The Affordable Care Act — and With It, Our Civil Rights — Are Under Attack
Ask a dozen civil rights lawyers to name the great civil rights laws of the last 100 years, and you’ll get a dozen answers. Some might name the Civil Rights Act of 1964, the landmark law which ended segregation in public places and barred discrimination on the basis of race, sex, color, religion, or national origin at work and in other public places. Others might point to the Fair Housing Act, which took aim at dismantling entrenched residential segregation and fighting housing discrimination. Still others might highlight the Americans with Disabilities Act, which paved the way for a more accessible world.
What few people might include in the list, but should, is the Affordable Care Act of 2010, the law that made health insurance — and with it, health care itself — accessible to millions for the first time. It earns its place as a great civil rights law for several reasons: It bars certain forms of discrimination; it begins to address effects of longstanding discrimination; and by providing coverage for the health care all people need, it enables the freedoms other civil rights laws aim to protect. Simply put, it is not possible to fully participate in the economic, social, and civic life of our nation without stable health coverage.
But the Affordable Care Act is now imperiled. This week, the Supreme Court will hear arguments in California v. Texas — a case that puts this critical law in jeopardy of being struck down in its entirety. While think such a ruling unlikely, any decision striking the law would have devastating ramifications for the civil liberties advancements that the ACA has provided. And it would have particularly cruel and deadly consequences in the midst of a pandemic and recession. Dismantling the ACA now would exacerbate the longstanding, systemic disparities in access to health care, economic opportunities, and other resources faced by Black, Latinx, and disabled people in this country — disparities that are now approaching epic proportions in light of the pandemic.
The Affordable Care Act made huge advancements for many groups of people to whom stable health insurance and health care were often denied, whether because of express discrimination or the effects of discrimination.
Women: The ACA bars sex discrimination, full stop. This means, for example, that at long last insurers may no longer charge women higher rates. The ACA as implemented covers care long excluded from insurance coverage that was seen as exclusively women’s care: mammograms, screenings for cervical cancer, contraception coverage and counseling, lactation support, and prenatal care. These forms of discrimination had material consequences. Before passage of the Affordable Care Act, women were estimated to spend 68 percent more than men in out of pocket health care costs. The ACA takes aim at discrimination that perpetuates gender inequity, including the discrimination in health care that perpetuates gender disparities in wealth.
LGBTQ people: The ACA’s bar on sex discrimination also means that LGBTQ people can’t be subject to discrimination in federally funded institutions, public health care programs, or by insurance companies. The ACA eliminates barriers that many LGBTQ people previously faced in receiving health care — a crucial step toward ensuring health care is accessible to all — regardless of gender identity or sexual orientation.
People of color: The ACA makes important strides to in health care as well. It bars discrimination based on preexisting conditions, a provision critical to ensuring that those who are sick — and thus most in need of health insurance — aren’t effectively barred from accessing it. While this provision is important to people of all races, it is also an essential part of beginning to redress the health disparities that reflect the legacy of race discrimination in the country. This is evident in the higher rates of among Black people, , and the of COVID-19 infections and deaths among Black and Latinx communities.
The data is striking: , between 2013 and 2017, the coverage gap between Black and white Americans declined from 11 to 5.3 percentage points. Similarly, during the same period, the coverage gap between Hispanics and non-Hispanic whites dropped from 25.4 to 16.6 percentage points. Additionally, the ACA expanded Medicaid for people whose income is below 138 percent of the federal poverty level. In short, the ACA has helped make important strides in in in access to health care and coverage.
People with disabilities: The ACA has been a life saver for people with disabilities. It protects against coverage limitations based on preexisting conditions or lifetime limits, and guarantees coverage of services for mental illnesses and developmental disabilities. It provides access to long-term, home-based health care, which can mean the difference between institutionalization and independence for people with disabilities. And it expressly precludes discrimination in access to health care based on disability.
People experiencing poverty: The ACA also expanded Medicaid for people up to 138 percent of the federal poverty level — although not every state availed itself of the option, despite its literal life-giving opportunities. Prior to the ACA’s passage, Medicaid eligibility for parents was limited to those with very low incomes (often below 50 percent of the poverty level), and adults without dependent children were ineligible under federal rules, regardless of their income level, according to a from the Kaiser Family Foundation.
