The repeal of Obamacare, a long-promised/threatened undertaking of the Republican-led Congress, is back in the news. After repeated failures, the latest incarnation of what most now call “Trumpcare” rolls back central elements of the Affordable Care Act, and replaces the national health care model with block grants that hand financial and systemic control back to the states.
As with past efforts at repeal, the new plan would seem to offer little reassurance for those with pre-existing conditions, or for those with medical needs which exceed “lifetime caps.” Potentially worse, however, is the situation for women. The new bill evidently includes elements that would limit or end access to Planned Parenthood (through which many Medicaid patients get their health care), and place new restrictions on coverage for abortion.
Of course, it’s hard to know what exactly is in the new bill or what its effects might be, as the push to pass it quickly means the Congressional Budget Office (CBO) hasn’t had a chance to review it—even those who would be voting on it likely won’t have a chance to fully digest it before offering a yay or a nay.
Women at risk
Harry Nelson, founder and managing partner of Nelson Hardiman in Los Angeles, and co-author of From ObamaCare To TrumpCare: Why You Should Care, identifies three groups of women as being particularly at risk:
- Women younger than 65. That’s the threshold for qualification to get Medicare benefits, and with the absence of protection for pre-existing conditions, many would no longer be able to afford coverage.
- Women who make “too much” money. Being above the income threshold for Medicaid further limits access for middle-class women who are by no means wealthy enough to cover their health care without insurance. “The biggest risk under Trumpcare is the absence of affordable coverage for middle-class women,” says Nelson.
- Women not covered by an employer-based plan. Most employer-based group health insurance plans are low cost and do not require employees to undergo medical exams to qualify for coverage.
Most of these at-risk women work in low-wage, service-sector jobs or are unemployed, and they reside in states that elected not to expand Medicaid under Obamacare. “In much of the country, there is either no coverage or one unaffordable option on the insurance exchanges, with premiums and deductibles that put care out of reach,” says Nelson.
The block grant model might return some of that funding to those states which opted out of Medicaid expansion. And it’s true that the affordability problems faced by the women in the above three categories are already present to some degree in Obamacare.
However those problems are likely to be exacerbated, as the aforementioned restrictions on using Medicaid for access to reproductive health care options through Planned Parenthood limits its usefulness for many women.
Furthermore, the proposal currently being considered does not actually require block grants to go toward health care at all. So what individual states choose to do with that money, at this point, is unpredictable at best.
Other possible issues
Moreover, the new plan would negatively affect two other groups:
- Women who use Planned Parenthood as their healthcare provider
“Many women, particularly younger women, get their primary care needs met through Planned Parenthood and the budget cuts would take a huge toll on their access to care,” says Nelson. For what it’s worth, Planned Parenthood also provides high-quality, affordable health care for men.
- Women who have a pre-existing condition
While both sexes are subject to pre-existing medical problems—say cancer or diabetes—women seem likely to get hammered on this front. Consider that the following women’s healthcare issues are being floated as pre-existing conditions: rape, domestic violence, C-sections, and postpartum depression.
Survivors of domestic abuse and sexual assault may be especially vulnerable to healthcare discrimination based on their medical history, because of the mental and physical conditions that often result from such violence, namely post-traumatic stress disorder and sexually transmitted diseases.
Many people—of both genders—have loudly complained about Obamacare, claiming their costs and/or access to health care have been negatively impacted since it passed in 2010. However, as women in particular survey what’s now being offered, they may find that the cure, at least in this case, is worse than the disease.