— -- Senate Republican leaders are planning to move fast now that legislation was revealed on Thursday to dismantle the Affordable Care Act (ACA) -- otherwise known as ObamaCare -- and drastically change the current healthcare landscape.
Senate Majority Leader Mitch McConnell has said he ambitiously hopes to pass the bill before the July 4 recess -- but in order to do so, Republicans would need to bypass the traditional committee process and forgo public hearings.
While advocacy groups argue the effects of the bill are complex and demand debate, many health care providers argue that women's health in particular could be greatly impacted if the bill were to pass.
Here are some of the ways the legislation could potentially impact women in the U.S.:
One program the bill contains significant cuts to is Medicaid, which currently provides health insurance for 74 million Americans. Experts argue that the Medicaid cuts proposed in the bill could impact women in particular, because of the disproportionately large number of low income women and women of color who depend on the program -- particularly for maternity care.
“Women are much more likely to work in low wage jobs and be tip workers. All of those jobs are more likely to come without health insurance,” Andrea Flynn, an economic policy fellow at The Roosevelt Institute said.
The Kaiser Family Foundation, a nonprofit focusing on major healthcare issues, reported in 2015 that about half of all births in the U.S. were covered through Medicaid.
By cutting federal funding to states to cover Medicaid, states would then have to decide to either cover fewer people, provide less substantive coverage or find alternative ways to shoulder the costs.
Women of color could be particularly affected by such Medicaid cuts. According to the Center for Global Policy Solutions, one in four black women of reproductive age is on Medicaid.
The bill also states that in order to remain eligible for Medicaid, a woman must return to work 60 days after she gives birth. Judy Lubin, a project director for Allies for Reaching Community Health Equity at the Center for Global Policy Solutions, notes that as there is currently no work requirement to be on Medicaid, the inclusion of this clause underscores the “false narrative” that “people on Medicaid do not work.”
Under the proposed bill, states would also be able seek a waiver from Obamacare rules and specifically permit insurance companies to offer plans that don’t meet the current baseline benchmarks for care and coverage.
For example, under current law, all plans must cover so-called essential health benefits, including maternity care, prescription drugs and ambulances. Under the Senate bill, states could do away with those regulations. Supporters argue that this makes the bill amenable to distinct, individual needs -- namely, those of men who do not want to pay for plans that cover maternity care. The ACA precisely aimed to prevent the uneven opportunity and cost disparity between men and women.
Flynn argued that when men buy into the same pool, costs equalize.
“We all pay into a system, and some of us use some benefits and some of us use some others," Flynn said. “Not a women's issue. It’s a family issue.”
Under the Senate bill, insurers cannot outright charge someone more for insurance based on gender, but experts worry that by changing plan requirements, the costs of individual plans that cover maternity care could skyrocket. According to Flynn and several other health care experts, the price of maternity care coverage for women buying their own insurance in individual marketplaces was prohibitively expensive prior to the ACA.
“What could happen under this bill is that some states will continue to mandate the coverage and others wouldn’t and you would see some plans that stop offering that coverage or charge much much more for it,” Flynn added.
The National Women’s Law Center reports that a hospital bill for childbirth care ranges on average from $30,000-$50,000.
If passed, the Senate bill would also prohibit women from using any tax credits available to them from the federal government to buy insurance plans that cover abortion services. This extends to small businesses, which under the bill as is would no longer be able to offer employees abortion coverage if they hope to use government tax breaks to help cover the cost of those plans.
The bill notes that these regulations would not apply to situations where an abortion is “necessary to save the life of the mother” or cases “of rape or incest.”
Christy Gamble, the director of health policy and legislative affairs at the Black Women's Health Imperative, explained how insurance is a safeguard against unexpected events: “Insurance is a safety net. A lot of times the financial means to afford an abortion is not available to these women. So insurance provides the ability to get the necessary services without going bankrupt and affecting every other area of your life.”
Gamble also notes the tangible effects this will have on women’s health coverage.
“There are not going to be plans that see the benefit of having abortion coverage, because individuals who need access to insurance are no longer going to be able to afford it, since the means to pay for those premiums are going to be taken away when it comes to the federal tax credit,” she explained.
Defunding Planned Parenthood
The current legislation would also completely defund Planned Parenthood for one year -- for all medical services. Under federal law, Planned Parenthood already cannot use any federal funds to perform abortions. But this bill would go further.
Women on Medicaid, for instance, could not be reimbursed for any services at these clinics, even for cancer screenings or STI and PAP tests. According to the organization’s official page, it administers 320,000 breast exams in a given year, and 80 percent of clients seek services to prevent unintended pregnancy.
According to previous estimates from the U.S. Congressional Budget Office, dismantling federal funding to organizations like Planned Parenthood would likely increase costs to the federal government. A 2015 report found that implementing such a bill to defund the group would increase direct spending by $130 million over 10 years. Women who can no longer afford these services will turn to hospitals and emergency rooms, the non-governmental organization argued.
This provision on Planned Parenthood presents a potential legal roadblock, though, and reproductive health activists hope the Senate parliamentarian will prohibit Republicans from including it in the final bill. Republicans want to pass the health care bill through a budget reconciliation process, which requires fewer votes, but has strict rules keeping out any “extraneous” language.
Planned Parenthood has released a statement opposing the bill, with President Cecile Richards stating, “One in five women in this country rely on Planned Parenthood for care. They will not stay silent as politicians vote to take away their care and their rights.”
One of the most popular parts of the ACA was access to free birth control. Obamacare designated contraception as a preventive service, and insurers had to front the cost. Flynn and others confirm that the Senate bill, as currently written, would not change that for now.
Flynn notes how currently the contraceptive mandate of the ACA is not under attack -- likely because of the reconciliation regulations. Though, as Flynn notes, “millions of women will lose access to health insurance and therefore they will lose access to family planning.”
McConnell needs 51 votes to pass the legislation. At least five Republican senators have said publicly that they will not vote for the bill in its current form. There are currently 52 Republican members of the Senate.