By Linda Basch, PhD, President, National Council for Research on Women
When the Patient Protection and Affordable Care Act (PPACA) was signed into law one year ago, it seemed that some legislators could hardly contain their exuberant rhetoric. They heralded , among other things, “the Civil Rights Act of the 21st century,” the completion of “the great unfinished business of our society,” and “a new day in America.”
To be sure, there was a lot to celebrate – including significant improvements for women. Among other things, PPACA banned exclusions based on pre-existing conditions in health insurance policies – which had long over-burdened women with exorbitant costs – it guaranteed maternity coverage and some preventive care including Pap smears and mammograms, it protected nursing mothers, and helped states support post-partum depression programs.
But President Obama offered a more realistic appraisal  when he said, “this isn’t radical reform, but it is major reform.” We cannot forget this distinction, and what it means for health care in the United States.
The legislation only covers 32 million of the 47 million uninsured in this country. It contains neither a single payer system nor a public option to ensure that consumer expenses are fully reigned in. In other words, the reform didn’t go far enough. And sadly, its shortcomings are most glaring when we examine coverage for women .
PPACA extended the Hyde Amendment that eliminates federal funding of abortion services, in particular for low-income women through Medicaid and for government employees, including women in the military. The legislation also lacks legal protections for immigrant and undocumented women. It continues the practice of imposing higher premiums on older people, or “age rating.” Gender-rating is also still permitted in larger group plans (more than 100 employees) sold through exchanges.
Gender disparities in health coverage are nothing new -- women have long shouldered a disproportionate share of health costs. In a 2009 issue brief  from the Commonwealth Fund, more than half of women reported delaying or avoiding needed care because of cost, compared with 39% of men. One-third of women have reported exhausting their savings, going into debt, or giving up basic necessities in order to pay for medical care.
Significant gaps also persist along racial lines . Among women, Latinas are most likely to be uninsured at 38 percent, followed by 17 percent of black women and 13 percent of white women. The consequence of these disparities can be life-threatening: Among women diagnosed with breast cancer at a similar age and stage, Hispanic women are 20% more likely to die from the cancer than non-Hispanic white women .
While PPACA does reform insurance, it fails to comprehensively address cost. Without a public option on the other side of the negotiating table, health care-related industries retain tremendous power over prices and quality. Costs are unsustainably high for the middle class and the elderly -- for everyone except the wealthiest. Continuing disparities in access may have dire consequences, and we cannot settle for a status quo that kills.
As we work to fill the gaps in legislation, we must remain equally committed to preventing opponents from moving us backwards on reform. The attempts to reverse PPACA – alongside recent attacks on reproductive rights and Planned Parenthood – endanger the lives and health of millions of women and families.
For our country's future well-being, it would be catastrophic to turn back now.