The Supreme Court's decision is in. With the Affordable Care Act mostly intact, tens of millions of uninsured Americans will gain coverage. Senior citizens will get billions of dollars of prescription drug benefits. Everyone with insurance will get preventive services at no cost. Roughly 60,000 people now covered by the new Pre-existing Condition Insurance Plan will still have that coverage, even though they are actually sick and thus might actually use it. We all still have the guarantee that our policies won't be canceled when we get sick. And our adult children can stay on our health plans until they're 26.
The bullet we just collectively dodged would have caused pain throughout the country, with women taking the hardest hit. That's because women stand to gain the most from the health law. We are already getting improved benefits under the Affordable Care Act - things like mammograms, pap smears and immunizations for our kids, which insurers have been required to cover without a co-pay since last year. And in just over a month, on Aug. 1, women will have the same unfettered access to diabetes screenings (men too, but women are more negatively impacted by the disease), annual well-woman visits, HPV testing, domestic violence screenings, breast-feeding support and, after much wrangling, contraception.
Even more is on the horizon, of course. Though the decision left new room for states to wiggle out of expanding their Medicaid programs in 2014, millions of uninsured women will still likely gain coverage this way, when states are made to include everyone with incomes below 133 percent of the federal poverty level. Also, by then, insurers will be forbidden from charging women more, an abhorrent practice known (though apparently not widely known) as gender rating.
Women have been getting a harsh deal on health care for years. We pay more than men on average for our policies. It's been de rigueur - and perfectly legal - to deny us coverage in the private insurance market because we have had breast cancer or a c-section or been sexually assaulted. (Men are denied coverage because of pre-existing conditions, too, of course, but women, being more likely to have chronic diseases, are more likely to face this problem.) Even pregnancy has been grounds for insurance companies to refuse policies on the grounds that it's a pre-existing condition.
All this made women more likely to be uninsured - as one in five women under 65 were in 2010. And even when we did have coverage, we often weren't able to get our insurers to pay for birth control and other basic prevention (even while they were doling out Viagra, no questions asked).
Many mothers stayed in full-time jobs they didn't otherwise want because they provided them, and their kids, with health care. Shameful bogus "maternity insurers" sprung up to exploit the very real desperation of pregnant women who couldn't find care in the individual market. And because many health plans lacked abortion coverage, some women even resorted to do-it-yourself abortions.
And then came the Affordable Care Act. Years after other rich nations figured out how to provide all their citizens with decent health care, we were finally heading there ourselves. Had the court decided to reverse that progress, women might have remained stoic. Given our years spent taking the greed and unfairness of the insurance industry on the chin (and uterus), you might think we'd just soldier on with our benefits returned to their former pathetic level.
But I don't think so. While this decision is a victory for the Obama administration, it should also come as a relief to the very Republicans who mounted the challenge -- and surely would have been the objects of wrath had they stripped these basic, humane gains from the millions of women and other Americans who are already benefiting from them.
Writer Sharon Lerner is a senior fellow at Demos, a policy research organization, and the author of "The War on Moms: On Life in a Family-Unfriendly Nation." She wrote this for slate.com.