Creatas/Thinkstock(WASHINGTON) — Democrats argue the American Health Care Act, the new Republican health care legislation, will set back advancements made in women’s health care.
According to Sen. Debbie Stabenow, D-Mich., the new bill “would take us back to those days where essentially being a woman was a preexisting condition.”
Republicans disagree. In a one page memo about the bill on the Ways and Means Committee website, Republicans state, “Our proposal specifically prohibits any gender discrimination.”
Here’s a closer looker at some key provisions in the Republican bill moving through the House of Representatives right now and how they might affect women and girls:
The newly proposed legislation, as currently written, would prohibit women from using any federal tax credits to buy a plan that covers abortion.
Under the current law, Americans buy their own insurance benefit from subsidized rates. (The government is paying to keep some costs down.) Under the Republican plan, these direct subsidies go away and the federal government gives a tax credit to individuals to help them purchase an insurance plan. The tax credits are not allowed to be used to buy a plan that covers abortion.
The new proposal is consistent with the so-called “Hyde Amendment,” which does not allow taxpayer dollars to go toward abortions except in the case of incest, rape or to save the mother’s life.
The Republican bill also promises to “defund” Planned Parenthood by prohibiting Americans on Medicaid, a government insurance program for the nation’s poorest citizens and the disabled, from receiving any reimbursement if they visit a Planned Parenthood clinic.
Medicaid payments make the up the majority of the organization’s funding, although current law already stipulates that the organization cannot use any government funds for abortion procedures. Instead, the clinics see people on Medicaid for contraception, screenings and other services.
Republicans argue that these Americans can visit other community health centers. Several leading abortion and contraception rights organizations point out that these centers may offer inferior care.
“Planned Parenthood health centers consistently perform better than other types of publicly funded family planning providers,” Ann M. Starrs, president and CEO of the Guttmacher Institute, wrote in an op-ed last week. “It is simply not feasible for other safety net providers that are often already stretched thin to quickly step up and provide timely, high-quality contraceptive care to the many women who might suddenly be unable to obtain care if their local Planned Parenthood has been shut down.”
The new report from the nonpartisan Congressional Budget Office estimates that approximately 15 percent of people currently on Medicaid who visit Planned Parenthood clinics would lose access to care all together, specifically those who “reside in areas without other health care clinics or medical practitioners who serve low-income populations.”
According to a recent Quinnipiac poll, cutting funding for the organization remains largely unpopular — with 80 percent of respondents opposed to it, including 65 percent of Republicans and 78 percent of independents.
Under current law, insurers are required to cover the entire cost of “preventative services,” copays and all. Those preventative services are determined and defined by the Department of Health and Human Services and right now include birth control.
This access to free birth control is arguably one of the more popular parts of the current Affordable Care Act. A poll from the Kaiser Family Foundation and the Washington Post found that over 77 percent of women and 64 percent of men support no-cost contraception coverage.
The Republican bill moving through Congress does not impact this “preventative services” provision, according to Laurie Sobel, associate director of Women’s Health Policy at the Kaiser Family Foundation. Theoretically, the Department of Health and Human Services could redefine what exactly counts in this category of care.
Republicans on the Hill and the newly appointed secretary of HHS have said new regulations should be expected as the second phase of their party’s plan to repeal and replace the current law.
Maternity care is categorized as an “essential health benefit” under current law, which means it must be offered under private plans but patients will likely pay some out-of-pocket costs, of varying levels, in addition to their monthly premiums. The new Republican bill does not address what qualifies as an “essential health benefit,” but, again, that could be changed through agency regulation.
The bill does, however, get rid of some cost-sharing standards that pre-determine how much patients would have to pay for specific services, like maternity care. The effect of scrapping some of these is debated among lawmakers and experts. Maximum out-of-pocket rules remain in place for now and some flexibility in what certain plans have to offer and pay for could lead to more competition and lower premiums.
On the other hand, Democrats worry that consumers may not realize that their plan does not cover as much as they had thought.
“In today’s market place you know you are actually buying real insurance and not a junk plan,” Sen. Stabenow said when asked about the change.
The GOP bill also says that in the next few years Medicaid plans will simply not have to cover these essential health benefits. States will get to decide what those plans have to cover.
Andy Slavitt, former acting administrator of the Centers for Medicare and Medicaid Services under President Obama, told ABC News that there are real consequences for the women on these plans.
“Once something is not required, it becomes difficult for one company to offer it,” Slavitt said in a phone interview this week. “It can be a tough business decision. The fear is that you may attract only sicker folks. It can be a race to the bottom in terms of what’s offered.”
“That’s why having a standard is so important,” he added.
Slavitt emphasized that the Medicaid program was founded in part with the explicit intent of helping poor mothers and children.
“It’s no different than why we invest in early childhood education,” he said. “When we show we can help mothers carry all the way to term and have healthy births — it’s a big deal.”
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