At the Supreme Court, Women's Health in the Balance

On Wednesday, the Supreme Court will hear oral arguments on King v. Burwell, a case challenging the federal government's ability to offer financial subsidies to people in states with a federally facilitated marketplace under the Affordable Care Act. While much of the national attention has centered on the far-reaching consequences the case could have on the millions Americans who have gained access to coverage thanks to the law, women, in particular, stand to lose the most.

The Affordable Care Act's signature promise was to make access to care more affordable and the health care system more equitable. The law has not only made major strides in getting millions of people covered, it is leveling the playing field for women. Market reforms have ensured that being a woman can no longer be considered a preexisting condition. Millions of women now have access to a range of preventive health benefits with no cost-sharing, including contraception, cancer screenings, well-woman visits, and more.

But affordability and access to care go hand in hand, and if the Court strikes down subsidies in the federally facilitated marketplace, we will quickly reverse those gains. A ruling effectively eliminating subsidies in 34 states would mean that 7 million women eligible for those subsidies will be at risk of losing access to affordable insurance, leaving them more vulnerable to disease and at a greater risk of unintended pregnancy and poor birth outcomes. Recent data show that unintended pregnancies cost federal and state governments $21 billion in 2010, a cost that the nation and the safety net cannot sustain.

Of course, the outcome of King v. Burwell will not change the publicly funded family planning safety net's commitment to providing high-quality family planning and sexual health care for patients regardless of their ability to pay. Many of those patients have seen the benefits of the Affordable Care Act firsthand, gaining private health insurance, some for the very first time. An increase in insured patients alleviates growing financial pressures on the safety net brought about by shrinking public funds. Federal funding levels for the Title X family planning program have not come close to meeting the demonstrated need for family planning care and growing challenges of our provider network. In an environment of fiscal austerity and politically motivated attacks, publicly funded family planning health centers cannot continue to do more with less. Returning to pre-ACA uninsured rates will not only have a drastic negative impact on those who lose their coverage, but will also place a potentially devastating burden on the providers who care for those women and men.

The Court would be wise to recognize that a ruling in this case could put a keystone provision of the law at risk, and for women and the providers who care for them, the stakes couldn't be higher.