Principles for Reform: New U.S. Health Care Proposals Cannot Overlook Sexual and Reproductive Health

摘要

Federal and state policymakers and advocates continue to debate what the future of the U.S. health care system will look like. Nearly a decade after it was enacted, the Affordable Care Act (ACA) remains under attack by conservative policymakers and in the courts. Meanwhile, progressive policymakers and advocates are eager to build on or even replace the ACA in order to address problems such as persistent coverage gaps and high out-of-pocket costs for patients. One approach would be incremental, such as establishing a “public option” to allow people to “buy in” to a publicly funded program like Medicaid or Medicare as a form of competition with private insurance plans. The second main approach would be a comprehensive overhaul of the existing health care system; some versions of this approach, often described as “Medicare for All,” would move most or all U.S. residents to government-run coverage. Whatever approach policymakers take, it is imperative that they fully address the wide array of sexual and reproductive health needs. The continued political and legal fights over the ACA have demonstrated that social conservatives will take every opportunity to undermine provisions that protect and promote sexual and reproductive health and rights. 1,2 The best defense against such attacks is specific and detailed statutory language, which can help guide implementation and is more difficult to undermine or reinterpret through federal or state agency regulations and guidance. To develop effective statutory language, policymakers will need a roadmap—a clear set of specific principles for how to ensure that everyone has comprehensive coverage for sexual and reproductive health services; has unrestricted access to a robust network of providers; and can rely on a wide array of patient protections (see figure 1).