The current version of Trumpcare is a disaster for women’s health

Republicans are one step closer to repealing Obamacare and the many health care protections it affords women.

The House narrowly passed the American Health Care Act Thursday, which would restrict access to abortion insurance coverage and block Medicaid money for Planned Parenthood. It would also make it easier for insurers to charge women more if their medical histories include “pre-existing conditions,” including a rape or a Caesarian section.

The Congressional Budget Office estimated that the original version of the bill, which never received a vote due to a lack of Republican support, would block Medicaid for 14 million enrollees and cut $880 billion from its budget over 10 years. The majority of Medicaid recipients are women.

Because Obamacare disproportionately benefited women, its repeal and replacement with the AHCA would disproportionately hurt them — and these are some of the most potentially damaging changes.

Pre-existing Conditions: Through an amendment to the AHCA introduced by Rep. Tom MacArthur of New Jersey, insurance companies could potentially make pricing decisions based on a person’s current health and medical history, just as insurers did before Obamacare. That means that depending on the state in which they live, women could once again be forced to pay higher rates because of so-called pre-existing conditions, which include sexual assault, C-sections, domestic abuse, pregnancy, and postpartum depression.

Protection against this kind of pricing was an extremely important and popular component of Obamacare, and one Donald Trump and several other Republican lawmakers had vowed to keep. MacArthur’s amendment states that “Nothing in this Act shall be construed as permitting health insurance issuers to discriminate in rates for health insurance coverage by gender” or to “limit access to health coverage for individuals with pre-existing conditions.”

But women’s health experts say that the amendment does just that.

“On one hand, it’s saying that we have these protections, but on the the other hand, it’s dismantling those very protections,” said Janel George, director of federal reproductive rights and health for the National Women’s Law Center. “So in effect it’s returning us to a time when being a woman was being treated as a pre-existing condition, charging them more for health coverage that didn’t even meet their needs.”

Essential Health Benefits: Obamacare requires marketplace and Medicaid expansion program plans to cover 10 categories of care considered “essential health benefits.” Those include maternity and newborn care, mental health and substance abuse treatment, and preventative and wellness services. States could also waive the guarantee of coverage for these services under MacArthur’s amendment.

Abortion: The AHCA prevents the use of federal tax credits for any health plan that includes abortion coverage, making it harder for women to have affordable abortions and limiting women’s choice of plans generally.

“What it’s doing is trying to end private health insurance coverage of abortion,” George said.

It’s unclear how this provision will play out in states like New York and California, where plans that cover pregnancy are required to also cover abortion, according to Alina Salganicoff, women’s health policy director for the Kaiser Family Foundation.

“That sets up for what could be legal challenges, because someone in California isn’t going to be able to buy a plan using federal subsidies if this passes,” she said.

Planned Parenthood: The legislation would ban Medicaid funding from going to Planned Parenthood for one year. Currently, Planned Parenthood receives money via reimbursements for care under Medicaid and through federal grants, neither of which can be used to cover abortions. At least 60 percent of Planned Parenthood patients rely on public health programs, so if Planned Parenthood can’t accept Medicaid, many low-income women will lose access to reproductive care.

Lawmakers have discussed redistributing those funds to other local health centers, but Salganicoff said it’s unclear whether they would have the capacity for what would be a dramatic increase in patients.

“It would be a very, very big blow to the family planning network,” she said.

Contraception: Trump signed an executive order Thursday directing the IRS to grant religious institutions freedom to endorse political candidates without putting their tax-exempt status at risk. But the ramifications of the order could very well affect health care.

The AHCA doesn’t specifically address contraceptive coverage — Obamacare provisions require employers to offer health care plans that offer it — but Trump and other Republicans advocate for “religious freedom” for businesses that don’t wish to provide employees health care that offers it. And shortly after Trump signed the order, Health and Human Services Secretary Tom Price promised to quickly “safeguard the deeply held religious beliefs of Americans who provide health insurance to their employees.”