Despite a failure to repeal the Affordable Care Act (ACA, also known as Obamacare) earlier this year, Republicans in Congress continue to push for an overhaul. The various versions of “repeal and replace” that have been put on the table, including the one passed by Congress on May 4, pose significant dangers to the health of American women.
1. Making Essential Health Benefits Optional
The ACA requires that health insurance plans in the individual markets and Medicaid expansion program cover ten “essential health benefits.” These include maternity and newborn care, preventive services, prescription drugs, and mental health treatment—services that are particularly important to women. Recent GOP proposals would leave it to the individual states to decide which benefits policies must contain.
If coverage of maternity care, mental health, and other essential services is not included in all policies, the only people likely to pay for such coverage are those who expect to use it. That would rapidly increase the cost of the coverage. Furthermore, many, if not most, insurers are likely to stop offering comprehensive plans entirely, for fear of attracting people with high health care needs.
2. Capping Federal Medicaid Spending
Medicaid is a leading source of coverage for low-income women of all ages, providing health coverage to nearly one in five women in the U.S. It pays for half of births and three-quarters of all public family planning, and provides supplemental coverage for nearly one in five senior women on Medicare. Capping the program would limit the federal dollars that states would receive, jeopardizing the care of millions of women. For details, see our earlier story on proposed Medicaid changes.
3. Banning Planned Parenthood as a Medicaid Provider
Medicaid provides coverage to one in four women of reproductive age. Planned Parenthood provides essential preventive care services to low-income women, including screening for cervical and breast cancer, and contraceptive services. At least 60% of Planned Parenthood’s 2.5 million patients in the U.S. rely on public programs like Medicaid to access preventive health care, with most of Planned Parenthood’s federal funding coming from Medicaid reimbursements for services provided.
The bill passed by Congress would deny Medicaid coverage for Planned Parenthood services. This would curtail access to essential reproductive health care services for over a million women. Planned Parenthood clinics provide services to more than a third (36%) of all women in the U.S. who need publicly funded care.
4. Eliminating Required Preventive Services or Charging Extra for Them
Under the ACA, all private insurance plans, Medicaid expansion programs, and Medicare must cover not only essential services but also a list of recommended preventive services at no additional cost to the patient. Recommended preventive services include some that are very important to women, including breast and cervical cancer screening, osteoporosis screening, pregnancy related services, well woman visits, and contraception. Medicare covers the full cost of mammograms, cervical cancer and bone density screening for older women under the ACA.
Some Republican proposals on the table would eliminate preventive services requirements for Medicaid beneficiaries or repeal the preventive services policy for all plans. Others would cover these services, but require consumers to bear part of the cost via co-pays, again curtailing access to affordable services.
5. Repealing Tax Credits and Subsidies for Low-Income Individuals
About 81% of ACA marketplace enrollees receive a tax credit that lowers the cost of their premiums, making health care coverage more affordable. The proposed GOP changes would award tax credit assistance mostly based on age, repealing existing cost-sharing protections for low-income individuals. Women in the U.S. have lower income than men at all age levels, so they would be disproportionately affected by these proposed changes.
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