Will health care for women improve if Affordable Care Act is repealed and replaced?
No: Trumpcare would result in less service and bigger bills
If the American Health Care Act — what some are calling Trumpcare — becomes law, we will see both short- and longterm negative consequences for women’s health.
Some of that would be due to gender-specific parts of the law, but other harms would come about because of general changes that would have an outsized impact on women.
Let’s start with the obvious harms: provisions targeting women’s reproductive health.
This bill would cut off coverage of family planning services, cancer screening services and STD screening provided by Planned Parenthood across the nation.
Because many low-income women and adolescents get their first reproductive health care from Planned Parenthood — 32 percent of all women get contraception at so-called safety-net clinics — the move would effectively cut off contraceptive services and deny basic health care to a larger population.
The AHCA would prevent Planned Parenthood from receiving Title X family-planning funds or Medicaid reimbursement for any service it provides. Abortion coverage would be even more restricted: Even private plans offered through the health exchanges would be banned from covering abortion care.
States would have the option of not including maternity care as a covered benefit, which could lead to insurance companies going back to the bad old days when pregnancy wasn’t covered under most individual insurance plans. Under such circumstances, a woman would be required to either purchase an expensive special plan or go uninsured during her pregnancy.
In the past, this led to Medicaid covering more than half of all pregnancy costs in the U.S.
To argue that not everyone needs maternity coverage fails to recognize the whole idea of
insurance. No one needs insurance for everything, but everyone needs it for something.
What about preventive services, now required to be covered without additional costs to consumers?
States also could opt out of this, affecting everyone seeking screenings for cancer, heart disease and other conditions. Women in affected states would once again be charged outof-pocket costs for contraception, mammograms, osteoporosis screening and annual well-woman visits.
Women nationwide could see their insurers refuse coverage of certain forms of pills or intrauterine devices. And if Secretary of Health and Human Services Tom Price revokes the contraceptive coverage requirement, women again could be required to share in costs of all forms of family planning.
Another state option is dropping the requirement for insurance companies to
Trumpcare would reverse the gains made and result in women missing needed care and experiencing worse health.
cover people with pre-existing conditions at the same premium level.
Women with a history of depression, hypertension, heart disease, caesarean sections, breast cancer or health problems arising from domestic violence could be charged higher premiums or denied coverage altogether.
Among the largest and least understood changes are the proposed dramatic cuts and restructuring of Medicaid, upon which women — more likely to have low incomes, reside in nursing homes and be without employer-sponsored insurance — are more dependent.
The proposed changes would limit Medicaid expansion and also squeeze states to provide Medicaid coverage with far less federal funding. Cutting women’s preventive services, limiting mental health coverage and slashing provider payments could be the first steps states would take in the face of such Medicaid changes.
The Affordable Care Act, while not perfect, dramatically improved the health care available to women, extending coverage to those previously uninsured and decreasing the number of women who delay coverage due to cost.
Being a woman is no longer a pre-existing condition, maternity care and mental health services are covered, and women no longer pay out-of-pocket for contraception.
Trumpcare would reverse those gains and others; the result would be women missing needed care and experiencing worse health. We should not go back.
Susan Wood is an associate professor of health policy and management and of environmental and occupational health at George Washington University.