Incoming House Speaker Nancy Pelosi recently reacted to a federal judge’s decision to declare the Affordable Care Act (ACA) unconstitutional just before the deadline to sign up for the 2019 insurance plan on Dec. 15. While the matter will be taken to the Supreme Court, Pelosi is already vowing to make this issue a priority.

In a press statement she said, “When House Democrats take the gavel, the House of Representatives will move swiftly to formally intervene in the appeals process to uphold the life-saving protections for people with pre-existing conditions and reject Republicans’ effort to destroy the Affordable Care Act.”

But, the polarizing act of reforming or repealing the ACA has many Democrats debating among themselves about health insurance coverage and care policies.

Ayanna Pressley became Massachusetts’ first African-American to be elected to Congress, representing the polarized 7th District of Massachusetts. We took a closer look at the kind of health policies Pressley will be prioritizing in 2019 that have an impact on Bay Staters at every stage of life. At a recent rally, Pressley mentioned the MBTA 1 Bus route that runs three miles through her district, from Harvard University to Dudley Square in Roxbury.

“Life-expectancy decreases by 30 years,” she said. “Low-income people are rationing insulin. We must not be moderate in our aspirations.”

 Life-expectancy decreases by 30 years. Low-income people are rationing insulin. We must not be moderate in our aspirations. —Ayanna Pressley

Pressley is a supporter of Medicare For All. In the affluent Back Bay neighborhood, the average life expectancy is 92 years. In Roxbury, that number is less than 60, according to a study conducted by Boston University in 2015.

Pressley, 44, is currently looking at health care by dividing her health policy priorities into the realms of children’s health, access and coverage of health insurance, substance abuse disorders and maternal health.

Children’s Health

A couple of her children’s health prerogatives will be to restructure federal programs to adjust federal programs to reimburse school nurses for health care services, with eligible reimbursements from Medicaid, CHIP and private insurers for health services provided at school.

She would also like to give every state, including Massachusetts, the ability to use CHIP funding to replace lead paint and eliminate mold in public housing. States like New York and Michigan are already doing this, according to the research from Princeton University. This could reduce environmental factors that cause asthma and lead poisoning in children, a problem that has persisted in low-income parts of the 7th district, like Dorchester, for many years.

Access to Health Care

Pressley told us, “I support Medicare For All and believe that universal coverage is necessary to address the health disparities in the Massachusetts 7th and across the country, which disproportionately hurt our most vulnerable communities.” She says the Trump administration “remains hellbent on dismantling the Affordable Care Act.”

Supporting Medicare For All is tricky, and it will be very expensive. Incoming Speaker Pelosi has embraced the pay-as-you-go method of legislating, which can limit how much can be spent by Democrats. Democrats claim the savings will come from lower costs on prescription drugs and physician reimbursement fees.

Reps.-elect Alexandria Ocasio-Cortez, Rashida Tlaib and Pressley are expected to join a new “Medicare For All” caucus with current congresswomen and men.

Pressley also wants to introduce legislation that requires health insurance providers, both public and private, to cover costs related to interpretation and translation services for non-English speaking patients.

Opioid Abuse

On substance abuse, Pressley acknowledges that the Bay State has a serious problem with deaths from opioids, and increasing costs from the epidemic, which cost the state $15.2 billion in 2017 according to the Massachusetts Taxpayers Foundation. According to figures released by the state in November, deaths mostly linked to synthetic opioid fentanyl numbered at over 1,500 for the first nine months of 2018.

Pressley thinks adopting a treatment-based approach could work, prioritizing prevention and treatment programs over incarceration. She is supporting Sen. Elizabeth Warren and Rep. Elijah Cumming’s Comprehensive Addiction Resources Emergency (CARE) Act that would funnel $100 billion to states impacted most by the crisis. She also supports Medication Assisted Treatments in prisons for the over 50 percent of incarcerated individuals in U.S. prisons with substance abuse and dependence disorders. Such a policy is being implemented successfully through the Middlesex Sheriff’s office, combining counseling with medications.

Maternal, Teen Health and Reproductive Rights

Womens’ health and reproductive rights has been of priority of Pressley’s since her first days as a city councilor. She supports the Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMA), which seeks to address the rising rate of black maternal mortality in the country. According to the American College of Obstetricians and Gynecologists, African-American women are three to four times more likely to die from a pregnancy-related complication than white women. The legislation would streamline protocols for obstetric emergencies and expand the period of Medicaid coverage for a new mom to a full year beyond two months postpartum.

For reproductive health, Pressley wants to repeal the Hyde Amendment, which prohibits federal funds to be used to pay for abortion services. She is also continuing to fight against the loss of the Teen Pregnancy Prevention Program, which forced the Massachusetts Alliance on Teen Pregnancy to shut down in June 2018 due to expected loss of funding.