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The ACA Repeal Is Back and Worse for Women Than Ever

UPDATE: The House is rushing to vote on ACA repeal today, May 4th, despite the fact that no one’s debated the latest repeal bill, the Congressional Budget Office hasn’t scored it, and members of Congress admit that they don’t even know what’s in it. The vote will be close, and every single member will count. Here are the Reps who are on the fence: call them and demand they vote NO on the ACA repeal. 

Republicans have a new bill to repeal the Affordable Care Act. This one is even worse for women, and everyone else, than before – and the House could vote on it as soon as next week.

Remember when House Speaker Paul Ryan and Donald Trump tried to repeal the Affordable Care Act last month? Their obscenely cruel bill would have stripped health insurance from 24 million people, dramatically raised premiums for people who could keep their insurance, and defunded Planned Parenthood all to cut taxes on the wealthy – which is why it went up in flames in March. But apparently, Paul Ryan is willing to endure any and all humiliations to cut marginal taxes for the wealthiest Americans, so the bill is back, and somehow worse than before.

The latest version of the House repeal bill, titled the American Health Care Act (AHCA), would allow states to opt out of the Affordable Care Act’s ban on discriminating against people with preexisting conditions – allowing insurers to charge people astronomically higher premiums for having medical conditions like diabetes, asthma, or cancer.

And guess what else counts as a pre-existing condition? Pregnancy. A study from the Center for American Progress estimated that if Obamacare’s preexisting conditions protections were rolled back, insurers would charge about $17,320 more in premiums to someone who had previously had a pregnancy – and that’s without complications. According to the same study, breast cancer survivors (under 50) would see an approximately $28,660 increase in premiums. And, like everyone else, women experience asthma (a $4,340 increase in premiums), depression and bipolar disorder ($8,490), and heart attacks (a staggering $57,960).

It gets worse. If passed, the new version of the AHCA would also allow states to opt out of Obamacare’s “essential health benefits” requirement.

When GOP congressmen misleadingly complain that “Obamacare makes men pay for maternity coverage,” what they’re actually objecting to is this “essential health benefits” requirement. The ACA requires that insurance plans sold in the individual market and the Medicaid expansion cover ten basic “essential health benefits” – including lab tests, hospitalization, prescription drugs, and, yes, pregnancy, maternity, and newborn care. In fact, thanks to the EHB requirement, insurers must cover 22 kinds of women’s health visits, prescriptions, and tests, including domestic violence counseling, mammograms, and contraception. This is for good reason – in 2009, prior to the passage of the ACA, the National Women’s Law Center found that just “13% of health plans available to a 30-year-old woman” in the individual market covered maternity care. In capital cities of nearly half the states, the Law Center couldn’t find a single plan that covered maternity care.

In other words, before Obamacare’s essential health benefits requirement, it was almost impossible for women in many parts of the country to get maternity coverage. If the AHCA passes, we risk going back to the times when mothers and would-be mothers were shut out of insurance markets (because nothing says “pro-life” like denying people maternity coverage). As Grancene Franke-Ruta notes in the Atlantic, GOP discomfort with maternity coverage seems rooted in conservative discomfort with motherhood outside traditional marriages – especially since the ACA empowered single women, especially single women of color, to access maternity care.

The new bill also still defunds Planned Parenthood, blocking them from receiving Medicaid reimbursements for basic, affordable health services. Federal money is already prohibited from being used to pay for abortions (#EndHyde), so this move does nothing to reduce abortion but instead blocks low-income people from accessing life-saving health care like pap smears and mammograms.

The repeal’s impact would be devastating for everyone, but especially so for women. In March, the first attempt at repealing Obamacare failed in part because the farthest-of-the-far-right Republicans in the House Freedom Caucus thought the bill didn’t hurt working-class people enough. With these changes – the ones that would let insurers gouge people with pre-existing conditions and offer coverage that doesn’t include ambulances, hospitals, or maternity care – the Freedom Caucus has gotten on board. Most of their 30 or so members will vote to repeal Obamacare, putting ACA repeal closer to the finish line than ever.

But the AHCA didn’t just fail because of the Freedom Caucus. Massive protests across the country pushed Republicans in swing districts into coming out against the AHCA. At least 17 still appear to be “no” votes, and more are undecided or leaning no; thanks to grassroots pressure on them, House leadership is already delaying the repeal vote. The AHCA isn’t dead yet, but Republicans can only lose 22 members – meaning that calls, protests, and letters in the next week could kill it once and for all.

We’re not telling you what to do. But you can find Indivisible’s Save the ACA Toolkit here.

Image credit: Megan McLemore via Human Rights Watch

Sejal Singh is a feminist writer and organizer living in DC. In her day job, she leads national campaigns for queer and trans rights; in her night job, she fights to end gender violence in schools as a Policy Coordinator at Know Your IX. Her views are her own, not necessarily those of her employers.

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