Last week, the nonpartisan Congressional Budget Office, or CBO, issued a cost estimate on the Republican repeal bill for the Affordable Care Act, or ACA. The House bill—the American Health Care Act, or AHCA—would reduce the federal budget deficit by $337 billion over the next 10 years. Significantly, however, it would also increase the pool of uninsured Americans by 24 million in 2026. The legislation would have a particularly harmful effect on low-income women by rolling back progress made in ensuring access to health insurance coverage for this segment of the population and pushing them further into the cycle of poverty.
Here are five ways the AHCA denies health insurance coverage for low-income women.
It guts the Medicaid program
Of the more than 19 million women who rely on Medicaid for health insurance coverage, 70 percent are of reproductive age. Medicaid has provided low-income people with health care coverage since 1965. Medicaid expansion, implemented as a way to widen the net of individuals eligible for the public insurance program under the ACA, has been instrumental in ensuring health insurance coverage for previously uninsured women and families. The Republican repeal bill would halt Medicaid expansion in 2020, drastically reduce spending for the program, and institute per capita caps. Together, the proposed changes translate into fewer low-income women and women of color having access to affordable health care services.
The CBO estimates a decrease of $880 billion in direct spending for the Medicaid program between now and 2026 under the AHCA. This means that the program would experience a reduction of 14 million enrollees. Because women of color are more likely to be insured through Medicaid, any efforts to derail expansion and reduce funding for the program will have a disproportionate effect on this demographic.
Medicaid is instrumental in helping low-income women and families access comprehensive health care. Particularly, Medicaid helps low-income women meet their reproductive health needs by covering services including maternity care, contraception, and services to support new mothers and families. It is the largest source of public funding for family planning. Under the AHCA, essential health benefits like these would be eliminated for the Medicaid expansion population.
It defunds Planned Parenthood
Planned Parenthood health centers served 2.5 million patients in 2014. The health care provider offers comprehensive sexual and reproductive health care, including breast and cervical cancer screenings; testing and treatment of sexually transmitted infections, or STIs; pap tests; birth control counseling and services; and sexuality education. With nonfederal funds, the organization also offers abortion care. The Hyde Amendment prohibits federal funds from covering abortion care, except in the limited cases of rape, incest, or if the life of the woman is in danger. The vast majority of Planned Parenthood patients are low-income: Approximately 75 percent earn incomes at or below 150 percent of the federal poverty level; 60 percent access health care through Medicaid and the Title X Family Planning Program.
Planned Parenthood receives federal funds through Title X and Medicaid reimbursements. The AHCA would strip the health care provider of federal funding by denying Medicaid reimbursements for low-income patients. This means that low-income women, many of whom rely on Planned Parenthood as their single access point for primary care, would lose access to vital health services from a trusted provider in their communities.
The CBO estimates that the prohibition on funding to Planned Parenthood would reduce direct spending by the federal government by $234 million over the next decade. However, these savings would be partially offset by increased spending for other health services covered by Medicaid including those related to births not averted because of lack of access to family planning and contraception through Planned Parenthood health centers, as well as health insurance coverage for children eligible for the Medicaid program. Additionally, the CBO projects a reduction in access to care for about 15 percent of low-income people who lack other options for health care providers.
It restricts private insurance coverage of abortion
The Republican repeal bill interferes with the patient-provider relationship and disempowers women to make their own health care decisions by denying them coverage of abortion through the private insurance market. It eliminates the option to purchase a health care plan that includes abortion coverage for any woman who receives a health care tax credit. The legislation does allow abortion coverage in the limited cases of rape, incest, and endangerment of the life of the woman. If passed, the AHCA could push abortion—which is an essential component in the continuum of reproductive health care—out of reach for millions of women. While the bill does nothing to keep a woman from purchasing separate coverage of abortion, this will almost certainly be an inconvenience for women with limited incomes and only serves to further stigmatize abortion by treating it as separate from other health care. The move to restrict private insurance coverage of abortion expands prohibitions already experienced by women who rely on public sources for their health insurance coverage.
It does away with the insurance coverage tier system
The AHCA would eliminate the bronze, silver, and gold insurance coverage tier system currently in place under the ACA. These changes create an avenue for insurance companies to offer health plans with less coverage. The legislation would allow states to offer health plans that provide less financial protection over time. The change in the insurance coverage tier system could leave women and families with fewer options for comprehensive coverage.
It endangers women’s economic security
Overall, the Republican repeal bill threatens the affordability of health care coverage for millions of women. Under the AHCA, women could incur out-of-pocket costs associated with essential health services that are eliminated under Medicaid expansion plans; changes in coverage due to elimination of the insurance coverage tier system; and the elimination of cost-sharing subsidies which can lower out-of-pocket costs for co-pays. To add insult to injury, the structure for refundable tax credits would change in a way that shifts the brunt of the financial burden to low-income people and away from the rich. The lack of private insurance coverage of abortion will inconvenience women who have to seek separate coverage for the medical service. For those who find themselves in need of an abortion, and lack separate abortion coverage, they will incur out-of-pocket costs for the procedure. This can be upwards of $500 or more. The bill would also make major changes to Medicaid—including denial of coverage for women who access health care through Planned Parenthood health centers—causing low-income women to go without health insurance coverage and quality health care.
President Donald Trump and congressional Republicans have made empty promises about an ACA replacement plan that would help more Americans get covered. The AHCA does the exact opposite: It would cause millions of Americans to lose coverage and would have a devastating impact on low-income women and families. Not only would the plan put women’s health and wellbeing at risk, it would also compromise their economic security. This legislation is an affront to low-income people and does nothing to ensure a healthier, more vibrant nation where all Americans can thrive.
Jamila K. Taylor is a Senior Fellow at American Progress.