What the GOP’s health­care bills could mean for women Many would lose cov­er­age and key ben­e­fits, pa­tient ad­vo­cates warn

Los Angeles Times - - THE WORLD - By Alexandra Zavis

Women’s health ad­vo­cates have as­sailed the plans put for­ward by con­gres­sional Repub­li­cans to replace the Af­ford­able Care Act, say­ing they would cause dis­pro­por­tion­ate harm to half the adult pop­u­la­tion.

“Both bills are noth­ing short of an all-out at­tack on women’s health,” said Janel George, di­rec­tor of fed­eral re­pro­duc­tive rights and health at the Na­tional Women’s Law Cen­ter.

Both the Se­nate plan, and the ver­sion that nar­rowly won ap­proval in the House of Rep­re­sen­ta­tives, would slash fed­eral spend­ing on Med­i­caid, which pro­vides cov­er­age to 1 in 5 women and pays for nearly half of all births in the coun­try.

Women with pri­vate in­sur­ance plans sold to in­di­vid­u­als could lose guar­an­teed ma­ter­nity cov­er­age in some states. And those on Med­i­caid wouldn’t be able to use their ben­e­fits at health cen­ters op­er­ated by Planned Par­ent­hood for one year.

That’s hardly a sur­prise, crit­ics say, con­sid­er­ing how lit­tle in­put women had in draft­ing the pro­pos­als to replace Pres­i­dent Obama’s sig­na­ture health­care leg­is­la­tion. A work­ing group con­vened by Se­nate Ma­jor­ity Leader Mitch McCon­nell in­cluded 13 men and no women.

“It is an out­rage that a bill, which will af­fect ac­cess to health­care for mil­lions of peo­ple, was writ­ten in se­cret with no women sen­a­tors and will not have a sin­gle public hear­ing,” said Nancy Northup, pres­i­dent of the Cen­ter for Re­pro­duc­tive Rights.

Faced with op­po­si­tion within their own party, Se­nate ma­jor­ity lead­ers this week de­layed a vote on their plan in or­der to give them­selves more time to win over re­luc­tant Repub­li­cans. They hope to have a re­vised ver­sion by Fri­day, so that it can be as­sessed by the Con­gres­sional Budget Of­fice over the Fourth of July hol­i­day.

But as law­mak­ers head back to their home dis­tricts, pa­tient ad­vo­cacy groups, med­i­cal or­ga­ni­za­tions, re­pro­duc­tive rights ac­tivists and oth­ers are mo­bi­liz­ing for an­other push to sink the bill.

Here are some of the ways that the leg­is­la­tion could af­fect women:

Med­i­caid cuts

Both plans would slash hun­dreds of bil­lions of dol­lars from Med­i­caid over the next decade, leav­ing states with some un­pleas­ant choices: limit el­i­gi­bil­ity, of­fer fewer ben­e­fits, re­duce the rates paid to health­care providers or spend more of their own money.

Any cuts would dis­pro­por­tion­ately af­fect women, ex­perts ar­gue, be­cause women make up the ma­jor­ity of adults who de­pend on the pro­gram that in­sures more than 70 mil­lion poor Amer­i­cans.

There are a num­ber of rea­sons for that. Women are more likely than men to work in low-pay­ing jobs that don’t of­fer in­sur­ance. They tend to live longer and have more health needs, par­tic­u­larly dur­ing their re­pro­duc­tive years. And they are more likely to be car­ing for de­pen­dent chil­dren or el­derly fam­ily mem­bers.

The pro­posed cuts to Med­i­caid spend­ing could af­fect more than the cov­er­age avail­able to women: They could dam­age women’s eco­nomic se­cu­rity, George ar­gues. Med­i­caid sup­ports jobs in the health­care in­dus­try that are over­whelm­ingly filled by women, in­clud­ing nurs­ing home em­ploy­ees and home health aides.

The Repub­li­can bills would also give states the op­tion to im­pose work re­quire­ments on Med­i­caid ben­e­fi­cia­ries who are not pregnant, dis­abled or el­derly. Un­der this pro­vi­sion, women could lose their cov­er­age if they don’t re­turn to work 60 days af­ter giv­ing birth.

Elim­i­na­tion of es­sen­tial ben­e­fits

The Repub­li­can bills would al­low states to do away with re­quire­ments that pri­vate health plans sold to in­di­vid­u­als of­fer ba­sic ben­e­fits such as ma­ter­nity and new­born care.

States could also scrap manda­tory cov­er­age of men­tal health ser­vices, in­clud­ing coun­sel­ing for de­pres­sion, which is more preva­lent among women than men. Even cov­er­age for pre­scrip­tion drugs, which women use more than men, may no longer be guar­an­teed.

Pro­po­nents ar­gue this would al­low greater flex­i­bil­ity to tai­lor poli­cies to in­di­vid­ual needs. But crit­ics say elim­i­nat­ing so-called es­sen­tial ben­e­fits could re­turn the in­di­vid­ual mar­ket to the days when cer­tain kinds of cov­er­age were hard to find — and of­ten un­af­ford­able when avail­able.

Be­fore the adop­tion of Oba­macare, just 12% of in­di­vid­ual plans in­cluded com­pre­hen­sive cov­er­age for preg­nancy costs, which can add up to $30,000 to $50,000, ac­cord­ing to the Na­tional Women’s Law Cen­ter.

Re­stric­tions on abor­tion cov­er­age and providers

It is al­ready il­le­gal to use fed­eral funds to pay for abor­tion ser­vices. The GOP leg­is­la­tion would also pre­vent women en­rolled in Med­i­caid from us­ing their ben­e­fits to pay for con­tra­cep­tion, breast and cer­vi­cal can­cer screen­ings, or any other ser­vice at the or­ga­ni­za­tion’s clin­ics for one year.

Gov­ern­ment fund­ing for Planned Par­ent­hood has been a peren­nial tar­get for con­ser­va­tives be­cause it is the largest sin­gle provider of abor­tions in the coun­try.

But the or­ga­ni­za­tion says the pro­ce­dure makes up a small por­tion of the ser­vices it pro­vides at its more than 600 health cen­ters, many of which are in ru­ral or med­i­cally un­der­served com­mu­ni­ties where there may be few other op­tions for low-in­come pa­tients. It has la­beled the Se­nate plan “the worst bill for women’s health in a gen­er­a­tion.”

The leg­is­la­tion would also deny fed­eral tax cred­its to in­di­vid­u­als and small busi­nesses who buy in­sur­ance plans that in­clude cov­er­age for abor­tions. Re­pro­duc­tive health ad­vo­cates worry this could lead in­sur­ance com­pa­nies to drop abor­tion cov­er­age from their plans in or­der to be able to ac­cept cus­tomers who need fi­nan­cial help to af­ford in­sur­ance for them­selves or their em­ploy­ees.

alexandra.zavis @la­times.com

Joe Rae­dle Getty Im­ages

NATALIA REYES waits for an exam at a Planned Par­ent­hood health cen­ter in West Palm Beach, Fla. GOP leg­is­la­tion would bar women for a year from us­ing Med­i­caid to pay for ser­vices at Planned Par­ent­hood clin­ics.

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