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1.     Maternity coverage, newborn care and more are threatened. The bill allows states to gut the Essential Health Benefits provision, which requires the majority of health plans to cover services like maternity and newborn care.  Approximately 13 million women who gained access to maternity coverage under the ACA stand to lose their coverage. Prior to the ACA only 12% of individual market health plans covered maternity care.  

2.     Pregnancy is once again a “pre-existing” condition and moms can be charged more for insurance because they had a baby.  For those women who won’t completely lose their coverage for maternity care, they can be charged more for insurance just because they were pregnant — an additional surcharge of more than $17,000 per year for coverage for a woman who was previously pregnant.  Prior to the ACA, some insurance plans did not cover C-sections at all; when they did, they charged women 25 percent more in premiums.

3.     New mothers with Medicaid coverage are forced to find work shortly after giving birth. The bill gives states the option to impose work requirements as a condition of obtaining Medicaid coverage. It also gives states the ability to revoke Medicaid from new mothers if they don’t find work within 60 days of giving birth. Work requirements are generally unnecessary and harmful, as nearly 60 percent 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 women are more likely to provide informal and undervalued caregiving to family members, including spouses and parents, and account for 62 percent of Medicaid enrollees who are not working. Work requirements for new mothers are especially harmful.

4.     Millions are prevented from receiving birth control, cancer screenings and other important care at Planned Parenthood. The AHCA includes a provision that prohibits anyone who relies on Medicaid from coming to Planned Parenthood for basic health care services, such as birth control, cancer screenings, STD testing and treatment, and well-woman exams. This so-called “defunding” of Planned Parenthood would be devastating, and puts the health of Planned Parenthood’s 2.5 million patients at risk. Many of Planned Parenthood’s 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. Despite false claims, community health centers simply cannot absorb Planned Parenthood’s patients. States, such as Texas and Wisconsin, have suffered serious public health consequences when communities lost access to Planned Parenthood.

5.     Discriminates against women. Despite the fact that the proposal claims to maintain the current prohibition on gender rating, it still allows states to waive current protections and lets insurers once again discriminate against women. Eliminating the community rating provision disproportionately affects women. Insurers can claim having given birth, having had a C-section, or having been a survivor of domestic violence is a so-called pre-existing condition. For example, a woman who had breast cancer could be charged a premium surcharge of more than $28,000 per year for coverage.

6.     Women’s access to no-copay birth control is reduced. While the bill does not specifically repeal the no-copay birth control benefit, the fact that millions of women will lose coverage means they will no longer have access to no-copay birth control. Under the ACA, more than 55 million women gained access to no-copay birth control in the private insurance market, and approximately 1 in 4 women of reproductive age 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 many young women and people with low incomes. A recent poll found that 33 percent of women could not afford to pay more than $10 for birth control.

7.     Creates a nationwide ban on abortion coverage. Abortion is a safe, legal, and common medical procedure that approximately one in three women will have in her lifetime. Fifty-nine percent of the women in America who have an abortion are already mothers. Yet the AHCA will coerce insurance plans to drop coverage of abortion because it will prohibit individuals from using their federal financial help to purchase a plan on or off the ACA Marketplace that covers abortion. At least 870,000 women will lose access to ACA Marketplace insurance plans that cover their full reproductive health care needs, including abortion, and millions more could lose access to abortion coverage in other plans given this provision extends outside of the Marketplace. Insurance plans, when not barred by state law, typically cover abortion, no matter how much money they make or how they get health insurance, women should be able to able to access the full-range of reproductive health care — including abortion, and make their own decisions about pregnancy based on their own unique circumstances.

8.     Millions of women and men are kicked off their insurance. The CBO reports that 24 million people will lose coverage over the next 10 years, 14 million of which will lose Medicaid coverage due to the bill's measures to boot  people off of Medicaid.

9.     Medicaid expansion ends and the Medicaid program is gutted. The AHCA will effectively end the Medicaid expansion, which has provided coverage to at least 11 million people, starting January 1, 2020, and will result in women, disproportionately women of color, losing critical access to care. The AHCA also provides states the option to receive federal payments in the form of a block grant or per capita cap, both of which will slash the amount of federal support states receive today and will force states to either come up with extra money or make difficult decisions about which services, benefits, or eligibility groups to cut. Reduced federal funds for state Medicaid programs will disproportionately harm women — women of color, in particular. For example, to save money, states may choose to limit coverage of prenatal visits and family planning services, or states may cut people from their programs. Approximately 25 percent 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. Nearly half of all births in America are covered by the Medicaid program.

10.  Additional costs on women are imposed. The AHCA will require people to pay more for less coverage. First, the bill reduces financial assistance by repealing the existing cost-sharing subsidies that assist with copays and deductibles, and replacing the ACA-created tax credits, which fluctuate by need, with less generous tax credits for low- and middle-income individuals. This will disproportionately impact women, particularly women of color, given the inequities in earnings for women, and exacerbate health care disparities, given insured people of color already report less confidence in being able to afford care.

Tags: minnesota, women's health, AHCA

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