The American Health Care Act (AHCA) aka Trumpcare aka Ryancare aka Republicancare
So, in the last week there has been a lot of social unrest regarding the American Health Care Act which the House of Representatives voted to pass on the 4th May 2017. Now, I know very little about American healthcare, and writing this got me all types of confused, but I hope that I can convey to those who are curious, like me, what this bill means for women.
To make it easier for me to write and you to understand I cut up this summary into four main sections that cover Medicaid cuts, Planned Parenthood defunding, abortion and the revision of laws regarding pre-existing conditions. As usual the links are at the bottom and I really encourage you to go and read more about it, especially if you are unfamiliar with the American healthcare system.
So let’s begin!
The Affordable Healthcare Act (Obamacare) saw the expansion of Medicaid and thus drastic decrease in the number of uninsured people in America. Well, the AHCA hopes to cut Medicaid and phase out its expansion. The revisions will see a decrease in the affordability of private insurance and a decrease in eligibility for the Medicaid program, thus millions of Americans with be left with fewer, costlier options, and ultimately uninsured. Medicaid pays for half the births in America and provides women with more access to reproductive services, so this phasing out will have a dramatic effect on women’s reproductive health.
Planned Parenthood, a non-profit organisation that provides reproductive healthcare, is the largest network provider of healthcare for women in the United States. This new bill, although it doesn’t explicitly mention Planned Parenthood, has taken a number of steps to “kill-off Planned Parenthood”, said the New York attorney general, who threatens to sue the federal government if he AHCA bill becomes law.
The AHCA blocks Medicaid patients from receiving Planned Parenthood care for the next year. Planned parenthood will not receive Medicaid reimbursements, which not only leads to potentially fatal consequences for women who rely on Planned Parenthood’s affiliates but also leads to the defunding of Planned Parenthood centres. This leaves women with limited access to sexual and reproductive health services and puts a lot of pressure on other clinics, who are unlikely to be able to cope.
Eric Scheiderman, NY attorney general, describes this bill as an “unconstitutional attack on women’s rights to reproductive services, including abortion.” The Hyde Amendment, that has been in place just over 40 years (since 1976) already limits access to abortions, as it states that federal funds cannot be used for abortions. The AHCA cuts access even further, in an attempt to essentially limit the legal avenues with which a woman can get an abortion, by stating that federal tax credits cannot be used to buy private insurance plans that cover abortion. This acts as a disincentive for private insurers to cover abortions as fewer women will be able to afford them. This law is particularly problematic in states such as California and New York, where plans that cover pregnancy are required to also cover abortion. In these states tax credits become ‘largely unusable’.
Where Obamacare protected people with pre-existing conditions from being charged more, Trumpcare allows insurers to charge people higher premiums based on their health history. The AHCA will bring back ‘high-risk pools’, which subsidise health insurance coverage for people with pre-existing conditions that have been shut out of the individual insurance market. The criticism of high risk pools is that they are very expensive, so they are underfunded and thus ineffective. The bill also gives states the option not to mandate the coverage of the 10 essential health benefits by insurers.These revisions leave many already vulnerable Americans even less protected.
Maternity care, being one of the 10 essential health benefits, will become more expensive and therefore less accessible. As being a victim of domestic or sexual abuse, having menstrual irregularities and being pregnant all constitute pre-existing conditions under the AHCA, it is clear that more women will be left vulnerable if this bill lands on Donald Trump’s desk.
As Julia Belluz put it, this new bill is a “not-so-veiled attack on women’s health”. Where Obamacare made advances in reproductive healthcare, for example demanding that companies provide their employees with healthcare plans that include contraceptives, the AHCA sees to roll back on this. Currently, America has one of the worst maternal health and maternal mortality outcomes in the developed world, with maternal mortality actually increasing! The AHCA doesn’t just seem like the administration has failed to consider women’s health, it actually looks like the administration is sticking its middle finger up at American women, as well as the less well-off American citizens – true Republican style.
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