Medicaid expansion is just the latest battlefield in the Republicans’ ongoing war against women. Republican governors turning down health care funds are making a political statement, but in the process are hurting, not helping, the women their states.

In fact, the two states with the highest number of uninsured women — Florida, where 30.3 percent are uninsured, and Texas, where 26.2 percent are — have been most vocal in opposing the expansion. Here is why turning down the Medicaid expansion is a war on women:

– Women are far more than half of Medicaid recipients. In fact, they make up 68 percent of the programs participants. That’s because women tend to live longer and meet more of the eligibility guidelines (often because they have children):

– Women are more likely to be poor. The Center for American Progress reports, “of the approximately 15 million adults eligible for coverage under the Medicaid expansion, around 10 million of them—or two-thirds of the expanded Medicaid population—are nonelderly women.”

– Women tend to work in industries that don’t offer coverage. Industries that are heavily female include: domestic workers, wait staff, cashiers, and child care workers, all of which tend not to offer health coverage to employees, but which provide a large enough income that those women tend not to be eligible for Medicaid currently.

– Without the expansion, women won’t get prenatal care. The Medicaid expansion requires coverage of prenatal assistance for women up to nearly twice the federal poverty level, 133 percent. Without it, those women won’t be able to get coverage while they’re pregnant.

– Women will not have expanded access to preventative care. Currently, women without coverage don’t seek care that could save their lives, and their dollars, later on down the line. But women who are eligible for Medicaid tend to seek preventative treatment at about the same level as women on private insurance plans:

– Children get won’t healthy parents. Low-income children are already covered under CHIP, but that doesn’t mean their parents are. Eligibility is different for adults and kids. Indeed, twenty four percent of the uninsured are parents of dependent children. Since low-income women, particularly, tend to be single mothers, the expansion means more coverage for more moms whose kids rely on them.

When the Supreme Court upheld President Obama’s health care reform bill, it also altered an Obamacare provision that expands Medicaid so that states could choose to opt out of program expansion without losing federal funds. Now, all eyes are on the states as more and more Republican governors announce they will refuse the Medicaid expansion provided by the Affordable Care Act. GOP governors from six states so far have said that they won’t expand Medicaid: Florida, Mississippi, Texas, Wisconsin, South Carolina and Louisiana.

Despite these governors’ opposition to expanding coverage to an estimated 17 million people through Medicaid, health care providers in several states where governors have opted out still support the expansion. A few of their comments include:

• “We are very much in favor of extending Medicaid programs in South Carolina. […] These people are going to hospitals and getting care without payment. […] It only makes sense that we would support expansion.” — Allan Stalvey, executive vice president of the South Carolina Hospital Association
• “Whether you take the most conservative or the most generous number, a lot of people [would gain from health insurance]. …We know from all of the research that’s available that people are better off with health insurance than without it.” — Bruce Rueben, president of the Florida Hospital Association
• “Without the Medicaid expansion, many will remain uninsured, seeking care in emergency rooms, shifting costs to the privately insured, and increasing uncompensated care to health care providers.” — an official from the Texas Hospital Association
• “We think there are essentially three options [for hospitals in states that refuse]. One is you start cutting back on services. …You find yourself basically putting this in the lap of taxpayers and tacking on the bill for your uninsured to their bills. In the worst circumstance, you simply decide you can’t go on in that situation and close your doors. It’s a pretty grim menu of choices.” — Bruce Siegel, the chief executive of the National Association of Public Hospitals, in an interview with Sarah Kliff

Designed specifically to help the poorest Americans, the expansion of Medicaid would provide insurance coverage to all individuals with incomes up to 133 percent of the poverty line. According to several reports, the expansion would also spur economic activity, increase employment, and save states money. Unfortunately, the states that have so far refused to expand Medicaid are also those with the largest number of uninsured.

– Nina Liss-Schultz

Women tend to have higher medical expenses and lower incomes, leading them to often forego expensive medical needs that might be a drain on their insurance policies. A new study from the Commonwealth Fund reveals that 18.7 million women in the United States between the ages of 19 and 64 were uninsured in 2010. That’s an increase of nearly six million women in just ten years.

Of those who were uninsured, 77 percent said they actually skipped care because of the cost. Tragically, 26 percent of women found themselves in recent medical debt because of high premiums and copays.

