Women are facing some changes with the ousting of Obamacare and a replacement plan that appears to be indifferent to women’s health issues. Across the country, women and their families are preparing for a future where preventive health care, birth control, maternity services and pediatric care may cost more and cover less.
Women and Obamacare
The Affordable Care Act (ACA) substantially improved women’s health care coverage over the last six years. Prior to Obamacare, many insurers didn’t cover maternity care. Women paid more than men for the same coverage, and pregnancy was considered a pre-existing condition that barred women from getting benefits in most states. Only employee group plans were required to cover maternity care and at a sizable additional cost.
The ACA made maternity care one of the 10 essential health benefits that all individual plans must cover. Every plan offered today, both on and off the marketplace, is now required to cover all pregnancy-related care. This extends guaranteed benefits to infants along with additional preventive services. Pediatric care was improved to cover vaccinations, screenings for certain birth defects, diseases, behavioral issues and autism.
Women and Trumpcare
The Trumpcare plan currently has several replacement options that will eliminate Obamacare legislation, and with it, the essential health benefits package for preventive care, family planning, maternity services and pediatric care. Access to birth control, safe and affordable delivery during pregnancy, and follow-up care for newborns are critical health care concerns not just among women but of their partners and families as well.
The discrimination allowing insurers to charge women higher rates than men for the same services could return in the form of additional riders and costs for health care specific to women’s reproductive health. A woman’s financial risk can be substantial if pregnancy once again becomes a pre-existing condition. Truven Health Analytics estimated the average cost of a healthy vaginal birth at $18,329 back in 2013. There’s also the problem of losing guaranteed coverage of maternity and newborn services afterward.
Trump has talked about keeping the provision for pre-existing conditions, but it’s not clear how that will work without the current supporting legislation involving the individual mandate and shared responsibility payments. There are opposing viewpoints on its potential for success. Eliminating the individual mandate will certainly remove the incentive for people to buy health insurance, but giving people more options to customize their policies could spur an increase in enrollment.
Several other women’s preventive health services could be on the line when the health law is repealed or dramatically changed. Losing access to free contraceptives has women reportedly looking for birth control pill alternatives such as IUDs, injections and patches already.
Trump has also made recent controversial comments supporting birth control without a prescription. While that may suggest easier access to birth control, it actually creates a new problem because insurance doesn’t cover over-the-counter (OTC) drugs, which would increase out-of-pocket costs. Republicans have generally opposed OTC birth control, and it’s not certain which direction this issue will take.
Current law states that other preventive services recommended by the U.S. Preventive Services Task Force must be covered without cost sharing. The endorsements affecting women include procedures for screening for breast and cervical cancer, and testing for genetic mutations indicating increased risk of breast cancer.
In 2011, the Institute of Medicine proposed their list of preventive services including all FDA-approved contraceptives without charging women out-of-pocket costs. Also included were requirements to cover annual well-visits, screening for gestational diabetes, breastfeeding support and supplies, and counseling and screening for sexually transmitted diseases as well as domestic violence issues.
The Trump administration may redefine preventive benefits available for women, write different rules or just not enforce the old ones, and not require coverage for all 18 FDA-approved methods of birth control. Trump’s current health care plan does not specifically address women’s health and reproductive care, but he has promised to defund Planned Parenthood and does not support abortion. These signs point to an ambiguous future for women’s health and one that could end up with major setbacks to the 2009 pre-Obamacare world.