Supporters of women’s rights gather for a press conference outside the U.S. Capitol where women members of the House Democratic caucus marked International Women’s Day and A Day Without a Woman March 8, 2017.
Long-awaited GOP-sponsored legislation intended to replace the Affordable Care Act has finally been released, with worrying implications for women’s health. The timing of the bill’s release couldn’t be more salient as much of the globe celebrates International Women’s Day and its central campaign theme, #BeBoldForChange.
Women are central to the health of the nation
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- Women comprise 80 percent of the healthcare workforce in the United States – including 90 percent of nurses, 82 percent of social workers, and 21 percent of healthcare executives, according to data from the Bureau of Labor and Statistics.
- Studies suggest that women make approximately 80 percent of healthcare decisions in households.
- Women comprise 60 percent of caregivers in U.S. households, according to AARP.
Several provisions in the proposed legislation have a direct impact on women’s health.
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Maternity coverage
Coverage for maternity care has long been a component of employer-sponsored health plans, thanks to the 1978 Pregnancy Discrimination Act. The Act required employers with 15 or more employees to provide maternity benefits as part of employer-sponsored health insurance coverage. However, prior to the Affordable Care Act, as few as 12 percent of individual market health plans covered maternity care, and women were forced to pay significantly higher average premiums for healthcare coverage, according to a report from the National Women’s Law Center.
The ACA closed the gap by requiring maternity coverage as one of the 10 ‘minimal essential benefits’ included in any qualified health benefits package. Moreover, these services were mandated to be provided with minimum patient cost sharing, requiring payers to provide first dollar coverage and significantly increasing the likelihood of utilization of these preventative services that have been demonstrated to improve health outcomes.
The newly proposed legislation removes that requirement at the federal level, shifting the responsibility to legislate maternity coverage to the states. This gives states the authority to guide local coverage rules and the opportunity to exclude maternity coverage altogether. The lack of a federally mandated requirement potentially enables local entities to set higher rates for these essential benefits and that may put them out of financial reach for many women.
Medicaid funding changes
Women make up 58 percent of Medicaid enrollees, according to data from the Kaiser Family Foundation. The new bill would effectively roll back Medicaid expansion as crafted by the ACA. It’s widely accepted that Medicaid expansion extended coverage to many low-income families that would not have received coverage otherwise. These are individuals who fall into the gap where income is too high to qualify for Medicaid but too low to afford insurance. In addition, historically low-income women could only qualify for coverage if they were pregnant, mothers of children 18 or younger, disabled, or over age 65. The ACA also expanded coverage beyond these specific requirements.
Given that Medicaid disproportionately helps poor and sick women, any limitation on Medicaid funding by default has a direct effect on healthcare coverage for these at-risk individuals in need.
Women’s preventive health services
The ACA mandated certain preventive services be covered as minimal essential coverage, including maternity care, breast cancer screening, pap smears, contraception, and other life-saving measures. Many low-income women who were unable to access affordable care receive these same services and more with the support of federal funds through clinics such as Planned Parenthood. But the proposed legislation threatens this practice.
Specifically, the bill proposes denial of all federal funding to any organization that provides abortions (with the exclusion of abortion in the case of rape or incest or in the case where the woman’s health is endangered) even if those funds are not utilized for abortion services directly. (Of note, the Hyde Amendment has long prohibited Planned Parenthood and similar entities from using federal funds to perform abortion). This new legislation is akin to the so-called ‘global gag rule’ barring U.S. funds for any international organization that ‘promotes’ abortion —even if those funds are not specifically used for that purpose.
These proposed funding changes directly impact access to preventive healthcare services proven to improve health and lower the cost of care. And the changes disproportionately affect poor women. About 78 percent of patients receiving preventive services at one of their clinics are at or below the federal poverty line, according to data from Planned Parenthood.
Unchanged provisions from ACA
Several popular provisions from the original Affordable Care Act have been left untouched, provisions that prove beneficial to both men and women alike. These include coverage for those with pre-existing conditions; coverage for young adults under a parent’s plan until age 26. Annual and lifetime coverage limits have been removed.
On this International Women’s Day, we need to be bold in the spirit of change to support women’s health. Women play critical roles in health care as providers, caregivers, and healthcare decision makers and disproportionately represent those most in need of our collective support and care. Like mental health, women’s health is a non-partisan issue.
Photo: Win McNamee, Getty Images
