This Article will scrutinize the separation of abortion from other aspects of women\u27s health through the vehicle of the Patient Protection and Affordable Care Act (ACA). Part I will examine briefly why the fragmented nature of American healthcare has facilitated the separation of abortion from women\u27s health, despite the fact that abortion is a medically necessary procedure for many women. To that end, this Part will explore the disjointed history of access to medicine juxtaposed against the strangely non-woman-centric nature of the fundamental rights at play in reproductive health. Part II will provide an overview of the ACA to explain the spending elements of the ACA that magnify greatly the limits on access to abortion in both public and private health insurance programs. Part III will summarize the jurisprudential changes resulting from National Federation of Independent Business v. Sebelius and analyze three ways in which NFIB affects women\u27s health under the ACA

Huberfeld, Nicole

English

University of Kentucky

With Liberty and Access for Some: The ACA\u27s Disconnect for Women\u27s Health

The ACA denies to women the  basic security  of providing insurance for a procedure that statistics show one in three women will need during their reproductive lifetime. On one hand, the access-enhancing elements of the ACA are likely to help women, who earn lower wages, need more medical care, and live longer than men, to gain access to preventive and regular healthcare and to keep the insurance that they have. On the other hand, poor women and women of color will lose ground in access to abortion, because the ACA prevents insurance payment for abortions through both public and private insurance. This new set of federal funding limits contradicts and undercuts the access enhancing goals of the ACA. Further, by inviting state lawmakers to limit insurance coverage of abortion, the ACA amplifies existing barriers to women’s reproductive care and further detaches abortion from holistic treatment of women’s medical needs.
The ACA is likely to exacerbate the class divide in abortion services. Women with private health insurance who historically have had health plans that cover abortion will likely continue with this coverage. But the millions of women who will rely on Medicaid and tax subsidies to pay for private insurance in the Exchanges will be subject to the Hyde Amendment with no alternative but to sacrifice life necessities to access a legal, non-experimental medical procedure. The decision in NFIB v. Sebelius contained federalism-enhancing language that may protect states that buck the anti-abortion tenor of the ACA, but it may also protect those states that have increased their abortion restrictions by preventing private insurance coverage of abortion. Whether such state limitations will give rise to additional access problems remains to be seen. In the meantime, women’s sexual health remains a political football

bepress Legal Repository