The ACA is part of the path to equity — remedying systems of oppression and discrimination — that runs to the core of living or dying, particularly during the time of COVID-19. As we said in our 2012 brief, the ACA “advances the twin goals of liberty and equal protection.” The ACA is worth fighting for. Our civil liberties and civil rights are worth fighting for.
Learn More About the Issues on This Page
-
CaliforniaDec 2024
Disability Rights
Powers v. McDonoughPowers v. McDonough
Every night, thousands of veterans sleep without shelter on the streets of Los Angeles. Meanwhile, the Department of Veterans Affairs owns hundreds of acres of land in prime West Los Angeles—land directly adjacent to a VA medical facility that was once earmarked to house veterans, but today is instead home to private school sports fields and an oil well. In November 2022, a group of unhoused veterans and a non-profit organization filed suit alleging that the Department of Veterans Affairs (“VA”) failed to provide adequate housing and health care to veterans with severe disabilities in Los Angeles. These failures have significantly undermined veterans’ abilities to access the benefits they are entitled to by law, leaving many stranded on the streets after serving our country. The veterans sued the VA under the Rehabilitation Act, a federal statute that prohibits federal agencies from discriminating against people with disabilities. As a remedy, the plaintiffs seek the construction of significant units of permanent supportive housing on the The VA argued that a provision of the Veterans’ Judicial Review Act (“VJRA”)— a federal statute that prohibits federal district courts from second-guessing VA’s individualized benefits determinations—bars federal district courts from hearing the veterans’ Rehabilitation Act claims. Should the court accept this position, it would deprive veterans of a meaningful opportunity to have their rights under the Rehabilitation Act and other generally applicable nondiscrimination statutes enforced. -
News & CommentaryDec 2024
Criminal Law Reform
Disability Rights
Incarceration Should Not be a Death Sentence for Individuals Who Use OpioidsIncarceration Should Not be a Death Sentence for Individuals Who Use Opioids
New litigation centered on increasing access to substance-use disorder treatment in jails and prisons is helping to reduce mortality rates among incarcerated individuals. -
Press ReleaseSep 2024
Disability Rights
Criminal Law Reform
Lawsuit Challenging Armed Police Response to Mental Health Emergencies in Washington, D.C. to ProceedLawsuit Challenging Armed Police Response to Mental Health Emergencies in Washington, D.C. to Proceed
WASHINGTON — A federal judge in Washington, D.C. today rejected the District of Columbia’s motion to dismiss a lawsuit brought by the American Civil Liberties Union, the ACLU of the District of Columbia, and the law firm Sheppard Mullin. The lawsuit contends that the District’s emergency response system discriminates against people with mental health disabilities by deploying armed police officers to address the vast majority of mental health crises while sending trained medical professionals to most other health emergencies. “This ruling moves us one step closer to bringing essential, life-saving emergency mental health care to D.C. communities. Qualified providers are best equipped to handle mental health emergencies with skills and compassion; police with a gun only serve to escalate, handcuff, and arrest,” said Ashika Verriest, senior staff attorney with the ACLU’s Criminal Law Reform Project. “Far too many people are harmed at the hands of police during a mental health crisis, or simply receive ineffective care. This must end.” The plaintiff in the case is Bread for the City, a D.C.-based nonprofit supporting underserved communities. The lawsuit contends that the District’s unequal response to mental health crises violates the Americans with Disabilities Act and the Rehabilitation Act. The ruling will move the case forward, allowing the ACLU to show in court that a fully functioning mental health crisis response system that sends a medical, rather than a law enforcement, response to most mental health crises is legally required. “Relying on mental health professionals, not armed police, to serve people experiencing mental health crises is not just logical, it’s required under the law. Today’s decision made clear that communities can’t single out mental health emergencies for worse services than other health emergencies,” said Michael Perloff, staff attorney with the ACLU of the District of Columbia. The ruling comes on the heels of a recommendation made in a similar case filed against Washington County, Oregon by the ACLU, the ACLU of Oregon, Disability Rights Oregon, and Sheppard Mullin. On August 30, 2024, a federal magistrate judge recognized that sending police, rather than health providers to a mental health crisis, may be discrimination against people with mental health disabilities in violation of federal law. The magistrate judge recommended that the case proceed. More details about the case are accessible here: /cases/bread-for-the-city-v-district-of-columbia -
