Important health care coverage for all is threatened by religious zealots
By Steve Ahlquist for UpriseRI
The bill attempts to safeguard a small set of the most basic health care protections covered by the Affordable Care Act (ACA). [One ACA protection not codified into state law by this bill, for instance, is the ban of annual and lifetime insurance caps.
Essentially, before the passage of the
ACA, insurance companies were allowed to cut customers off from services once
their health care costs hit arbitrarily imposed annual or lifetime limits.]
It is now up to the House to pass similar
legislation, but a successful outcome there seems far from certain.
S0023A provides guaranteed availability
of coverage to any eligible individual resident of this state regardless of
pre-existing condition. It would also require individual health insurers, large
group health insurers, and small employer health insurers to provide coverage
for ten categories of essential health benefits listed in the act.
Why is this bill important?
On March 30 the United States District Court of Texas issued a ruling that
certain parts of the ACA were unconstitutional and violated religious rights.
The ultra-conservative United States Supreme Court is not expected to
overturn this decision, and could in fact expand it.
As a result, according to KFF, an independent health policy research, polling, and journalism non-profit, millions of people across the United States could end up paying more for preventive care and some may lose access to important and life saving services.
Specifically, the ruling wipes out
preventative services recommended by the United States Preventive Services Taskforce (USPSTF)
since the ACA was passed in 2010. From now on and across the country, these
services will carry out-of-pocket expenses for a majority of us. These services
include:
- Colorectal cancer screenings for adults ages 45 to 49. (People ages 50+ are still covered);
- Lung cancer screening with low-dose CT scans for adults aged 50 to 80 years with a 20-pack-year smoking history and currently smoke or have quit within the past 15 years was recommended in 2021 and could therefore be subject to out-of-pocket costs;
- Medication to reduce the risk of breast cancer in women at increased risk for breast cancer aged 35 years or older;
- Statin used for the primary prevention of cardiovascular disease in adults;
- Screenings for hepatitis C virus infection in adolescents and adults;
- Screenings for unhealthy drug use;
- Aspirin use to prevent preeclampsia and related morbidity and mortality for pregnant people;
- Preventative interventions for perinatal depression;
- The use of pre-exposure prophylaxis (PrEP), a medication taken to prevent HIV. [PrEP has been a cornerstone in the United States’ effort to combat HIV.]
In addition, modifications to existing
services the USPSTF has recommended since 2010 are being rolled back to their
pre-2010 status, meaning some patients receiving preventative care will find
themselves paying out of pocket going forward, if they can afford the services
at at all.
Remember that these preventative care
provisions were adopted to save money. Preventing diseases now with low-cost
screenings and medications not only leads to better health outcomes for
patients, it prevents those patients from accessing more expensive treatments
in the future.
This is why it is so important to pass this
legislation now, at the state level, before these important protections lapse
nationally. Maine, Connecticut, Massachusetts and 17 other states, as well as
DC, have codified the protections of the ACA in their states.
Some of these states tied their legislation
to triggers, mandating the law go into effect if and when the ACA were repealed
or overruled in Court. This is why the Massachusetts legislature, for instance,
is now working to make sure that they have legislation in place to
safeguard the protections of the ACA from court decisions that are chipping
away at the Act, rather than fully repealing it.
In Rhode Island, the bills under
consideration would safeguard the protections of the ACA in state law as they
exist now, [mostly], so we have a chance to do Massachusetts one better.
Unfortunately, House Bill 5426, from Representative June Speakman (Democrat,
District 68, Bristol, Warren), is meeting resistance.
Why is this a religious issue?
It’s not, but some conservative
politicians, activists, and judges are pretending it is. The lawsuit in Texas
was brought by lawyers representing the Little Sisters of the Poor, who
want to eradicate preventive services because it provides no-cost preventative
care for contraception.
That’s right, we are not talking about
abortion here. We are talking about birth control, specifically hormonal
contraception.
During the Senate debate on the bill, Senator Deluca proposed an amendment, supported by his Republican colleagues, to insert sweeping religious and conscience exemptions into the bill.
The language in the amendment is far broader than what the Supreme Court Hobby Lobby ruling decided, and what the existing guidelines within the ACA allowed, for religious exemption.
The bill, if amended by Senator Deluca, essentially would allow an
employer to provide a really skinny healthcare plan without any preventative
services coverage.
As Senator Samuel Bell (Democrat,
District 5, Providence) noted, “The way it’s worded… it would allow an
employer, with basically no restrictions, to deny coverage on any moral
conviction whatsoever… This would allow, for instance, an employer to decide to
exclude coverage to same-sex spouses. And I think it’s plausible some employer
might want to do that.”
Similar language was brought up during
the House Committee on Health and Human Services discussion. The
amendment was authored, at least in part, by Barth Bracy, who heads
up Rhode Island Right to Life, an anti-abortion group.
As it exists now, House Bill 5426 does not have the
sweeping language of this proposed amendment but does include all the
exemptions granted in the Supreme Court Hobby Lobby case. Advocates for the
bill have worked with policy staff, the sponsor, and others to include the
words, “including existing exemptions.” This codifies federal statute and
related regulations and guidance, including the Hobby Lobby decision.
A personal story
Ten years ago, as my spouse Kathy and I turned 50, we scheduled his and her colonoscopies. My wife, just 50 years old, was diagnosed with stage 4 colorectal cancer, which then moved to her liver. Since then, she has been enduring chemo, surgeries, and radiation treatments every six to 18 months.
Had the recommendation then been to screen for
colorectal cancer at the age of 45, these ten years of invasive and costly
medical treatments and surgeries may have been prevented.
As the United States moves forward from the Covid state of emergency, thousands of people will be losing Medicaid protections and entering the private insurance market under the ACA.
Many of
these people may choose to go without health insurance coverage. Or, if
covered, may forgo preventive care that carries expensive out-of-pocket
co-pays. The diminishing protections of the ACA mandated by religious
extremists and captured courts adds to this looming disaster.
Thousands of families risk the negative
impacts of a failing health care system, just as my family did. And they will
suffer not because they didn’t know better, but because right-wing ideologues
care more about their vision of God than about the reality of their friends,
neighbors, and fellow Rhode Islanders.
The House cannot sit on this bill. Speaker Joseph Shekarchi (Democrat, District 23, Warwick) needs to act and codify the health care protections of the ACA before people start to suffer.
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