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Sandra Fluke: The fight for Obamacare isn't over yet


Last February I testified before Congress about the need for access to affordable preventative health care for women, specifically contraceptive coverage. I told the stories of the women in my life who need contraception for medical reasons, as well as to prevent pregnancy. I shared the dire financial and medical consequences they had suffered when they were denied that insurance coverage: consequences like painful ovarian cysts, risking a dangerous pregnancy, and even the loss of an ovary.

Under the Affordable Care Act, women will never again be denied that coverage and forced to suffer those consequences. But the battle isn't over yet.

Already, pundits are debating the political winners and losers from Thursday’s Supreme Court ruling. But those things pale in comparison to what the decision means to women who can now count on that coverage—not to mention the millions of other Americans, men and women, young and old, who will be able to access affordable, life-saving health care.

Once it's fully implemented over the next few years, here's what the law will mean for women:

  • Insurance companies will no longer be able to drop women’s coverage when they become pregnant or fall ill.
  • Forty-five million women will be guaranteed free coverage of important and potentially life-saving preventative care, such as mammograms.
  • Women will no longer be denied coverage or charged more for having supposed pre-existing conditions, such as breast cancer, cervical cancer, pregnancy, having had a C-section, or for being a victim of domestic violence.

But there's more work to be done. In Thursday's decision, while upholding the individual mandate, the Justices opened a dangerous door by ruling that individual states can choose not to expand their Medicaid programs, an expansion designed to provide crucial coverage for families whose income is around $25,000 or less, for a family of three. That means around 17 million lower-income Americans would not receive this coverage, denying them the full promise of the benefits of the Affordable Care Act.

There’s no good reason for any state to deny this Medicaid coverage, especially when, thanks to the new law, the federal government will chip in about 90 percent of the cost. But already there's speculation that some states might do so anyway, out of pure ideological opposition.

There's no place for politics in the health care of millions of the most vulnerable Americans. That's why governors and state legislators who might be thinking about rejecting the money need to know that we want the Affordable Care Act’s promise to be fully realized, and that we will fight to ensure that it is.

As we move forward, let's remember what today’s decision means for American women, as well as for anyone lacking access to affordable coverage: real benefits for real people that have already started saving lives and improving families’ economic and health security. And let's not quit until those benefits have been secured for everyone, no matter where they live.


Sandra Fluke graduated cum laude from Georgetown University Law Center and has served as president of Georgetown Law Students for Reproductive Justice. She has endorsed and campaigned for President Obama.