The Affordable Care Act (ACA) has helped millions of women access health insurance coverage and important services such as maternity care, cancer screenings, and prescription drugs. However, attempts to sabotage the ACA have put women’s health and well-being on the line. In addition to full-scale attempts to repeal the ACA, congressional Republicans and the Trump administration have worked to weaken the ACA in many other ways, creating uncertainty in the health care marketplace and, as a result, uncertainty for individuals and families across the country who rely on comprehensive, affordable health insurance to stay healthy and protect themselves from high premiums or unexpected health care costs. Such sabotage actions include last year’s repeal of the individual mandate and administrative actions that have expanded the availability of “junk plans,” among other things.
Sabotage has real costs. The Center for American Progress estimates that ACA sabotage through just two actions—repeal of the individual mandate and increased availability of short-term plans—will result in an additional $970 in premiums for a typical 40-year-old purchasing health insurance through the marketplace, beyond what the person would have paid absent that sabotage. For a family of four, sabotage results in an additional $3,110 in premiums. While many individuals and families who receive federal financial help to purchase insurance through the marketplace will not have to pay the full amount of these unnecessary costs, middle-class individuals and families who do not receive financial help will be responsible for the added costs. In addition to these two sabotage actions, the administration has taken a number of other steps to damage the ACA, many of which directly affect access to health care and affordability of services for women.
This column focuses on the threat that ACA sabotage actions—such as expanded availability of junk plans and administration rules that could limit access to important services and roll back protections—pose to women’s health, highlighting the particular risk for women with pre-existing conditions.
Women with pre-existing conditions are particularly at risk
The Trump administration has taken numerous actions that put the health of women and girls with pre-existing conditions once again at risk. Before the ACA, pregnancy and cancer, for example, were considered pre-existing conditions for which women could be denied health care coverage. CAP and the National Partnership for Women & Families have estimated that more than 67 million women and girls across the country have a pre-existing condition. This figure includes more than 8 million women and girls in California alone, as well as more than 4 million in Florida and more than 6 million in Texas.
These individuals—and millions more—are in danger of being charged more or denied insurance if current pre-existing conditions protections in the ACA are rolled back. Although congressional efforts to roll back protections for pre-existing conditions through full-scale ACA repeal have failed so far, these protections are still under threat in other ways, such as through junk plans—described below. The U.S. Department of Justice’s decision not to defend the community rating and guaranteed issue provisions of the ACA in Texas v. United States also threatens to undo protections for people with pre-existing conditions.
The expanded availability of junk plans hurts women
In June, the administration finalized a rule around expanding access to association health plans (AHPs). Then, in August, it finalized a rule regarding short-term limited-duration plans. Both types of plans provide far fewer consumer protections than ACA marketplace plans. The combination of repealing the individual mandate and allowing expanded use of these junk plans means that fewer healthier people will purchase health insurance in the marketplace. This will drive up prices for those who continue to buy marketplace coverage—including the many women who purchase marketplace insurance because they need or want the benefits and protections that ACA plans provide.
Short-term plans and AHPs are not required to include the same protections as ACA plans. They do not have to cover essential health benefits (EHBs)—the important services such as maternity care, prescription drugs, and mental health and substance use disorder services that all marketplace plans include. In fact, many plans choose not to cover these services. An analysis of short-term plans offered across the country by two insurers revealed that none of the plans included maternity care, and many other essential services were not covered by all plans. For example, substance abuse services were not included in 62 percent of the short-term plans.
Short-term plans also do not include protections for people with pre-existing conditions, and AHPs are allowed to charge more to businesses that generally have people who are less healthy. In addition, short-term plans lack other consumer protections provided under the ACA; they are able to charge higher prices to women and older people, among other things. AHPs can also exclude certain types of businesses, meaning they could exclude businesses that employ more women. The expanded availability of these plans will leave many women unable to access or afford health insurance. This is why several members of Congress are taking steps to mitigate the administration’s sabotage efforts. For example, a resolution led by Sen. Tammy Baldwin (D-WI) seeks to reverse the administration’s rule regarding short-term plans.
Administration rules could limit access to services and roll back protections
The Trump administration has also issued rules that could further restrict access to services and roll back important protections for women. Because of the ACA, more than 62 million women now have coverage of no-cost birth control. Last fall, however, the administration released two interim final rules that would make it harder to access no-cost birth control, based on an organization’s religious or moral beliefs. While these rules are currently on hold, allowing them to take effect would mean that organizations have more say in whether people can access birth control through company or university health plans.
In addition, the administration is soon expected to release a proposed rule that is likely to roll back protections provided under the Health Care Rights Law. This part of the ACA generally prohibits discrimination in health care. Unequal treatment across the health care system is detrimental to the health of women, LGBTQ people, and others, often leading to unequal interactions with the system and poorer health outcomes. Rolling back protections could leave women and others with fewer options or unable to combat such treatment.
Women rely on affordable, comprehensive health care to keep themselves and their families healthy and thriving. Yet ACA sabotage restricts access to health care and increases prices. Actions that Congress and the Trump administration have taken to sabotage the ACA limit access to important services such as maternity care and birth control for women across the country—and put in peril the health of more than 67 million women and girls with pre-existing conditions, in particular. Instead of sabotaging the ACA, the administration should allow the law to work as intended: providing people with comprehensive health insurance on which they can rely.
Theresa Chalhoub is a senior policy analyst for Health Policy and the Women’s Initiative at the Center for American Progress.