Protecting the Affordable Care Act goes beyond preexisting conditions

 As the president continues his treatment for COVID-19 with the benefit of the best medicines and care that taxpayer funding can buy, he has called for “his representatives” to focus solely on confirming his Supreme Court nominee Amy Coney Barrett, shelving discussions of additional COVID-19 relief. Coupled with his administration’s continued support for repeal of the Affordable Care Act (ACA), the president continues to neglect a basic duty of care to the public at large in the face of an ongoing crisis.

With the future of the ACA on the line as the Supreme Court is scheduled to hear oral arguments the week after the election, advocates are stressing the need for the nomination process to be slowed down if not stopped outright. A 2017 maneuver by the current administration reduced the ACA’s individual mandate to $0, setting up the current legal challenge over the law’s constitutionality.

“Coming from marginalized communities, we are very clear on the fact that there's a set of rules for the Republicans and there's a set of rules for the Democrats,” said Rebecca Cokley, director of the Disability Justice Initiative at the Center for American Progress. “But there's also a set of rules for those in power. And then there [are rules] the rest of us have to play by.”

When asked about the stakes in the battle around the Supreme Court, Cokley named the ACA as her primary concern. “Many times when people think about the disability community and the Affordable Care Act, all they think about are preexisting condition protections,” said Cokley. “But the ACA is so much more than that.” Cokley explained that the protections for preexisting conditions provide disabled people with greater flexibility in terms of their job options. Students who receive special education services through age 22 remain on their parent’s insurance thanks to the ACA.

“It means having the opportunity to go to college and have the expectation of insurance,” said Cokley. Cokley notes the ACA can also alleviate the burden of a person feeling like they have to stay in a potentially abusive or unhealthy relationship with a caregiver or significant other because their insurance is tied to another person.

The ACA is not without its issues, but invalidating the law without a viable alternative to replace it would put many people in dire positions. With an ongoing pandemic and deepening recession, the ACA has provided a stop-gap for those who lost insurance due to layoffs. Writing for Kaiser Health News, Steven Findlay pointed to the safety provided by the ACA at this moment. Citing health policy experts and insurers, Findlay wrote that absent additional congressional assistance, the country could see more people becoming newly uninsured. Findlay also noted that insurance coverage provided through the ACA had already been in decline since 2016 due to efforts taken by the current administration and some Republican-controlled states.

In the middle of crisis and widespread uncertainty, the president of the United States, members of his administration, and members of his party are calling for the end to a law that provides access to health care for millions of people and protections for millions more. While the president and congressional Republicans failed to “repeal and replace,” they have not put forth a clear alternative if the ACA is struck down.

At various points, the ideological debate unfolding from the president’s selection of nominee to the nominee’s particular beliefs and priorities treats marginalized communities as a secondary concern.

“Judge Coney Barrett’s nomination also threatens people’s ability to make decisions about their bodies and lives, putting Roe v Wade and reproductive rights at risk,” said Emily Stewart, executive director of Community Catalyst, in a statement. “There is no question that Judge Coney Barrett’s nomination undermines efforts to advance equity in all areas of our society.” Stewart further said the nomination of Coney Barrett would undermine the health and well-being of millions who count on the ACA.

Cokley echoed the concern around reproductive rights and reproductive justice. “For the disability community writ large, what matters to us is that notion of bodily autonomy, which is a core function of the reproductive justice movement,” said Cokley. “You have the right to decide what happens to your body.”

For Cokley, discussing the ACA, reproductive rights, and more broadly reproductive justice opens up a lane for discussing additional concerns impacting the disability community, such as disabled parents and child custody. Although made unlawful decades ago through Section 504 of the Rehabilitation Act and the Americans with Disabilities Act, discrimination against disabled parents continues by state agencies and the courts.

“In 20 states, you can still lose custody of your child solely on the basis of any diagnosis of disability of a parent,” Cokley said. “And we know that it disproportionately impacts Black women with mental illness. We know that it impacts people who literally have lost their kids, because they went to grief counseling for the loss of a parent.”

To some advocating for the ACA, reproductive rights and justice, and disability justice may seem like distinct lanes for organizing. But Cokley stresses the need for the inclusion of a disability justice lens in advocacy work around these issues if advocates are to work effectively and functionally. “There is no movement across a marginalized community that is not disproportionately disabled, because trauma is a disability,” said Cokley. As the fight to save the ACA ramps up, there needs to be space for talking about disability, mental health, and mental well-being without penalizing others.

“It is what we're all living with,” said Cokley. “And trauma must be centered in such a way that people don't see the level of respect others have for them diminish because they're dealing with real life right now.” 

Anoa Changa is Prism’s electoral justice staff reporter. Follow her on Twitter @thewaywithanoa.

Prism is a BIPOC-led nonprofit news outlet that centers the people, places and issues currently underreported by our national media. Through our original reporting, analysis, and commentary, we challenge dominant, toxic narratives perpetuated by the mainstream press and work to build a full and accurate record of what’s happening in our democracy. Follow us on Twitter, Facebook, and Instagram.

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