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Just How Bad for Women Is the American Health Care Act?

Tuesday, May 16, 2017
Susan Buttenwieser
Women's Media Center
Wilmarie Ríos Jaime Phone: (202) 754-8811 Email:

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“Across the board, this is a terrible bill for women,” said Jamila K. Taylor, senior fellow at the Center for American Progress, speaking about the American Health Care Act (AHCA). The Republican-led House of Representatives passed the bill on May 4, without waiting for a report from the nonpartisan Congressional Budget Office, whose economic analysis of proposed legislation would provide an estimate of how much it will cost and how many people could lose health insurance. The Senate is expected to start work on its version once the CBO score is completed later this month. But advocates and angry constituents were already voicing their outrage.

The Center for American Progress called the AHCA “one of the worst bills for women’s health in a generation” because it would defund Planned Parenthood; institute work requirements for most mothers on Medicaid; allow states to waive requirements that all insurers cover all essential health benefits including maternity care, mental health services, and prescription drugs; restrict private health insurance of abortion; increase premiums for people with pre-existing conditions; and throw millions of people off their coverage.

Under the existing law, the Affordable Care Act, insurers are not allowed to set premiums based on a person’s health status. “The basic idea behind the ACA is that everybody must have health insurance,” said Laurie Sobel, associate director of women’s health policy at the Kaiser Family Foundation. “This creates mixed risk pools with healthy people and sick people. Under the ACA, insurers cannot charge higher premiums to people with pre-existing conditions. Under the AHCA, individuals would not be required to have health insurance. States could ask for waivers to allow insurance companies to review people’s health status and could charge higher premiums to people with pre-existing conditions who have a lapse in their insurance of 63 days or longer. This provision could make premiums unaffordable for some people applying for health insurance after a lapse in coverage.”

“States can decide whether or not to cover certain essential health benefits,” said Taylor. “This could mean only bare-bones coverage and the exclusion of vital care like maternity care. Coverage will now be based on a person’s ZIP code.”

The uninsured rate among women 19 to 64 fell from 17 percent to 11 percent between 2013 and 2015, according to the Kaiser Family Foundation, in large part because of the ACA’s Medicaid expansion and federal tax credits. A new report from the Center on Budget and Policy Priorities, a nonpartisan research and policy institute, states that the AHCA’s proposed deep cuts to Medicaid would disproportionately harm women, who make up the majority of Medicaid beneficiaries and are the main users of family planning.

“Medicaid is the leading source of public financing for family planning services, accounting for 75 percent of all public funds spent on contraceptive services and supplies in 2015,” said Sobel. “Medicaid covers one in five women of reproductive age.”

The pre-existing conditions component of the Republican plan has been a hot-button topic. An estimated 130 million nonelderly Americans have pre-existing conditions. While the AHCA contains language prohibiting insurers from limiting access to coverage for people with pre-existing conditions, it undermines their access to coverage and makes it possible for them to be priced out of the market by allowing state waivers of essential health benefits and allowing health status underwriting. “The idea that those with pre-existing conditions will not encounter discrimination in the health marketplace under the House bill’s provisions is nothing more than political fiction,” said Janel George, director of federal reproductive rights and health at the National Women’s Law Center.

While the AHCA doesn’t explicitly state that sexual assault and domestic violence will be considered pre-existing conditions, advocates are still concerned that in practice, this will be a by-product of the bill. Insurers could increase premiums by unlimited amounts for people with a medical history that includes illnesses such as depression. “Survivors of sexual violence will be harmed by this bill,” said Sofie Karasek, director of policy at End Rape on Campus. “People could be afraid that if they report that they have a history of rape or domestic violence, it will impact their health insurance premiums. We are already seeing reports that undocumented survivors have stopped seeking services out of fear that they will be deported. And we are concerned that survivors of sexual violence and domestic violence, no matter their immigration status, will have the same concerns about seeking help out of fear that it will impact their ability to get health insurance.”

“Nothing in the bill says anything about sexual assault, but we know if someone has multiple gynecological visits in one year, HIV tests, and receives HIV medication, that it’s a signal to health insurance companies that a woman may have a serious health problem. Before the ACA, that would be enough for an applicant to be red-lined,” said Linda Blumberg, senior fellow in the Health Policy Center at the Urban Institute.

“Women who have experienced injuries or STI transmission that are the result of sexual and domestic violence could have their health insurance rates go up or become unaffordable altogether if they were to seek care under the AHCA,” said Taylor. “Another concern is that this could have a chilling effect. Fifty-one percent of nonelderly women have a pre-existing condition. Women might be concerned about obtaining services like getting HIV testing or violence screenings, and try to avoid having anything on their health records that could be seen as a pre-existing condition, which could impact their health insurance. This will have a particularly harmful effect on low-income women and families.”

George pointed out that the AHCA “undermines access to coverage for sexual assault and domestic violence survivors by stripping away critical ACA protections. And it penalizes those with a gap in coverage, who are more likely to have pre-existing conditions, by allowing insurers to take health status into account in setting pricing and to charge them more for those conditions. While there is a patchwork of state laws that vary in their protections for survivors of sexual assault or domestic violence, they don’t come close to the ACA’s nationwide guarantee of coverage no matter your health condition or where you work or where you live.”

The ACA, which has not been overturned and remains in effect, constituted a giant step toward providing comprehensive and affordable health care for all Americans and has benefitted women especially. Before the ACA, almost two-thirds of women in the individual marketplace had plans that didn’t include maternity coverage. “Prior to the ACA, women were routinely charged more than men. The AHCA opens the door for women and others with pre-existing conditions to once again be priced out of the health care market,” said George.

By pushing through the AHCA, “the House is knowingly jeopardizing the health and lives of millions of Latinas and other women of color,” said Ann Marie Benitez, senior director of government relations at the National Latina Institute for Reproductive Health. “The AHCA puts women and their families in a position where they will have to ask themselves if they can afford the care they need. Women are the backbones of this nation, and without access to affordable coverage and critical healthcare, we all stand to lose.”

The views expressed in this commentary are those of the author alone and do not represent WMC. WMC is a 501(c)(3) organization and does not endorse candidates.