Pro-Con: Will the health care available to women improve if the Affordable Care Act is repealed and replaced?
Yes: Replacement would afford women better options, lower costs
Women make the majority of decisions about care and insurance for our families and we generally consume more health care than men. As a result, women have a lot at stake when it comes to the laws that govern American health care and insurance.
In 2010, the Affordable Care Act, also known as Obamacare, made it illegal for insurers to charge women more than men and mandated that insurance plans cover women’s preventive care, including birth control, with no copay.
Therefore, some now suggest repealing the Affordable Care Act would be detrimental for women’s health. But the opposite is true: Repeal will afford women greater choice and lower costs when it comes to insurance plans, doctors and care.
The supposed benefits of the ACA have been oversold. No copay birth control sounds like a gift, but savvy shoppers know the difference between what’s truly free and what's simply included in a larger cost.
Rather than actually making birth control free, this provision forces women to pay for birth control without seeing the price. It’s rolled into the cost of insurance premiums, which have increased dramatically due to the law — even if men and women now both pay equally high rates.
The group that has seen the largest increase in costs under the ACA are women ages 55-64.
Before the ACA, these women — outside their childbearing years — paid lower premiums and didn’t have to buy costly maternity coverage.
But now these women suffer from the flipside of the gender-equity coin; they are averaged with 55-64-year-old men, many of whom have high health costs.
Further, some ACA plans provide coverage in name only: Oftentimes, the out-of-pocket costs are too high and the doctor’s networks are too restrictive, meaning women and men in these plans don’t always have access to the services they need.
And importantly, the ACA took away women’s choice in plans: Not only have the many regulations in the law limited what types of plans can be bought and sold, but overregulation has led to financial losses and insurer exits, leaving few choices for consumers. In one in three U.S. counties, ACA customers have only one option.
Women deserve better. Repeal would entrust women with the choice to determine what coverage they want — or don’t want — for themselves and their families. And removing Obamacare’s regulatory burdens would reduce costs and entice more insurance companies to compete for our business, giving consumers more power.
It should also be noted that support for repeal of the ACA does not equate with a desire of returning to the previous status quo.
We would still need further health reform. For example, we need to move beyond our employer-centric insurance system to allow for greater portability in plans, lower costs and more choice.
Women in particular need a strong market for individually purchased insurance plans as we are less likely than men to get insurance through work.
Many women suffer from expensive health conditions and some may fear that without the protections in the ACA, they will be harmed. But no one wants a policy where people die for want of care and no one wants to see compatriots face financial ruin due to health costs.
That’s why the proposed replacement plan includes additional funding and protections to help people with pre-existing conditions. There are better ways to address this issue than the ACA approach.
The fatal flaw in the ACA’s treatment of women, like so many other big-government schemes, is its misguided premise that all women are the same and want the same things. This is wrong.
Women and their families have unique, individual needs and preferences for health care and insurance. Repealing the ACA is the best first step to offering women — and men — the freedom to find and afford what they want in a robust, competitive marketplace.
Hadley Heath Manning is director of health policy at the Independent Women’s Forum, a nonpartisan research and educational organization. Readers may write her at IWF, 1875 I St. NW, suite 500, Washington, D.C., 20006.
No: Trumpcare would result in less service, bigger bills
If the American Health Care Act — what some are calling Trumpcare — becomes law, we will see both short- and long-term negative consequences for women’s health.
Some of that would be due to gender-specific parts of the law, but other harms would come about because of general changes that would have an outsized impact on women.
Let’s start with the obvious harms: provisions targeting women’s reproductive health.
This bill would cut off coverage of family planning services, cancer screening services and STD screening provided by Planned Parenthood across the nation.
Because many low-income women and adolescents get their first reproductive health care from Planned Parenthood — 32 percent of all women get contraception at so-called safety-net clinics — the move would effectively cut off contraceptive services and deny basic health care to a larger population.
The AHCA would prevent Planned Parenthood from receiving Title X family planning funds or Medicaid reimbursement for any service it provides. Abortion coverage would be even more restricted: Even private plans offered through the health exchanges would be banned from covering abortion care.
States would have the option of not including maternity care as a covered benefit, which could lead to insurance companies going back to the bad old days when pregnancy wasn’t covered under most individual insurance plans. Under such circumstances, a woman would be required to either purchase an expensive special plan or go uninsured during her pregnancy.
In the past, this led to Medicaid covering more than half of all pregnancy costs in the U.S.
To argue that not everyone needs maternity coverage fails to recognize the whole idea of insurance. No one needs insurance for everything, but everyone needs it for something.
What about preventive services, now required to be covered without additional costs to consumers?
States could also opt out of this, affecting everyone seeking screenings for cancer, heart disease and other conditions. Women in affected states would once again be charged out-of-pocket costs for contraception, mammograms, osteoporosis screening and annual well-woman visits.
Women nationwide could see their insurers refuse coverage of certain forms of pills or intrauterine devices. And if Secretary of Health and Human Services Tom Price revokes the contraceptive coverage requirement, women could again be required to share in costs of all forms of family planning.
Another state option is dropping the requirement for insurance companies to cover people with pre-existing conditions at the same premium level.
Women with a history of depression, hypertension, heart disease, caesarean sections, breast cancer or health problems arising from domestic violence could be charged higher premiums or denied coverage altogether.
Among the largest and least-understood changes are the proposed dramatic cuts and restructuring of Medicaid, upon which women — more likely to have low incomes, reside in nursing homes and be without employer-sponsored insurance — are more dependent.
The proposed changes would limit Medicaid expansion and also squeeze states to provide Medicaid coverage with far less federal funding. Cutting women’s preventive services, limiting mental health coverage and slashing provider payments could be the first steps states would take in the face of such Medicaid changes.
The Affordable Care Act, while not perfect, dramatically improved the health care available to women, extending coverage to those previously uninsured and decreasing the number of women who delay coverage due to cost.
Being a woman is no longer a pre-existing condition, maternity care and mental health services are covered, and women no longer pay out-of-pocket for contraception.
Trumpcare would reverse these gains and others; the result would be women missing needed care and experiencing worse health. We should not go back.
Susan Wood is an associate professor of health policy and management and of environmental and occupational health at George Washington University. Readers may write her at GWU, 950 New Hampshire Ave., 7th floor, Washington, D.C., 20052.
This story was originally published May 25, 2017 at 1:15 PM with the headline "Pro-Con: Will the health care available to women improve if the Affordable Care Act is repealed and replaced?."