In the wake of the midterms, as political analysts assess the driving forces behind the blue wave (mostly consisting of women) that flipped the House, two things have become increasingly apparent.
First, this midterm election was unquestioningly about healthcare. According to NBC News, exit polls indicated 41 percent of voters said healthcare was the deciding factor in this election, and 58 percent of those same voters agreed Democrats were better positioned to deliver on issues like protecting Americans with pre-existing conditions.
In fact, the California Republican delegation, whose 13 members voted unanimously to repeal the ACA under Kevin McCarthy’s leadership, bore the brunt of voter wrath with more than half losing their bids for re-election.
Secondly, voters elected an unprecedented number of women to represent them in the 116th Congress. The importance of these two effects of the midterms cannot be underestimated. For the first time, more women than ever before will have a seat at the table and a stronger voice in the healthcare decisions that affect our bodily autonomy and right to affordable care.
In many ways, the war on healthcare is simply an extension of the war on women. Hidden beneath the constant attempts by the GOP to undermine and repeal the Affordable Care Act is the simple fact that the loss of healthcare disproportionally affects women — either through the removal of basic coverage, cuts to Medicaid, limiting access to maternity care, or rolling back reproductive rights.
Why does targeting healthcare uniquely affect women? Women are more likely to have pre-existing conditions like autoimmune disorders, osteoporosis, and breast cancer. They also suffer from mental health concerns (like depression at higher rates), and are more likely to shoulder the burden of providing healthcare for dependent children. Because women live longer, and more of them live in poverty, they also make up a greater portion of those on Medicare and Medicaid. A study from the Henry Kaiser Foundation indicates one in five senior women are supplementing Medicare coverage with the Medicaid program.
The GOP’s war on healthcare has done more than target vulnerable women with pre-existing conditions on government programs like Medicare and Medicaid. The Trump administration has also undermined access to contraception for millions of American women, attempting to allow employers with strongly held religious beliefs to opt out of the birth control mandate. A series of policy moves on the national level since Trump took office have left the ACA and the insurance marketplaces limping along, on the edge of collapse despite growing popularity and posting booming enrollment numbers.
On the state level, the landscape can look better or worse for women, depending on the local politics. Several Republican-controlled states have tried to limit access to Medicaid through a variety of efforts, including work requirements that unfairly target women.
Healthcare advocates say states like Kentucky, Arkansas, and Alabama, that have attempted to implement Medicaid work requirements, have large populations of women who are unable to join the workforce due to a lack of affordable childcare and transportation. In Iowa, where the Republican governor signed a bill defunding Planned Parenthood by barring the organization from receiving Medicaid dollars, four of the state’s clinics shuttered within a week. This resulted in nearly 15,000 women in rural communities losing access to basic reproductive care.
According to the Guttmacher Institute, Medicaid pays for three-quarters of all publicly supported women’s healthcare and family planning services. These misplaced attempts at both the state and national level to limit access to affordable care for women and insert religious morality into the healthcare debate ignore the fact that better access to contraception and reproductive care consistently lowers the abortion rate, while improving infant outcomes.
On this front, the Affordable Care Act has been an enormous success story for women, bringing about better not just better healthcare coverage, but increasing access to birth control. States that offered Medicaid expansions saw decreases in infant mortality and were able to demonstrate higher rates of breast cancer screenings and better outcomes in maternity care. As a result of the ACA and the Medicaid expansions, the Women’s Health Issues Journal estimates the uninsured rate of women of reproductive age fell by more than 13 percent.
As the new House majority — stacked with new female representatives — prepares to be sworn in this January, there is much more work to be done to shore up the ACA and push for some critical improvements in healthcare coverage. Stabilizing the insurance exchanges and expanding premium subsidies, as well as increasing tax credits and closing loopholes that allowed insurers to avoid covering people with preexisting conditions, should be the first order of business.
Hopefully, we’ll see a more ambitious healthcare agenda take shape under the leadership of women from the 116th Congress. While they may not be able to usher in sweeping change without a Senate majority, Medicare for all, single-payer healthcare, lowering drug prices, and a more robust public option must all be on the table and be the focus of continued healthcare-related discussions among Democrats.
The new Democratic majority is compromised of a large number of women whom voters have trusted to push for a more progressive agenda that will enable a majority of Americans to afford basic healthcare services. Hopefully they’ll get to work crafting policy that puts women, who are the primary consumers of healthcare in this country, front and center.
Kaz Weida is a freelance journalist and photographer. Her areas of expertise include education, gender equality, and all things #MeToo. You’ll find her on Twitter @kazweida, getting into “good” trouble.