Just within the first two years of expansion, nearly four million women were newly insured through Medicaid between 2013 and 2015 -- women who are now at risk of losing health care coverage.
Women, who are the primary beneficiaries of Medicaid, could be the hardest hit by these changes. In 2015 alone, nearly four million more women were using Medicaid than men according to the U.S. Census Bureau.
“Medicaid is a critical lifeline to health care services,” said Alina Salganicoff, vice president and director of women's health policy at the Kaiser Family Foundation. “Now, nearly one in five women have Medicaid coverage and anything you do to change Medicaid will impact women in this country, especially the women who have the fewest resources to get care.”
Medicaid expansion under the ACA discarded "categorical" eligibility -- where low-income individuals only qualified if they were pregnant, a parent of a dependent child, over age 65, or had a disability—in favor of criteria solely based on income. For the first time, it allowed low income women without children to gain access to health insurance.
The CBO estimates that under the AHCA, Medicaid expansion would no longer be sustainable, with states curtailing their programs or choosing not to expand eligibility due to the lack of funds. By 2018 the CBO estimates that 4 million people will lose coverage with that number steadily increasing to 14 million by 2026.
The dramatic losses in insurance coverage are primarily driven by changes to Medicaid enrollment and funding under the legislation, according to the CBO. The AHCA would cut federal funds to match state budgets and place caps on the amount that can be spent for each Medicaid user.
Instead, the new bill proposes a system of block grants in which fixed amounts of money are doled out to states, allowing them to tailor health care services offered to their local populations.
“We believe that it's important to allow states to have that flexibility to fashion the program for their vulnerable population that actually responds to that population in a way that gives them the authority, them the choices, them the opportunity to gain coverage and the care that they believe most appropriate,” said Secretary of Health and Human Services Tom Price during a White House press briefing in March.
But Dr. Diane Cosper Horvath, a reproductive health advocacy fellow at Physicians for Reproductive Health disagrees, saying that the cuts to Medicaid would be “catastrophic to health care in our country.”
“When Medicaid gets cut, the people that are hurt the most are women,” she said. “Women who are heads of households, single mothers. People who are struggling to make ends meet, they lose insurance coverage and risk not being healthy enough to work and not being able to maintain their health well enough to care for their families.”
Since its inception in 1965, Medicaid has become a linchpin in America’s health safety net, especially for low-income women. The program is an important protection for vulnerable populations, providing coverage for nearly half of reproductive aged women living below the federal poverty line according to the Guttmacher Institute. Women of color are also more likely to rely on Medicaid -- the Kaiser Family Foundation found that one in four African American and Latina women using the program.
Without insurance, this woman never sought out more medical care and succumbed to an illness that is eminently preventable, Horvath said.
“I think about how life would’ve been different for her if she was able to come in and get routine health care, it would have saved her life," Horvath said.
With millions of women at risk of losing access to health care, Horvath views the cuts to Medicaid as a part of a larger trend to disadvantage women.
“It’s a clear pattern of de-prioritizing women's health, reproductive health, and health and well-being of families,” she said. “This is really an assault on families in this country, low-income individuals, people of color. It’s terrifying.”