Seema Verma, President Donald Trump's nominee to head the Centers for Medicare and Medicaid Services, has built a career on finding ways to break down the government's role in health care. So it wasn't all that surprising when, at her nomination hearing, Verma said she doesn't think insurance companies should be required to provide maternity care coverage.
"Some women might want maternity coverage and some women might not want it, might not choose it, might not feel like they need that," Verma told senator Debbie Stabenow (D-Michigan). "So I think it's up to women to make the decision that works best for them and their families."
The comment offered a glimpse of how the Trump administration may impact women's health care in the US. Trump and Republican members of Congress have pledged to repeal the Affordable Care Act which, among many other provisions, made maternal health and reproductive health coverage mandatory. But they haven't been very clear on what they plan to introduce to replace the ACA.
Comments from Verma, along with executive moves from the White House, and a spattering of bills that have been introduced, give us an idea of what to expect when it comes to women's healthcare.
"This gives us an idea of what that plan might look like," said Nadereh Pourat, the director of the Health Economics and Evaluation Research Program at the UCLA Center for Health Policy Research. "You cannot replace [the ACA] with something cheaper that gives you the same benefits or more. That's not possible."
Pourat said it's been clear from the beginning that repealing and replacing the ACA would mean some cuts to health care, but there's a lot of uncertainty of what that looks like. Part of the problem is that many Republicans think the ACA is too costly, both for the government and individuals, and want to reel it in. But Pourat told me many of these cuts actually end up costing taxpayers more in the long run, including removing mandatory maternity coverage which can cost families up to $50,000 for one birth.
Having maternity coverage mandatory does mean a slight increase in insurance costs across the board, but making it optional means those who need it most might not be able to afford this "extra" coverage. If they then get pregnant, even middle class Americans may not be able to afford paying out of pocket for maternity care, which puts the pregnancy at risk, Pourat said.
In most other developed countries, including Canada, the UK, and France, maternal health is covered and guaranteed.
"Maternity benefits are not something anyone should think about making optional. It's shortsighted and it could have huge negative implications," Pourat told me. "All you need is to have a few children born with disabilities and you're talking about long-term suffering and costs, very big costs, for the taxpayer. It's a fallacy in this argument that we're going to save money by not providing it."
Meanwhile, it's not just expecting mothers who could be impacted. The GOP has continued to threaten to cut federal funding for Planned Parenthood, which provides reproductive health care like birth control to millions of women and men. And while President Trump and his cabinet can't single-handedly change a lot of these laws, they're signalling their mandate to a GOP congress that's already starting to follow suit. Bills have been introduced to allow states to withdraw funding from Planned Parenthood and repeal the ACA.
Some of this is par for the course when it comes to the Republican party. GOP congresses typically mean a shifting of more power back to the state level, and state governments can potentially protect some women's healthcare by introducing their own laws—like the three states that now allow pharmacists to prescribe birth control—to counteract the action in the capitol.
In the meantime, there's a lot of uncertainty, and the few hints we're getting of what's to come could mean far higher health care price tags for women.
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