Press ReleaseSep 2024
Criminal Law Reform
+2 Issues
Judge Orders Supervision System in Washington, D.C. to Accommodate People with DisabilitiesJudge Orders Supervision System in Washington, D.C. to Accommodate People with Disabilities
WASHINGTON – A federal court granted a preliminary injunction yesterday in a case filed on behalf of people with disabilities on parole and supervised release in Washington, D.C., ordering immediate action to address discriminatory conditions faced by the two named plaintiffs. The court also denied the government’s motion to dismiss, allowing the case to proceed. The case, brought by the American Civil Liberties Union, ACLU of D.C., Public Defender Service for the District of Columbia, and Latham & Watkins LLP, challenges the federal government’s post-conviction supervision system in Washington, D.C. for systematically ignoring the needs of people with disabilities, thereby setting them up for failure on supervision and putting them at constant risk of sanctions, including incarceration. As the court held in its decision, such accommodations are likely required under federal disability law, specifically the Rehabilitation Act of 1973. The preliminary injunction requires that the United States Parole Commission and the Court Services and Offender Supervision Agency (CSOSA), the two federal agencies responsible for supervision in D.C., assess what reasonable accommodations the two named plaintiffs require to have an equal opportunity to succeed on supervision, and provide all such required accommodations. “Absent an injunction,” the court’s decision reads, “the Parolees will be forced to participate in the Government’s supervision programs on an unequal footing just because of their disabilities.” People on supervision in D.C. are required to comply with myriad and onerous rules. For people with disabilities, navigating these complex conditions is even more challenging. For example, Plaintiff Mr. Mathis — a 70-year-old military veteran with congestive heart failure that limits his ability to walk — struggles to travel throughout the city to attend frequent supervision meetings that often conflict with necessary medical procedures and hospitalizations. His supervision officer required him to wear an ankle monitor even after his doctor warned the monitor would jeopardize his health due to his heart condition. Plaintiff Mr. Davis, who lives with chronic pain stemming from third-degree burns as well as mental health conditions, also faces disability-related barriers getting to required meetings. Yet failing to meet any of these conditions, even something as simple as missing an appointment, can land a person back in jail or prison, even when no new criminal conduct is alleged. The court agreed that “absent immediate relief, the Parolees will face irreparable harm; namely, obstacles to success on supervision solely because of their disabilities, which expose them to downstream harms like revocation and reincarceration.” The court did not decide whether it will ultimately certify a class that could yield relief for all people on supervision in D.C. who need accommodations. Instead, the court directed the parties to agree on a schedule for further proceedings on that issue. “The undue hardships faced by people with disabilities on federal criminal supervision in the District of Columbia have gone unaddressed for too long,” said Scott Michelman, legal director, ACLU of the District of Columbia. “This decision is a victory for equal treatment and common sense.” “The Court’s opinion emphatically rejects the federal government's ‘do-nothing’ policy for people with disabilities on supervision in Washington, D.C., who have been forced to navigate onerous requirements without accommodations for decades,” said Allison Frankel, staff attorney with the ACLU Criminal Law Reform Project. “This ruling ensures that our named Plaintiffs will have the accommodations they need to have a fair shot at completing parole and remaining in their communities.“ “We are thrilled the Court recognized that the Parole Commission and CSOSA must accommodate our clients’ disabilities so that they have an equal opportunity to succeed on supervision,” said Zoé Friedland, staff attorney with the Public Defender Service for the District of Columbia. “We will keep fighting to make this relief permanent and systemic so that all people on supervision have an equal chance to succeed.” The decision on the preliminary injunction can be found here: /cases/mathis-v-united-states-parole-commission?document=Preliminary-Injunction-Opinion The complaint can be found here: /documents/w-mathis-v-united-states-parole-commission-complaint