At a hearing markup on Wednesday, Rep. John Shimkus (R-IL) suggested that one reason Republicans object to Obamacare is that men have to pay for plans that cover maternity services, such as prenatal care.
The heated exchange happened during a lengthy markup session for the GOP’s Obamacare replacement bill in the House Energy and Commerce Committee. Shimkus was responding to a question from Rep. Michael Doyle (D-PA), who asked a different colleague which mandates in Obamacare he took issue with.
“What mandate in the Obamacare bill does he take issue with?” Doyle asked. “Certainly not with pre-existing conditions, or caps on benefits or letting your child stay on the policy until 26, so I’m curious what is it we’re mandating?”
“What about men having to purchase prenatal care?” Shimkus butted in. “Is that not correct? And should they?”
— NARAL (@NARAL) March 9, 2017
Doyle appeared flabbergasted by Shimkus’ response. “There’s no such thing as a la carte insurance, John,” he replied.
One of the big changes Obamacare brought to American insurance was setting a minimum level of coverage, preventing insurance companies from offering skimpy plans that would leave people responsible for large costs when they needed insurance the most. Preventative care, birth control, and maternal health services are among the essential benefits laid out in Obamacare — which does mean that men have to purchase plans that include maternal care.
That’s part and parcel, however, of how insurance works. You buy insurance to protect against events you don’t expect to occur as well as ones you do — and the system depends on the income from people who don’t need to call on it to pay for the people who do. Take car insurance for example: If everyone who bought car insurance had an expensive accident, the system would collapse. Nor do you buy car insurance only if you expect to get in a wreck.
Mandating that everyone pay for maternal care helps bring the costs down for the women who need it — who, typically, got pregnant with at least a little help from a man. And both men and women benefit from health insurance pooling risks.
It also helps make sure that women don’t end up paying more for insurance and for health care than men.
Prior to Obamacare, women were commonly charged more than men for the exact same coverage — a disparity that the National Women’s Law Center estimated cost women about $1 billion a year. And that more expensive coverage didn’t even include all the services that women need — according to the NWLC, only 6 percent of individual-market health plans offered maternity coverage before Obamacare made it mandatory.
A routine hospital delivery could then cost women over $10,000 out of pocket. If they needed a cesarean or had any other complications, that cost could climb over $18,000.
As it stands, Trumpcare does not immediately repeal these minimum insurance mandates. However, they are set to sunset in 2019 — at which point it would be up to the states to decide.
In fact, one reason those mandates might stand is because the GOP can’t pass sweeping changes to them. The GOP is passing its Obamacare repeal plan through a process called budget reconciliation, which enables them to push it through without Democratic votes. However, budget reconciliation is supposed to pertain only to the budget — not to policy.
Even within these bounds, the GOP’s Obamacare replacement would disproportionately hurt women’s access to care.
For one, it defunds Planned Parenthood, which is the primary care provider for many low-income and rural women. And, because the Hyde Amendment currently prohibits federal funds from subsidizing abortions, in reality defunding Planned Parenthood means taking away money that subsidizes cancer screenings, contraceptive access, and STD testing for low-income women.
It also rolls back the Medicaid expansion and would increase insurance costs for the elderly — both populations that are disproportionately female.
Trumpcare also prohibits any tax credits for plans that cover abortion, carving it out from every other unexpected medical procedure even for women on private (that is, non-government) plans. The attack on abortion care would reach into employee-sponsored plans too — it would make plans covering abortion more expensive for small businesses, because they wouldn’t receive tax credits for them.
Women could choose to add abortion coverage as a rider at an extra cost, but in practicality, it’s unlikely that many women would opt to pay extra to have abortion coverage on top of what they already pay for insurance. That would make the market small, and the plans even more expensive. Likely, the end result would be an end of affordable abortion care for many women.
In effect, the GOP plan signals a step back towards the pre-Obamacare landscape where women could be charged more for insurance simply for being women — and would often receive less coverage for it.