How Heartless is the Senate’s ACA Repeal Bill? Let me count the ways

The Senate is said to have pushed the vote on their “Better Care Reconciliation Act” (BCRA) until after the July 4th recess. I say: good. It’s a bad bill that has nothing to do with promoting better health care.

 Quite the opposite, in fact: it will leave 22 million uninsured, those who remain insured will lose key protections, and it is an outright attack on women and vulnerable communities and their health. Here are ten ways the Senate’s ACA Repeal Bill is heartless: 

1. Slashes Medicaid Funding

Medicaid, a lifeline for 13 million women of reproductive age, covers 3/4s of all publicly funded family planning services. For more than 50 years, Medicaid always covers the actual costs of providing services.

The BCRA will do away with this mechanism by placing a per capita cap (PCC) that sets a projected rate that is less than the yearly growth of health care costs. Additionally, BCRA allows states to operate their Medicaid programs as block grants, locking funding for a five-year period without accounting for increasing needs. Under both PCCs and block grants, Medicaid would cover less women and provide less reproductive health services.

2. Less People Qualify for Medicaid

Millions of women gained access to health care when the Affordable Care Act (ACA) expanded Medicaid coverage for low-income individuals who were neither minors, pregnant, or had a disability. The Senate bill would repeal coverage for this Medicaid expansion population by 2021.

3. Prohibits Medicaid Funding for Planned Parenthood

Effective immediately, the BCRA forbids Planned Parenthood from participating in Medicaid for one year. Planned Parenthood is often the only service provider for millions of Medicaid enrollees. Barring Medicaid funding means that these patients will lose access to reproductive and other essential preventive care.  

4. Allows States to Impose Work Requirements on Medicaid Enrollees

The BCRA allows states to institute a work requirement for most adult Medicaid enrollees. While pregnant women are exempted from this requirement, they must return to work as early as eight to nine weeks after giving birth, whether or not they have access to child care or experience complications like postpartum depression.

5. Repeals Mandatory Medicaid Coverage for Children ages 6-18

Currently, children below the age of 18 with family incomes under 133% of the Federal Poverty Level (FPL) are eligible for Medicaid. The BCRA would only cover Medicaid for children with incomes below 100% of the FPL, meaning that millions of adolescents who need reproductive health care will lose coverage.

6. Repeals Presumptive Eligibility in Medicaid Programs

Two key successes of the ACA were the extension of presumptive eligibility for the Medicaid Expansion population, and hospitals’ ability to determine presumptive eligibility. The BCRA strips these key provisions, meaning that less people will be able to enroll and gain immediate access to health care coverage.

7. Eliminates Retroactive Eligibility in Medicaid Programs

The BCRA no longer allows states to retroactively cover medical expenses prior to the date the individual applies for Medicaid. For pregnant women who incurred costs before applying to Medicaid, they could potentially face severe medical debt due to initial expenses.

8. Allows States to Waive Essential Health Benefits (EHBs)

Under the ACA, Medicaid expansion programs and private plans had to cover at least 10 “essential health benefit” categories. BCRA repeals this requirement, weakening  beneficiaries’ coverage with cuts to preventive and wellness services as well as maternity and newborn care. Before the ACA set this requirement, only 12% of plans covered maternity care. With the BCRA, we are back to the time where being a woman is a pre-existing condition.

9. Makes Private Coverage for Women Less Affordable.

As I explained here, thanks to the ACA’s tax credits and premium subsidies, nearly 7 million women and girls gain access to affordable health care through marketplace plans. The BCRA significantly reduces these tax credits and also lowers the income threshold for eligible applicants.

10. Prohibits Abortion Coverage in the Marketplaces

The BCRA prohibits the use of tax credits to purchase insurance plans that include abortion coverage, except when the woman is a rape or incest survivor or her life is in danger (i.e. Hyde Amendment).

The health care bills in the House and Senate are heartless, and we must do everything in our power to prevent them from coming into effect. You can start by following these steps.

Fabiola Carrión is a senior staff attorney in the National Health Law Program’s Los Angeles office. She directs the Reproductive Health Data and Accountability Project, which establishes systems to collect, analyze, and utilize data on access barriers to family planning and abortion services in public programs and private health insurance.