It's right that we hold the president accountable—any president, because by now Hillary Clinton, to say nothing of John Edwards (!), would surely have let us down. But ladies, let's give the guy some credit. This president took on the combined power of the Catholic, evangelical and fundamentalist churches only a few weeks after the Plan B fiasco by insisting that religious institutions get only a narrow exemption from birth control coverage requirements in the Affordable Care Act. That was a bit of a surprise, wasn't it, coming from a man widely castigated as weak, timid, temporizing and eager to make deals with conservatives? Obama took a huge political risk for women's health and rights—and in an election year. It's not at all clear how this will play out in November, either, now that opponents are reframing the issue as "religious freedom." I'd say the president deserves a hearty round of applause.
The fact is, progressive women should be more enthusiastic about Obama. After all, he got through Congress a massive expansion of healthcare—something the Democrats have been trying to do since Truman. Bill Clinton, in retrospect everyone's favorite shrewd and savvy politician, tried and failed, spectacularly. Yet the "weak and timid" Obama succeeded. How about that?
The Affordable Care Act has never gotten much love from progressives, still pining for single-payer or at least the public option. It's not perfect, but the ACA will help millions of people—by 2014, about 30 million uninsured people will get access to coverage. That is just huge. Already, we are seeing the good effects of the ACA, as young people are permitted to stay on their parents' insurance plan until they turn 26. That's almost 6.6 million twentysomethings and counting.
Women will get a lot out of the Affordable Care Act. Here are just some of the ways:
1. As many as 10 million will get coverage in 2014 under Medicaid expansion, and by 2016, thanks to other provisions of the ACA, that number will grow to 13.5 million women.
2. By 2014, all plans sold to individuals will be required to cover maternity care. According to the National Women's Law Center, 12 percent of those plans include that. Remember when Arizona's Jon Kyl said he didn't think his insurance should have to cover pregnancy and childbirth because he would never need it? The ACA destroys the mindset that care needed only by women is of no general concern.
3. More than 20 million women will get expanded coverage of preventive services—prenatal care, mammograms, pap smears, breast-feeding supplies, testing for sexually transmitted diseases, well woman checkups, immunizations, birth control and more.
4. Insurance companies will be barred from dropping women's coverage when they become pregnant or sick.
5. Companies will be barred from denying coverage because of "pre-existing conditions," like having had breast cancer, being pregnant (funny how that keeps coming up), having had a Caesarean or being the victim of domestic violence.
6. No more "gender rating"—charging women more for coverage just because they are women. This practice, already banned in some states but permitted in thirty-seven others, costs women a staggering $1 billion a year.
7. Older women will receive expanded preventive services through Medicare, like bone-density screenings for those at risk of osteoporosis.
8. The expansion of Medicaid will cover people who make up to 133 percent of the poverty line (about $31,000 a year for a family of four). True, enabled by the recent Supreme Court decision, at least eight red-state governors have said they will reject it. Let's see how that works out for them.
9. The birth control provision is mammoth all by itself. Not only will it be costless to the patient; all methods must be covered. That means women will be able to choose the kind of birth control that works best for them, which means they are more likely to use it consistently. In particular, it means insurance must cover the most effective methods, including the IUD, which many plans exclude. At up to $1,000 upfront, it is too expensive for many women to shell out for, even though the IUD is one of the cheaper methods when you consider that it lasts for ten years or more. If anti-choicers really wanted to lower the number of abortions, they would be cheering this huge expansion of access to contraception. But no.
If Romney wins, women can wave goodbye to what Planned Parenthood has called "the single biggest advancement in women's health in a generation." Think about that next time someone tells you there's no difference between the candidates. It's just not true.
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