At this point, it’s cliché to say there is “so much at stake” in the upcoming election, but only because it’s painfully true. In addition to determining how (or if) the U.S. recovers from the devastating consequences of the COVID-19 pandemic, the outcome of the vote on November 3 will also have a major impact on Americans’ reproductive rights and sexual health.

To help us better understand how reproductive rights are at risk in the upcoming election—and what we can do about it—Lifehacker spoke with Jacqueline Ayers, the vice president of government relations and public policy at Planned Parenthood Federation of America (PPFA). Here’s what you need to know.

Your vote really does matter

As we’ve witnessed over the past few weeks, the power the president has to appoint Supreme Court justices can’t be overstated—not to mention the ability to sign executive orders and dictate the vision and aims of their party. And as dire as the situation may seem for reproductive rights with Donald Trump as president, it can get much worse if he is reelected.

“Right now where we find ourselves in this country, is facing an election that’s really going to be a fight for our survival,” Ayers tells Lifehacker. “Literally everything is on the line, with the election at the intersection of issues that are important for race, class, gender—there is still a lot of opportunity to make policy change, but only if people come out and come out and vote.”

Statewide and local elections are also extremely important

But it goes far beyond who will spend the next four years in the Oval Office and in Congress—reproductive and sexual health policies are being implemented on a state and local level as well, and the way we vote on these races really matters. “Up and down the ticket, what we know is that we’ve seen an unprecedented attack on our healthcare and a state, local, federal level,” Ayers explains.

There are currently 17 state-level cases that are only one step away from the Supreme Court that would determine access to abortion. One such case involves a six-week abortion ban passed in Georgia that would outlaw and restrict abortion—even at a point in time when a person may not know that they’re pregnant, Ayers says. In response, the PPFA is working to flip Senate seats in places like Maine and Colorado, Arizona, Montana and North Carolina, she notes.

Don’t ignore state and local judicial races

If you live in a state that elects judges, keep in mind how of an impact the results of this election might make. For an example of why these races matter so much, look no further than 2018. After Brett Kavanaugh was confirmed to the Supreme Court, Ayers says that some states started passing extremely restrictive abortion laws, fully expecting them to be challenged in the lower courts, and hoping they will work their way up through circuit courts and then ultimately to the Supreme Court, where they will be decided upon by a conservative bench. According to Ayers, the current administration has put forward nearly 200 judges on the federal and lower courts who are hostile to reproductive health care—a trend she says could change if people voted all the way up and down the ballot.

“There is absolutely an importance in paying attention to the judiciary,” she says. “Because in states where they do elect judges, we know that everything is on the line there, too. And the ability to protect access to reproductive healthcare and make sure that restrictions on abortion are not able to move forward—a lot of that begins in the state courts.”

The Affordable Care Act has a huge impact on sexual and reproductive health

With so much emphasis placed on the abortion access granted through Roe v. Wade (and rightfully so), it can be easy to overlook exactly how much we stand to lose if the Affordable Care Act (ACA) were to be eliminated. For example, Ayers says that getting rid of the ACA would do a tremendous amount of harm because people would lose mandated coverage for pregnancy, labor and delivery—and at a time when Black women who are pregnant in the United States are still three times more likely to suffer complications or death from pregnancy.

“We can’t allow people to lose their coverage,” Ayers says. “It’s important to remember [that] 29.8 million people have health insurance today because of the Affordable Care Act. We know that there are 62 million women who now have access to expanded contraceptive coverage with no out-of-pocket costs—that includes 70 million Latinas [and] 50 million Black women. Having that guarantee of birth control coverage is essential, and cannot be eliminated.”

Beyond birth control, the ACA also ensures that simply having a uterus isn’t considered a pre-existing condition, along with being a survivor of domestic abuse.

“One of the reasons why Planned Parenthood and our supporters fought really hard to pass the Affordable Care Act was because we knew that it was important to expand coverage [including] contraceptive coverage, to make sure that people can get more care by expanding Medicaid,” Ayers says. “We want to make sure that it is never repealed, and in fact, we’re voting in this election to continue to grow that success. The ACA has made so much possible, and particularly now in a pandemic, I think people want better access to health care—not less.”

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