The House GOP’s newly released plan to repeal and replace the Affordable Care Act, called the American Health Care Act, eliminates the individual mandate, decreases tax credits for the elderly, and gives the wealthiest Americans a big tax break. It will also limit coverage for millions of American women, particularly the poorest.
Here’s what you need to know about the proposed plan and if passed, what it would mean for women’s health care.
1. Birth Control Is OK…For Now
There’s no need to rush out for an IUD just yet if you have employer-sponsored insurance. The bill keeps intact the essential health benefits coverage that was instituted under the ACA. This currently includes co-pay free birth control coverage, as well as newborn and maternity care. There’s no indication that this coverage will go away.
However, the bill allows states to define essential benefits beginning in 2020 for Medicaid recipients. With decreased funding for Medicaid, this will likely lead to cuts in what types of care are covered.
“Access to all FDA methods of birth control without cost sharing has been really important to women,” says Gretchen Borchelt, vice president for Reproductive Rights and Health at the National Women’s Law Center. “For women who are in the expansion population, they will be losing access to guaranteed coverage to all of those essential health benefits.”
2. However, Less Access is Coming With Potential Defunding of Planned Parenthood
The AHCA’s implementation would also lead to less access to birth control coverage and other services for low-income women (and other groups) by defunding Planned Parenthood. Though it doesn’t explicitly name the organization, it is very clearly targeted in the AHCA. As MONEY reported yesterday, the bill “restricts fundings to organizations that provide abortions except in the case of rape, incest, or health of the mother.”
Despite the fact that none of the $500 million Planned Parenthood receives from the federal government each year can be used for abortion services, the GOP plan would strip the organization of Medicaid reimbursements, which account for 40% of Planned Parenthood’s annual budget overall, and 75% of the federal funds Planned Parenthood receives.
Planned Parenthood uses the Medicaid funding to provide millions of women (and men) with primary and preventive care each year, things like cancer and diabetes screenings, flu shots, and birth control.
“Essentially what this language would do is take away the ability of Planned Parenthood to bill for the services under Medicaid, for any service,” says Laurie Sobel, associate director of Women’s Health Policy at the nonprofit Kaiser Family Foundation.
Currently, federal law gives Medicaid recipients freedom of choice to select any health care provider that has the capability to perform a service in a safe and ethical manner. The language in the AHCA would also override this to exclude Planned Parenthood.
3. Your Pre-Existing Conditions Will Still Be Covered
The AHCA does not get rid of the Obamacare provision that prohibits insurers from denying people with pre-existing conditions coverage, or charging them more. (Instead, it institutes a “continuous coverage” provision.) It also keeps the prohibition on gender rating plans.
In the pre-ACA days, 30% of Americans under the age of 65 were uninsurable due to pre-existing conditions like cancer, hypertension, or diabetes. Crucially, women were disproportionately impacted because pregnancy—even the possibility of becoming pregnant—could be considered a pre-existing condition. Sobel notes women also count for a disproportionate percentage of people with mental illnesses like depression, also considered a pre-existing condition.
The National Women’s Law Center notes that before the ACA, “the practice of gender rating costs women approximately $1 billion a year.”
4. Abortion Coverage Is Specifically Targeted
The plan dedicates a hefty portion of its pages to detailing ways abortion will not be covered. Most notably, those receiving tax credits cannot purchase plans that cover abortions, except in the instance of rape, incest, or to save the life of the mother. Under the ACA, federal subsidies cannot be used to pay for abortions.
This new plan gives women the option to buy separate abortion coverage.
5. Medicaid Is In Serious Jeopardy
The Republican plan would “freeze” the Medicaid expansion in 2020. According to statistics compiled by the Centers for Medicare & Medicaid Services, the majority of Medicaid recipients are female, and the program “covered nearly half of poor women aged 15–44 in 2015,” per a report from the Guttmacher Institute.
In fact, the uninsured rate of women of reproductive age dropped by 36% between 2013 and 2015 because of the ACA’s expanded coverage and subsidies, according to the report. Rolling back the ACA’s Medicaid expansion and decreasing its subsidies would ensure fewer women have access to affordable, comprehensive care.
“This plan is really bad for women overall,” but especially for those on Medicaid,” says Borchelt. “Any system that favors the wealthy hurts women more because they are more likely to go without care because of cost. They have less ability to pay out-of-pocket for care.”
6. It Puts Domestic Abuse Victims at Risk
Under Obamacare, couples have to file taxes jointly to receive a tax credit—unless they are victims of domestic abuse, domestic violence, or spousal abandonment. The AHCA doesn’t account for this and requires all couples to file jointly to receive a tax credit, without exception.
Men can also be victims of domestic violence, however women are disproportionately affected by this. “We’re really worried about women who would be hurt by this and wouldn’t get a tax credit,” Borchelt says. “Women in these situations need to not be forced to disclose their new address or phone number.”