The American Health Care Act (Trumpcare) has received strong criticism from Democrats and even some Republicans who feel that the law will cause millions of Americans to lose healthcare coverage. In addition to a loss of coverage for many people, the bill, if signed into law, may significantly impact women’s healthcare. Particular complaints include eliminating federal funding for Planned Parenthood, nixing coverage for abortions and potentially reducing access to healthcare services for women with limited incomes.
Planned Parenthood has long come under fire from conservative Republicans because the organization provides abortion services at some of their clinics. According to Planned Parenthood, abortions account for 3 percent of their offered services while 80 percent of their services are aimed at preventing unwanted pregnancies. Currently, Planned Parenthood receives $500 million in federal funds each year. The Hyde Amendment, which has been part of abortion legislation in some form since 1976, already prohibits any organization from using federal funds for abortions. The loss of funding for Planned Parenthood could result in many women being unable to obtain birth control, be tested for STDs, or receive cancer screenings like pap tests and mammograms.
Right now, 75 percent of Planned Parenthood’s funding comes from Medicaid reimbursement. The AHCA effectively eliminates the organization from the pool of Medicaid providers. There are many low-income and rural women who depend on Planned Parenthood for necessary medical care that is then reimbursed through Medicaid. This could mean that as many as 2.5 million people could lose access to care from the organization because Medicaid wouldn’t be able to cover the costs. According to some analysts, the poor, people of color and those who live in rural areas, already populations with limited access to healthcare, would have essential health services pushed even farther out of reach.
Maternity and Birth Control Benefits
Under Obamacare, insurance policies are required to include access to preventive services like maternity care and birth control. Because the 10 essential benefits provision implemented under the ACA is not connected to the federal budget like other portions of the law, it will remain intact under the Republican law. But the provisions could be changed in the future. Trumpcare calls for all provisions of the ACA to sunset at the end of 2019 for anyone on Medicaid. That would mean anyone who received coverage under the expansion of Medicaid would no longer be guaranteed the same coverage after 2019.
The essential health benefits provision can only be repealed with 60 votes in the Senate. At this time, repealing that portion of the ACA does not seem probable. However, Republicans could modify the essential benefits regulation or give states more leeway in determining which services insurance plans must cover. Maternity care and birth control, for example, could be eliminated using these methods.
Republicans are largely pro-life and anti-abortion, and abortion is one of the key issues that conservatives want to tackle with healthcare reform. Under Trumpcare, tax credits cannot be applied toward any insurance plan that includes abortion coverage unless the abortion was due to a pregnancy caused by rape or incest. Even if a woman never plans on getting an abortion, she can’t use tax credits to pay for a plan that even covers it.
Tax credits are being used to offset the cost of monthly insurance premiums. Although the bill does not forbid abortion coverage, it would make plans that do include this coverage more expensive, and many people wouldn’t buy them anyway since tax credits can’t be applied toward the cost. Analysts suggest that if this bill passes, insurance companies may choose to eliminate abortion coverage in an effort to keep premiums affordable. Although the law only applies to individual policies in the state marketplace, some believe coverage will also be eliminated for those who receive non-marketplace or employer-funded policies.
Reduced Access to Care
Research indicates that between 6 and 10 million people will lose coverage under Trumpcare. This loss of coverage will have a more profound impact on women because they make up a larger share of low-income workers, and many of them rely on Medicaid for healthcare. In fact, 69 percent of all Medicaid enrollees are women. Starting in 2020, the new law would end the expansion of Medicaid that was implemented under Obamacare.
This means that those already on Medicaid could keep coverage as long as their policies do not lapse, but no new enrollments will be authorized after 2020. Another area where the AHCA could affect women is Medicaid funding, which will now be based on enrollment levels in the state rather than on how much is spent on healthcare. This approach will make it harder for some states to cover the cost of Medicaid, which will reduce the number of people who can enroll, most of whom will be women.
Higher Costs for Seniors
Under Trumpcare, insurance will be less costly for young people and more expensive for senior citizens. The AHCA allows older people to be charged five times as much as younger enrollees. The cost is offset by higher tax credits offered to seniors, but the tax credit is only worth twice the dollar amount of a younger person’s subsidy. Younger people benefit from this measure, but older people may end up buying cheaper, less comprehensive coverage to save money. Women they tend to live longer than men. This means that the senior citizen population has a higher number of women, and higher premiums could price them out of the insurance market altogether.
Women’s rights organizations and the American Civil Liberties Union (ACLU) are speaking out against the AHCA. The ACLU asserted that Trumpcare basically makes being a woman a pre-existing condition. It remains to be seen how the bill will change once senators start amending it. Many senators have been outspokenly opposed to the House bill, especially where women and the poor are concerned.