— -- Democrats argue that the American Health Care Act, the new Republican health care legislation, would set back advancements made in women’s health care.
According to Sen. Debbie Stabenow, D-Mich., the new bill “would take us back to those days where essentially being a woman was a pre-existing condition.”
Republicans disagree. In a one page memo about the bill on the Ways and Means Committee website, Republicans state, “Our proposal specifically prohibits any gender discrimination.”
Here’s a closer look at some key provisions in the Republican bill moving through the House of Representatives and how they might affect women and girls.
The legislation, as currently written, would prohibit women from using any federal tax credits to buy a plan that covers abortion.
Under current law, the Affordable Care Act, Americans who buy their own insurance can benefit from subsidized rates. Under the Republican plan, these direct subsidies would go away, and the federal government would give a tax credit to individuals to help them purchase insurance plans. The tax credits would not allowed for plans that cover abortion.
The new proposal is consistent with the Hyde Amendment, which does not allow taxpayer dollars to go toward abortions except in the case of incest or rape or to save the mother’s life.
The Republican bill also promises to defund Planned Parenthood. Under the bill, a visit to a Planned Parenthood clinic -- for any service -- would not be covered for Americans on Medicaid. The bill prohibits states from paying Planned Parenthood a reimbursement. However, the Trump administration said if Planned Parenthood stopped offering abortions, it would continue reimbursements for Medicaid patients.
Medicaid payments make the up the majority of the organization’s funding, and current law stipulates that Planned Parenthood may not use any government funds for abortion procedures, though its clinics may see people on Medicaid for contraception, screening and other services.
Republicans argue that Americans would be able to visit other community health centers. Several leading abortion and contraception rights organizations point out that those centers may offer inferior care.
“Planned Parenthood health centers consistently perform better than other types of publicly funded family planning providers,” Ann M. Starrs, the president and CEO of the Guttmacher Institute, wrote in an opinion piece for CNN last week. “It is simply not feasible for other safety net providers that are often already stretched thin to quickly step up and provide timely, high-quality contraceptive care to the many women who might suddenly be unable to obtain care if their local Planned Parenthood has been shut down.”
A new report on the bill from the nonpartisan Congressional Budget Office estimates that approximately 15 percent of people currently on Medicaid who visit Planned Parenthood clinics would lose access to care altogether, specifically those who “reside in areas without other health care clinics or medical practitioners who serve low-income populations.”
The report also estimates that more babies would be born because of this provision.
According to a recent Quinnipiac poll, cutting funding for the organization remains largely unpopular, with 80 percent of respondents opposed to it, including 65 percent of Republicans and 78 percent of independents.
Under current law, insurers are required to cover the entire cost of preventive services, including copays. Those preventive services are defined by the Department of Health and Human Services and include birth control.
Access to free birth control is arguably one of the more popular parts of the Affordable Care Act. A poll from the Kaiser Family Foundation and The Washington Post found that over 77 percent of women and 64 percent of men support no-cost contraception coverage.
The Republican bill moving through Congress would not affect the preventive services provision, according to Laurie Sobel, an associate director of women's health policy at the Kaiser Family Foundation. But the Department of Health and Human Services could redefine what qualifies for this category of care.
Republicans on the Hill and the newly appointed HHS secretary have said new regulations should be expected as the second phase of their party’s plan to repeal and replace the current law.
Maternity care is categorized as an “essential health benefit” under current law, which means it must be offered under private plans but patients likely pay some out-of-pocket costs, of varying levels, in addition to their premiums. The new Republican bill does not address what would qualify as an essential health benefit, but, again, that could be changed through agency regulation.
The bill would, however, get rid of some cost-sharing standards that determine how much patients have to pay for specific services, like maternity care. The effect of scrapping some of these is debated among lawmakers and experts. Maximum out-of-pocket rules would remain in place for now, and some flexibility in what certain plans must offer and pay for could lead to more competition and lower premiums.
On the other hand, Democrats worry that consumers may not realize that plans do not cover as much as they thought. “In today’s marketplace you know you are actually buying real insurance and not a junk plan,” Stabenow said when asked about the change.
The GOP bill says that in the next few years, Medicaid plans would no longer be required to cover these essential health benefits. States would get to decide what those plans must cover.
Andy Slavitt, an acting administrator of the Centers for Medicare and Medicaid Services under President Obama, told ABC News that there would be real consequences for women on these plans.
“Once something is not required, it becomes difficult for one company to offer it,” Slavitt said in a phone interview this week. “It can be a tough business decision. The fear is that you may attract only sicker folks. It can be a race to the bottom, in terms of what’s offered.”
“That’s why having a standard is so important,” he added.
Slavitt emphasized that the Medicaid program was founded in part with the explicit intent of helping poor mothers and children. “It’s no different than why we invest in early childhood education,” he said. “When we show we can help mothers carry all the way to term and have healthy births, it’s a big deal.”