Senator Joshua Miller (Democrat, District 28, Cranston)’s bill, S0023A, passed out of the Senate on Tuesday, surviving attempts to undermine and derail the bill’s intent by religious fundamentalist Senators such as Anthony Deluca II (Republican, District 29, Warwick) and Jessica de la Cruz (Republican, District 23, Burrillville, Glocester). The bill attempts to safeguard a small set of the most basic health care protections covered by the Affordable Care Act (ACA). [One ACA protection not codified into state law by this bill, for instance, is the ban of annual and lifetime insurance caps. Essentially, before the passage of the ACA, insurance companies were allowed to cut customers off from services once their health care costs hit arbitrarily imposed annual or lifetime limits.]

It is now up to the House to pass similar legislation, but a successful outcome there seems far from certain.

S0023A provides guaranteed availability of coverage to any eligible individual resident of this state regardless of pre-existing condition. It would also require individual health insurers, large group health insurers, and small employer health insurers to provide coverage for ten categories of essential health benefits listed in the act.

Why is this bill important?

On March 30 the United States District Court of Texas issued a ruling that certain parts of the ACA were unconstitutional and violated religious rights. The ultra-conservative United States Supreme Court is not expected to overturn this decision, and could in fact expand it.

As a result, according to KFF, an independent health policy research, polling, and journalism non-profit, millions of people across the United States could end up paying more for preventive care and some may lose access to important and life saving services. Specifically, the ruling wipes out preventative services recommended by the United States Preventive Services Taskforce (USPSTF) since the ACA was passed in 2010. From now on and across the country, these services will carry out-of-pocket expenses for a majority of us. These services include:

• Colorectal cancer screenings for adults ages 45 to 49. (People ages 50+ are still covered);
• Lung cancer screening with low-dose CT scans for adults aged 50 to 80 years with a 20-pack-year smoking history and currently smoke or have quit within the past 15 years was recommended in 2021 and could therefore be subject to out-of-pocket costs;
• Medication to reduce the risk of breast cancer in women at increased risk for breast cancer aged 35 years or older;
• Statin used for the primary prevention of cardiovascular disease in adults;
• Screenings for hepatitis C virus infection in adolescents and adults;
• Screenings for unhealthy drug use;
• Aspirin use to prevent preeclampsia and related morbidity and mortality for pregnant people;
• Preventative interventions for perinatal depression;
• The use of pre-exposure prophylaxis (PrEP), a medication taken to prevent HIV. [PrEP has been a cornerstone in the United States’ effort to combat HIV.]

In addition, modifications to existing services the USPSTF has recommended since 2010 are being rolled back to their pre-2010 status, meaning some patients receiving preventative care will find themselves paying out of pocket going forward, if they can afford the services at at all.

Remember that these preventative care provisions were adopted to save money. Preventing diseases now with low-cost screenings and medications not only leads to better health outcomes for patients, it prevents those patients from accessing more expensive treatments in the future.

This is why it is so important to pass this legislation now, at the state level, before these important protections lapse nationally. Maine, Connecticut, Massachusetts and 17 other states, as well as DC, have codified the protections of the ACA in their states.

Some of these states tied their legislation to triggers, mandating the law go into effect if and when the ACA were repealed or overruled in Court. This is why the Massachusetts legislature, for instance,  is now working to make sure that they have legislation in place to safeguard the protections of the ACA from court decisions that are chipping away at the Act, rather than fully repealing it.

In Rhode Island, the bills under consideration would safeguard the protections of the ACA in state law as they exist now, [mostly], so we have a chance to do Massachusetts one better. Unfortunately, House Bill 5426, from Representative June Speakman (Democrat, District 68, Bristol, Warren), is meeting resistance.

Why is this a religious issue?

It’s not, but some conservative politicians, activists, and judges are pretending it is. The lawsuit in Texas was brought by lawyers representing the Little Sisters of the Poor, who want to eradicate preventive services because it provides no-cost preventative care for contraception.

That’s right, we are not talking about abortion here. We are talking about birth control, specifically hormonal contraception.

During the Senate debate on the bill, Senator Deluca proposed an amendment, supported by his Republican colleagues, to insert sweeping religious and conscience exemptions into the bill. The language in the amendment is far broader than what the Supreme Court Hobby Lobby ruling decided, and what the existing guidelines within the ACA allowed, for religious exemption. The bill, if amended by Senator Deluca, essentially would allow an employer to provide a really skinny healthcare plan without any preventative services coverage.

As Senator Samuel Bell (Democrat, District 5, Providence) noted, “The way it’s worded… it would allow an employer, with basically no restrictions, to deny coverage on any moral conviction whatsoever… This would allow, for instance, an employer to decide to exclude coverage to same-sex spouses. And I think it’s plausible some employer might want to do that.”

Similar language was brought up during the House Committee on Health and Human Services discussion. The amendment was authored, at least in part, by Barth Bracy, who heads up Rhode Island Right to Life, an anti-abortion group.

As it exists now, House Bill 5426 does not have the sweeping language of this proposed amendment but does include all the exemptions granted in the Supreme Court Hobby Lobby case. Advocates for the bill have worked with policy staff, the sponsor, and others to include the words, “including existing exemptions.” This codifies federal statute and related regulations and guidance, including the Hobby Lobby decision.

A personal story

Ten years ago, as my spouse Kathy and I turned 50, we scheduled his and her colonoscopies. My wife, just 50 years old, was diagnosed with stage 4 colorectal cancer, which then moved to her liver. Since then, she has been enduring chemo, surgeries, and radiation treatments every six to 18 months. Had the recommendation then been to screen for colorectal cancer at the age of 45, these ten years of invasive and costly medical treatments and surgeries may have been prevented.

As the United States moves forward from the Covid state of emergency, thousands of people will be losing Medicaid protections and entering the private insurance market under the ACA. Many of these people may choose to go without health insurance coverage. Or, if covered, may forgo preventive care that carries expensive out-of-pocket co-pays. The diminishing protections of the ACA mandated by religious extremists and captured courts adds to this looming disaster.

Thousands of families risk the negative impacts of a failing health care system, just as my family did. And they will suffer not because they didn’t know better, but because right-wing ideologues care more about their vision of God than about the reality of their friends, neighbors, and fellow Rhode Islanders.

The House can not sit on this bill. Speaker Joseph Shekarchi (Democrat, District 23, Warwick) needs to act and codify the health care protections of the ACA before people start to suffer.