But relief is on its way. The Commonwealth Fund report shows that Obamacare will dramatically decrease (PDF) the cost of care for women, and thus drastically lower the rate of women who skip the doctor or don’t have insurance:

The health law will require insurance companies to provide contraception free of charge; ensure that pregnancy is no longer a ‘pre-existing condition‘; offer maternity care in all new plans; protect women from out-of-pocket payments for preventative care; and expand the eligibility guidelines for Medicaid, of which women are a majority of recipients.

Despite the fact that conservative evangelicals are opposed to premarital sex — and, along with it, comprehensive sex education that informs young adults about their reproductive health options — public support for contraception is on the rise in the evangelical community. As growing numbers of evangelicals are facing unplanned pregnancies, evangelical leaders and institutions have begun to consider promoting preventative measures to combat abortion rates.

13 percent of all abortion patients describe themselves as evangelical or born-again Christians, a statistic fueled by the fact that a full 80 percent of unmarried evangelicals are having sex. Of course, failing to fully educate young adults about their reproductive health has been proven to lead to decreased use of contraception and increased rates of unplanned pregnancies.

The Daily Beast details a few examples of the evangelical community’s evolving attitudes on sex education:

• The largest evangelical organization in the country, The National Association of Evangelicals (NAE), sparked controversy when it accepted a grant from the National Campaign to Prevent Teen and Unplanned Pregnancy. NAE defended its decision by saying it is concerned about the abortion rate in the evangelical community.
• This year’s Q Ideas Conference, a gathering of evangelicals in Washington, DC, held a panel on reducing abortion that included an employee from the National Campaign to Prevent Teen and Unplanned Pregnancy. Audience members were asked whether churches should support the use of contraception among single young people, and 64 percent said yes.
• A feature story in the evangelical magazine Relevant last year addressed the issue of young evangelicals having premarital sex, including stark data that points to fact that churches pushing for abstinence are largely failing in their efforts.
• A wider range of evangelical leaders are beginning to concede that contraception is “a valuable tool in the abortion reduction toolkit.”

The divide between evangelical leaders’ and the evangelical community’s attitudes about contraception and premarital sex mirrors a similar divide among Catholics, whose leaders have been vocal opponents of birth control following the Obama administration’s regulation requiring employers and insurers to cover contraceptive services at no additional cost to employees. Despite the fact that over 40 Catholic institutions arefighting against Obama’s birth control provision, citing violations to their religious freedom despite the fact that the policy already includes an exemption for religious organizations, 82 percent of Catholics believe birth control is morally acceptable. Similarly, 88 percent of evangelicals report that they support birth control.

Our guest blogger is Jessica Arons, the Director of the Women’s Health and Rights Program at the Center for American Progress.

In the Supreme Court’s recent decision upholding the Affordable Care Act, also known as Obamacare, an important question before the Court was whether it was coercive for the federal government to threaten to withhold current federal funding for Medicaid, the joint federal-state health insurance program for the poor, if states did not expand the program in compliance with a new requirement in the health reform law. The Court ruled that yes, it is coercive to do so.

Below are the six key things you need to know about the Court’s decision and how it will affect women, the working poor, and state and federal governments:

1) The federal government keeps its carrot but loses its stick. The Supreme Court said that it is up to states to decide whether they will join the Medicaid expansion established under the Affordable Care Act. That means states must have the ability to take or leave the new funds offered under the Medicaid expansion. If they take the new funds, then they must comply with the new rules of the program, which means extending eligibility to anyone who meets certain income requirements.

But if they choose not to participate in the expansion, the federal government cannot penalize them by taking away the Medicaid funds they already receive. This means that governors have full discretion to decide whether their states will participate in the expansion. Already seven states have denied Medicaid coverage to millions of citizens who became eligible under the Obamacare expansion.

2) The working poor will suffer if states do not participate in the Medicaid expansion. Under the old Medicaid rules, only certain categories of poor people such as pregnant women, parents with dependent children, the disabled, and the elderly could qualify for Medicaid. But under the Medicaid expansion, anyone can qualify for Medicaid as long as their annual income is less than 138 percent of the federal poverty level.[1] In addition, the Affordable Care Act offers tax credits that help people with incomes between 100 percent and 400 percent of the federal poverty level ($11,170 to $43,320 for an individual) purchase private health insurance.

Two groups of people will be left out if a state chooses not to expand its Medicaid program: 1) those who make less than 100 percent of the federal poverty level but do not fit into one of the traditional Medicaid categories, including people who are single, childless, or do not live with their children; and 2) low-income people who qualify for premium assistance under the Affordable Care Act but nevertheless cannot find insurance that they can afford to purchase or use. The majority of people in both these categories are low-wage workers.

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