ruling underscores the urgency of repealing this harmful law in its entirety," Speaker of the House John Boehner, R-Ohio, said in a written statement, reported the Washington Post June 27.
An advisor to Mitt Romney told the National Review that the Republican nominee would "do away with all of it once he becomes president."
Samantha Kimmey is a writer in Brooklyn, N.Y. covering women and politics this election season.
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