Health care is on the ballot – and women know what’s at stake.

“Women of Ohio should pay attention because this is about their health and their future, and nothing could be more important. And this has really been not only a war about: Should people have the right to affordable health care? But really a war about women’s health.” – Kathleen Sebelius, Former United States Secretary of Health and Human Services

For the last eight years in Ohio, health care access has been on the line: Under Governor John Kasich, there have been 19 bills enacted into law that limit or restrict access to reproductive health services and abortion care; the Republican-controlled legislature has chipped away at the state’s Medicaid program, with additional threats to coverage for hundreds of thousands of Ohioans looming on the horizon with a lame duck session; and Republicans in Congress – including many Ohio members – have voted to repeal or dismantle the Affordable Care (ACA) countless times, almost succeeding in their efforts last year.

Now, all of these health care issues – from abortion rights to Medicaid coverage to pre-existing conditions – are center stage in the Ohio governor’s race between Richard Cordray (D) and Mike DeWine (R). In fact, a recent poll found that Ohio voters rank health care as the number one issue of the 2018 election. Both candidates have clear differences in their positions, particularly when it comes to health care issues important to women.

One of the most consequential health care issues in the current electoral narrative has been the Affordable Care Act; most significantly, the provision of the health care law that protects patients with so-called pre-existing conditions. Before the ACA, insurance companies routinely denied coverage or charged exorbitant rates for individuals with pre-existing conditions, such as diabetes or cancer. Women were often disproportionately harmed by this practice as insurance companies would regularly classify Cesarean sections, pregnancy, domestic violence, and sexual assault as pre-existing conditions and deny coverage.

The ACA put an end to this practice, no longer treating being a woman as a pre-existing condition – and the benefits that women have experienced as a result of the ACA don’t stop there. The ACA has been the greatest advancement for women’s health in a generation, playing an instrumental role in groundbreaking improvements for women’s health care coverage, access, and costs.  What’s more, health care is inextricably tied to economic security, and these improvements in access and affordability to care have contributed to greater educational attainment, workforce participation, and economic potential for Ohio women –  myself included.

Because of the ACA, I was able to continue on my parent’s health insurance plan until I turned 26. This specific provision in the ACA – allowing for dependents to remain on a parent’s health care plan until age 26 – is estimated to have helped 2.3 million young adults gain coverage between 2010 and 2013. It had an immense impact on my life: Providing me with the opportunity to continue using my family’s insurance to receive high-quality health care as I completed college and began my career.

Eventually, I began the process of switching to the insurance policy that was provided through my employer as my 26th birthday approached. Shortly after the insurance through my parent’s plan ended and my new insurance was set to begin, I received notice that my birth control prescription was ready for pick-up. As I stood at the check-out in the pharmacy, though, I was told that my new insurance was not showing up on their system. I decided to pay for the prescription out-of-pocket while I waited to sort out the issue with my new insurance, not wanting to face a gap in my birth control coverage. It cost me more than $30 for a one-month refill – that would have been more than $300 per year. The issue with my insurance was quickly resolved that week, but that moment made me realize that had it not been for the ACA, I might not be able to afford my birth control.

That’s because the ACA guaranteed women coverage for preventive services like birth control, cervical cancer screenings, and annual well-woman exams, without co-pays, deductibles, or other out-of-pocket costs. It lifted the financial weight of crucial preventative services that women need to stay healthy and in control of their reproductive lives. For me, it means being able to access and afford the contraception that fits my health and personal needs, without budgeting hundreds of dollars a year for preventative health care services I needed as a woman.

There have been far-reaching benefits as a result of the ACA beyond my own experience. The Ohio Women’s Public Policy Network, a coalition of more than 30 organizations focused on collaboratively advancing policies that create economic security for women and strengthen families, produced an analysis of the impact that the Affordable Care Act has had on women’s health and economic security. In the report, they found that:

  • Millions of women gained access to affordable health care coverage under the ACA as a result of expanded Medicaid coverage and subsidies to purchase coverage for those without insurance through an employer. The ACA allowed for states to expand Medicaid eligibility to individuals with household incomes up to 138 percent of the Federal Poverty Level, which has greatly increased access to coverage for low-income women. In Ohio, 700,000 people have gained coverage under Medicaid Expansion, dramatically reducing the rate of uninsured people in the state. Medicaid has long been a lifeline for women, and the ACA’s provision encouraging states to expand eligibility has been particularly beneficial to women.
  • Increased access to care for women of color contributes to the reduction of racial health disparities. Women of color are more likely to be uninsured, yet they experience disproportionally higher rates of diabetes, obesity, and reproductive health care disparities. With increased coverage rates under the ACA, women of color have greater access to services to treat these health care needs, as well as greater access to critical preventative care services. In addition, the ACA created data-collection standards to better understand health disparities, and allocate resources more efficiently.
  • Women can no longer be charged more for health coverage simply because they are women. Prior to the ACA, women were routinely charged as much as 50 percent more for the same coverage simply for being a woman. Now, under the ACA, there are protections against gender-based discrimination in health coverage.
  • Under the ACA, women are guaranteed coverage without copays, deductibles, or other out-of-pocket costs for preventive services such as birth control, cervical cancer screenings, and annual well-woman exams. According to federal officials, an estimated 55.6 million women with private insurance are able to access contraception, mammograms, Pap smears, cervical cancer screenings, and other essential preventive services without cost-sharing.
  • The ACA protects against insurance discrimination for survivors of domestic violence. The ACA created reforms that prohibit insurance discrimination against survivors of domestic violence. The preventive health services that insurance plans must offer without co-pays includes screening and counseling for domestic violence.
  • Coverage for maternity care is guaranteed as an essential health benefit, without extra cost to women. Before the ACA, many health insurance plans did not cover maternity care or they required women to pay more out-of-pocket for the additional coverage. What’s more, pregnancy could be considered a pre-existing condition, meaning women could be denied coverage for maternity care.
  • Insurance companies can no longer discriminate or deny women coverage for gender-related health conditions. Insurance plans can no longer deny coverage or charge excessively high premiums to cover gender-related conditions, such as breast cancer or heart disease. The ACA prohibits sex discrimination in federal health programs, health programs that are receiving federal funding, and any programs created by the ACA.
  • Health care providers like Planned Parenthood receive federal funding from Title X to provide access to preventative and primary care for millions of people, particularly low-income women, women of color, and women in rural areas. Planned Parenthood provides many of the services covered under the ACA for low-income women insured through Medicaid, including cancer screenings, HIV testing, and birth control.

This election, health care is on the ballot in Ohio – and it’s arguably one of the most important elections for the future of health care in our state. As Kathleen Sebelius so aptly said: This election is about women’s health and futures, and Ohioans – particularly women – understand what is at stake.