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Who’s at stake in King v. Burwell

The Supreme Court heard oral arguments this week in King v. Burwell, a case challenging to the workings of the Affordable Care Act. What’s at stake? Whether those who buy insurance through the law can get the help they need no matter where they live. 

But the far more important question is who is at stake? This case is not really about the language of the law. Rather, it is about the survival of the Affordable Care Act’s financial underpinnings and, one could say without exaggeration, the survival of 41 million Americans who would not have access to life saving health insurance if it were not for the Affordable Care Act. They are people of every religious and ethnic background, and include those who already face barriers to health care, such as members of the LGBT community, persons with disabilities, and those geographically or otherwise isolated. Jewish values – indeed universal values – call upon us to care for each and every individual, as we are each created in the divine image. That is the spirit in which we must consider this political struggle.

{mosads}Where were we as women before the Affordable Care Act became law? Not in a good place. According to the National Women’s Law Center, seven in ten women were either uninsured or underinsured, struggling to pay a medical bill or deal with another cost-related problem in accessing needed care. More than half could not get the care they needed because of cost. They didn’t fill a needed prescription; they skipped a medical test; or they could not afford to see a doctor when they needed to. The situation was most dire for African American, Hispanic, and Native American women, who reported such problems two to three times as often as white women. Insurance often failed to cover contraception, now required by the new law. 

Six years ago, before health care reform, women were more likely to obtain insurance through a male spouse, because they were more often working part-time and in lower wage jobs with no access to insurance on their own. Therefore, they lost insurance more often than men because of divorce or widowhood.  

Indeed, women just have less money than men. Fifteen million women are single heads of households, compared to only six million men. And those women have a median income of $35,000 compared to $51,000 for single men who head households. Women in general are paid 78 cents on average for every dollar a man earns. The ratio is worse for African-American and Hispanic women, more than half of whom live in poverty or near poverty, both because of the wage gap and because they are employed in lower wage jobs. So it is not surprising that almost a quarter of women of color could not afford to visit a doctor, compared to 15 percent of white women.

Before the Affordable Care Act, it was legal in 38 states to charge women or their employers more for insurance compared to men – even when maternity benefits were excluded. In practice, insurance could cost as much as 40 percent more for women than men for the same package of benefits. Insurance companies could deny coverage for pre-existing conditions or charge more for those with a history of health problems that disproportionately affected women. One of the most egregious practices allowed insurance companies in eight states and the District of Columbia to label domestic violence a “pre-existing condition” and deny coverage to its victims. 

When we think of what is at stake in King v. Burwell, it’s easy to lose sight of who is at stake: our own daughters, sisters, wives, and mothers, and our neighbors, friends, co-workers and colleagues. Protecting care for the women in our lives – and the women we don’t know – is our moral imperative as a nation – one not only dictated by my own Jewish faith, but by the creed of every faith community and others who espouse humanist values. The Supreme Court must not invoke technicalities to deny this truth. 

Kaufman is the chief executive officer of the National Council of Jewish Women, a grassroots organization inspired by Jewish values that strives to improve the quality of life for women, children, and families and to safeguard individual rights and freedoms.


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