ACA Repeal Bill: The Worst Legislation for Women in a Generation

Late yesterday night, the U.S. House of Representatives released last-minute changes to the bill repealing the Affordable Care Act (ACA) that add to the bill's already long list of anti-women’s health provisions. In doing so, the bill could force women into a world where it’s nearly impossible to both prevent pregnancy and  get medical care once they’re pregnant.

“As members of Congress cut backroom deals, millions of women across the country face a terrifying future where they and their families go without health care. Simply put, the American Health Care Act is the worst piece of legislation for women in a generation, and the Senate must reject this bill.” 
—Dawn Laguens, Executive Vice President of Planned Parenthood Federation of America

Before the series of changes, the bill had already:

• Upended the the Affordable Care Act, a law that helped drop the uninsurance rate among women of reproductive age by 36%;
• Prohibited women from getting care like birth control and lifesaving cancer screenings at Planned Parenthood health centers;
• Kicked millions of women off their insurance;
• Undermined coverage for reproductive health care and maternity care; and
• Essentially imposed a nationwide ban on private insurance coverage of abortion.

Impact of the ACA Repeal Bill on Women’s Health

The bill repealing the ACA — titled the American Health Care Act — is now an even bigger step back for women. In particular, it:

Blocks Low-Income Patients from Receiving Health Care at Planned Parenthood Centers

In the bill's only provision unrelated to the ACA, it prohibits millions of Americans — mostly  women — from accessing care at Planned Parenthood health centers.   Every year, 2.5 million women, men, and young people rely on Planned Parenthood for essential health care services, like birth control and life-saving cancer screenings. Many of these patients, particularly those in rural areas and medically underserved areas, will have nowhere else to turn to for care if Planned Parenthood health centers are forced to close their doors.

Reduces Women’s Access to Birth Control

Although the ACA repeal bill does not specifically repeal the no-copay birth control benefit, women will still find it more difficult to access birth control because the bill makes coverage less affordable by:

• Reducing financial assistance to purchase coverage; 
• Eventually ending the Medicaid expansion, and
• Making cuts to the Medicaid program.

Collectively, this results in fewer women having access to coverage at all.

Remember: More than 55 million women have gained access to no-copay birth control in the private insurance market. Approximately 16.7 million women benefit from Medicaid coverage, which also covers birth control at no cost. Paying out-of-pocket for birth control pills can cost a woman up to $600 per year, which is simply unaffordable for young women and people with low incomes who are struggling to make ends meet. 

Reduces Coverage of Maternity Care

The Affordable Care Act made history by requiring almost all plans to cover maternity and newborn care, in addition to other essential health care. But under ACA repeal bill, the nearly 9 million women who gained access to maternity coverage may now only have access to plans with bare-bones maternity coverage, such as plans that cover only a few prenatal visits and ultrasounds.

Restructures Medicaid

The bill repealing the ACA restructures and slashes the Medicaid program. Those cuts and restructuring will result in women — disproportionately women of color — losing critical access to care.

The bill seeks to effectively end the Medicaid expansion, which has provided coverage to at least 11 million people. It also makes substantial cuts in federal funds for the Medicaid program, which will make it impossible for states to continue providing the same level of coverage to the nearly 17 million women enrolled in Medicaid today. The new “manager’s amendment” ends Medicaid expansion two years earlier (the end of 2017 as opposed to the end of 2019).

It's important to note that approximately 20% of women of reproductive age rely on Medicaid to access no-cost, critical reproductive health care such as birth control, lifesaving cancer screenings, and maternity care. For example:

• Medicaid programs may scale back coverage of maternity care services (e.g., limiting the number of covered prenatal visits) and family planning services (e.g., refusing to cover IUDs and implants).
• Medicaid programs may reduce eligibility for pregnant women, cutting them off completely from critical care, like prenatal and postnatal care, which will further exacerbate health inequities in infant and maternal mortality.

• Medicaid programs may slash provider payments, further heightening existing barriers to women’s health care. Women often rely on their ob-gyns as their main source of care, yet most Medicaid programs already face a shortage of ob-gyns.

Requires Employment as a Condition of Medicaid Coverage

The “manager’s amendment” added a requirement that non-disabled adults without dependent children obtain work as a condition of obtaining Medicaid coverage. Such requirements are generally unnecessary and harmful, as nearly 60% of Medicaid enrollees who can work do, and if they don’t work it’s as a result of a major impediment. Work requirements disproportionately impact women as they account for 62% of Medicaid enrollees who are not working.

Creates a Nationwide Ban on Abortion Coverage

The AHCA is an unprecedented attack on coverage for safe, legal abortion. The AHCA prohibits financial assistance from being used to purchase a private plan on or off the Marketplace if it covers abortion. As a result, Marketplace plans will not be able to cover abortions, outside of rape, incest or life endangerment to the woman.  

More than one million women currently have access to Marketplace plans that cover their full reproductive health care needs, including abortion. This provision extends outside of the Marketplace, so the number of women impacted could be far greater — given that insurance plans (when not barred by state law) typically cover abortion.

Here's the thing: Women should be able to make their own decisions about pregnancy based on their own unique circumstances, and have the resources they need to exercise that decision with autonomy and dignity. Each woman — no matter how much money she makes or how she gets her health insurance — should be able to able to access the full-range of reproductive health care, including abortion.

Prohibits Excess Tax Credits from Going into HSAs

Under the initial version of the ACA repeal bill, money left over from tax credits (after paying for premiums) could be invested in an HSA and there was no explicit prohibition against using money in HSAs to pay for an abortion. The “manager’s amendment” would prevent tax credits from being deposited into HSAs. This is a backdoor way to ensure that women will not be able to use any tax credits deposited into an HSA to cover abortions. Please note: This change does not prohibit a HSA from reimbursing for abortion; only tax credits won't be able to be used from HSA to cover abortion.

"Americans will not stand for this. This is why millions of women who marched in Washington and across the country just two months ago, why they have flooded town halls, and why they will continue to make it clear that we will not stand to see women’s basic health and rights disappear.”

—Dawn Laguens, Executive Vice President of Planned Parenthood Federation of America

Take Action

Infuriated at extreme politicians trying to repeal the ACA and shut down Planned Parenthood? Join the fight to protect access to care. Call your representatives and tell them that you’re a part of the overwhelming majority that opposes defunding care at Planned Parenthood health centers.