Stakes Are Huge in High Court ACA Hearing Today

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Credit: Mark Fischer on Flickr, under Creative Commons

(WOMENSENEWS)– When the Supreme Court hears arguments on March 4 in King v. Burwell women will have a lot riding on this case concerning the Affordable Care Act. Just as women gained so much from the passage and implementation of the ACA, they stand to lose big as well.

The high court will determine whether individuals and families who purchase insurance from federally-facilitated health insurance marketplaces can continue to receive financial help–in the form of tax credits–with their health insurance premiums, or if the tax credits are only available in states that opted to run their own marketplaces. The justices’ decision will come by early summer.

It will have a significant impact on the nearly 3 million women who are enrolled in health insurance through the federal marketplaces. In fact, the majority of new enrollees in these marketplaces are women.

The tax credits not only make health insurance more affordable, they are essential to making the ACA work for everyone. The tax credits are part of the law’s three-legged stool of affordability, access to coverage and individual responsibility. When you eliminate one of the legs, the law falls apart, putting women at risk of going back to the bad old days.

Opponents of the law know how critical tax credits are to making the law work. That is why they have targeted eligibility for tax credits in this lawsuit and believe they have found a soft spot in how the law describes individuals who are eligible for these credits.

Potential ACA Unravelling

But the Affordable Care Act is perfectly clear: All Americans who purchase coverage through a health insurance marketplace, and meet other key criteria, can receive this help to lower their health insurance premiums. This could not be more important, particularly for women. If people no longer have access to tax credits to make coverage affordable, the insurance market could quickly destabilize and unravel the ACA’s hard-won insurance reforms.

First, without the tax credits to lower the costs of premiums, coverage becomes prohibitively expensive.

Many people would then qualify for a hardship exemption; meaning they are no longer legally required to have health insurance because it costs more than 8 percent of their income.

Meanwhile, people who really need health coverage–older Americans, individuals with complex conditions and people with chronic diseases–would stay in the market. Health plans would be largely covering people who really need health care services, so they couldn’t spread the financial risk across healthy and sick enrollees–leading to even higher premiums.

At that point, the health insurance market would be so disrupted that other parts of the law–the ban on pre-existing condition exclusions, the end of gender rating, benefit improvements and other reforms–would be up for grabs, too.

The ACA is one of the biggest advancements for women’s health in a generation.

Prior to this historic law, women who wanted to purchase insurance in the individual market were routinely denied coverage because they had "preexisting conditions" such as pregnancy, a cesarean delivery or because they were survivors of domestic violence–in practice, just being a woman was a preexisting condition. When women were offered a plan, it lacked coverage for essential services such as prescription drugs and maternity care, and insurance plans often charged women more than men, a practice known as "gender rating."

A Supreme Court decision that has the effect of eliminating tax credits could result in millions of Americans becoming uninsured and could leave women and their families worse off than before the law.

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