The new GOP health bill before the Senate — written and largely advocated by Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) — threatens to devastate the health of millions of women and gender minorities.
Technically, the Graham Cassidy Bill, which will be voted on next week, does not repeal the Affordable Care Act (ACA) requirement that insurance companies cover people with pre-existing conditions. Nor does it allow states to waive that provision. But the bill does allow states to roll back essential health benefits offered on ACA marketplaces and permits insurers to raise premiums for people with pre-existing conditions — or as soon as they are sick.
Under current health law, insurance companies are required to cover things like pregnancy, maternity, and newborn care. Pre-existing conditions like breast cancer — which disproportionately affects women of color — are also covered and more importantly people don’t have to pay more for being sick. Under the Graham-Cassidy bill, however, both of these things are no longer certain. People are no longer guaranteed affordable sex-specific coverage, as discretion is largely left to the states.
Prior to the ACA, studies found insurance companies charged women more than men based on sex alone, something called the “gender rating.” Under Graham-Cassidy, states technically cannot waive gender rating, but they can waive consumer protections to reign in costs and insurance companies can charge people more for a specific medical condition.
Andrea Flynn, a women’s economic security policy expert and fellow at the liberal think tank Roosevelt Institute said that the GOP health bill would allow insurers to implicitly price women out of coverage. Ultimately, patients would see “the same disproportionate impact” that they did before the ACA, when they were flat out denied coverage.
“Pre-ACA, insurance companies could very explicitly say these people are not covered,” Flynn siad. “It was perfectly legal for insurance companies to charge woman more than men. Now, [Sens. Graham and Cassidy] bake in the mechanism where insurers and states, for that matter, write the rules that don’t sound discriminatory.”
There’s already a gender wealth gap in this country. Women’s median earnings are lower than men’s in nearly all occupations. The disparities inevitably grow when accounting for gender and race. It’s in this context that predominantly white male lawmakers are deciding what affordable care should look like in the United States.
There will like be gaps in sex coverage, like before the ACA, if authority is left to the states. According to a Health and Human Services (HHS) report, 62 percent of patients did not have coverage for maternity services prior to the ACA. Due to the essential health benefits provision under current law, 8.7 million Americans gained maternity coverage. The cost of having a child? Expensive. The total payment for a vaginal birth was $18,329 in 2010, according to one health study.
Republican lawmakers have repeatedly criticized the ACA’s maternity coverage over the years. In March, former White House Press Secretary Sean Spicer boldly said, “I think if you’re an older man you can generally say that you’re not going to need maternity care.” Prior GOP health bills also gave states flexibility to waive benefits.
Leaving essential health benefits up to the states effectively allows them to avoid providing this coverage. Ohio Governor John Kasich (R) has repeatedly asked Congress to allow states to define essential health benefits. “You shouldn’t have to comply with every one of those essential health benefits,” the governor said earlier this month. He cited maternity services as fiscally burdensome and said someone who is 23 years old should have the option to purchase a plan that doesn’t include maternity coverage.
“How have we lost the basic essence of what insurance is in this conversation?” Flynn asked of the Ohio governor’s comments. “A 24-year-old doesn’t know if she wants or will get pregnant.”
When asked if states with progressive governors would keep all the essential health benefits afforded under current law, Flynn said it’s hard to say for certain, because money is being shifted from blue to red states. Under the Cassidy-Graham bill, block grants would replace federal money currently being spent on the Medicaid expansion and subsides, which help low-income people buy coverage on the individual and small group marketplace. The way the formula is constructed, states that saw high coverage gains under the ACA — mostly blue states — will be penalized.
The Graham-Cassidy bill repeals the Medicaid expansion and makes cuts to the overall entitlement program. But Medicaid finances half of all births in the country. The bill could also add to health coverage disparities, said Dr. Jamila Perritt, a fellow with Physicians for Reproductive Health, as black and brown women are more likely to be covered by Medicaid.
If this bill is enacted, maternity care could be optional for states. Additionally, preventative reproductive care — the type that helps 24-year-old people control when they get pregnant — is jeopardized. The bill prohibits federal Medicaid funding for Planned Parenthood clinics for one year. In 2010, Planned Parenthood cared for at least half of all women who depend on publicly funded family planning services.
Other family planning centers would not be able to fulfill the role of Planned Parenthood, as was the case in Texas in 2011 when the state barred state funds to the women’s health clinic. The Congressional Budget Office concluded that if Planned Parenthood loses federal funding, access to birth control would reduce for many women and result in thousands of additional Medicaid births.
The ACA is still the health law of the land, and there are a handful of Republican senators who have not thrown their support behind the Graham-Cassidy bill yet. Sens. Susan Collins (R-ME) and Lisa Murkowski (R-AK) have not backed the GOP health bill. They voted against the last GOP health bills largely because of the severe cuts to Medicaid. Both women were also against the bills because they defunded Planned Parenthood.