On Thursday, the Senate finally released a draft of its super-secret health-care bill, which is hardly less mean than the House’s version. Hours later, four Republican Senators — Rand Paul, Ron Johnson, Mike Lee, and Ted Cruz — issued a joint statement announcing they wouldn’t vote for the bill, but are “open to negotiation and obtaining more information before it is brought to the floor.” (Meanwhile, moderate senator Susan Collins said she planned to vote “no” because she “cannot support a bill that is going to result in tens of millions of people losing their health insurance.”)
So the bill is stalled until Senate Majority Leader Mitch McConnell wrangles at least 50 votes — a figure that allows him to lose only two members of his own caucus. Assuming he manages to do that, and the bill — or something closely resembling it — becomes law, certain of its provisions will have a disproportionate impact on women’s health. In its current form, the bill will pretty much eliminate insurance coverage of abortion; prevent women enrolled in Medicaid from using Planned Parenthood as a health-care provider; and could do away with required maternity coverage. The Cut talked to experts to break down all the ways in which the bill will impact women’s health care.
In several states, laws already prevent insurance providers from covering abortion. But in other states, such as New York and California, insurers are actually required to cover it. The goal of the Senate bill, said All* Above All co-director Destiny Lopez, is to end insurance coverage of abortion altogether.
The House of Representative’s version of the bill did this by ensuring that women who receive subsidies to help pay for their insurance would not be able to use that money on plans that include abortion coverage. That, said Lopez, would create a chilling effect among insurers, meaning that if fewer women could purchase plans that include abortion coverage, fewer insurance companies would have an incentive to offer those types of plans in the first place. The Senate’s version of the bill is a bit different, explains Usha Ranji, the associate director of women’s health policy at the Kaiser Family Foundation. It (a) makes it so women can only use tax credits on qualified health plans (the House bill allowed them to be used on either qualified health plans or off-the-market plans), and (b) redefines those plans so that they can’t cover abortion, period.
The Senate’s bill also creates a fund that insurance companies can draw from to help cover people, but it channels that fund through the Children’s Health Insurance Program, which contains the Hyde Amendment. So insurers who use the fund wouldn’t be able to offer plans that cover abortions beyond the Hyde Amendment’s restrictions.
There’s also a provision about small employers, which is defined as a company that employs 50 people or less. Right now, those types of companies have the option to receive tax credits to help insure their employees. But under the Senate bill, small employers will be cut off from the credits if they use plans that cover abortion.
Planned Parenthood funding
The Senate bill bars Planned Parenthood from receiving Medicaid reimbursements for one year. In other words, those enrolled in Medicaid — of whom 1 in 5 are women of reproductive age — won’t be able to use Planned Parenthood as their health-care provider at all. That, of course, would limit their access to contraceptives, breast exams, STI screenings, and the dozens of other services Planned Parenthood provides.
The ban is restricted to a year, but Lopez cautioned that “that doesn’t mean this administration won’t find other vehicles to do the same thing for a longer period of time.” It’s also worth noting that the language defunding Planned Parenthood is highly contentious — it almost didn’t make the cut in the first place because the AHCA is technically an appropriations bill, meaning everything included in it has to directly affect the budget and the defunding provision doesn’t meet that criteria. If the provision makes it into the final version of the bill, Senator Susan Collins has said she’ll introduce an amendment to strip it out — although it’s unlikely to succeed.
Under the Affordable Care Act, insurers were required to cover certain “essential health benefits,” one of which was maternity care. But under the Senate bill, states would have the option to waive those requirements, meaning depending on what state a woman lives in, insurers may or may not be have to include maternity coverage in her insurance plan. “It will vary widely among states,” Ranji said. And for women living in states that waive the requirements, maternity coverage could become that much more expensive.
According to Ranji, the Senate’s bill doesn’t touch the ACA’s contraception mandate, or the requirement that insurance companies foot the bill for contraception. So at least for now, your IUDs are safe.
Along with everything else, the Senate bill also fundamentally restructures Medicaid. First, the bill phases out the expansion of Medicaid programs in all states by 2019, meaning fewer people will be able to enroll in the program, and fewer services would be covered, said Lopez. The bill would also restructure how Medicaid is funded — instead of states and the federal government funding the program in partnership, the government would give each state a fixed, per-capita dollar amount. “That really limits states’ ability to respond to higher medical costs,” Ranji said. And for a variety of reasons, the majority of adults enrolled in Medicaid are women.
Of course, there’s no guarantee the Senate bill will pass in its current form. But considering how closely it hews to the House bill in terms of abortion coverage and Planned Parenthood funding, it seems likely that significant aspects of women’s health coverage will ultimately be on the chopping block.