WASHINGTON, DC – Late last night, the U.S. House of Representatives released its “manager’s amendment,” which includes a series of changes to the bill to repeal the Affordable Care Act.
The last-minute changes add to the already long list of anti-women’s health provisions in the repeal bill.
“In the dead of night, Congress traded away women’s health and lives to get a few more votes from far-right extremists,” said Dawn Laguens, Executive Vice President of Planned Parenthood Federation of America. “Simply put, the American Health Care Act is the worst piece of legislation for women in a generation, and the Senate must reject this bill.”
The ACA repeal bill already prohibited women from getting care like birth control and lifesaving cancer screenings at Planned Parenthood; kicked millions of women off their insurance; undermined coverage for reproductive health care and maternity care; and essentially imposed a nationwide ban on private insurance coverage of abortion.
At the last minute, as part of the “manager’s amendment,” Congress added a backdoor provision that would make it more difficult for women to use their health savings accounts to pay for the full range of reproductive care, including abortion, and would also allow states to erect additional barriers that block low-income women and families from accessing Medicaid coverage.
Dawn Laguens said, “As members of Congress cut backroom deals, millions of women across the country face a terrifying future where they and their families go without health care. This bill could force women into a world where it’s nearly impossible to both prevent pregnancy and get medical care once they’re pregnant. Americans will not stand for this. This is why millions of women who marched in Washington and across the country just two months ago, why they have flooded town halls, and why they will continue to make it clear that we will not stand to see women’s basic health and rights disappear.”
Impact of American Health Care Act (AHCA) on Women’s Health:
The American Health Care Act is a huge step back for women. Not only does this bill upend the the Affordable Care Act –a law that has helped drop the uninsurance rate among women of reproductive age (15-44) by 36 percent – it also plays politics with women’s health.
Blocks low-income patients from receiving health care at Planned Parenthood health centers.
The bill would prohibits millions of Americans – mostly women – from accessing care at Planned Parenthood health centers. It is the only provision in the bill that is not related to the Affordable Care Act. Every year, 2.5 million women, men, and young people rely on Planned Parenthood for essential health care services, like birth control and life-saving cancer screenings. Many of these patients, particularly those in rural areas and medically underserved areas, will have nowhere else to turn to for care if Planned Parenthood health centers are forced to close their doors.
Reduces women’s access to birth control. Although the AHCA does not specifically repeal the no-copay birth control benefit, women will still find it more difficult to access birth control because the bill makes coverage less affordable (by reducing financial assistance to purchase coverage), eventually ends the Medicaid expansion, and makes cuts to the Medicaid program. Collectively, this results in fewer women having access to coverage at all. More than 55 million women have gained access to no-copay birth control in the private insurance market, and approximately 16.7 million women benefit from Medicaid coverage, which also covers birth control at no cost. Paying out-of-pocket for birth control pills can cost a woman up to $600 per year, which is simply unaffordable for young women and people with low incomes who are struggling to make ends meet.
Reduces coverage of maternity care. The Affordable Care Act made history by requiring almost all plans to cover maternity and newborn care in addition to other essential health care. But under AHCA, the nearly 9 million women who gained access to maternity coverage may now only have access to plans that have bare-bones maternity coverage, such as plans that cover only a few prenatal visits and ultrasounds.
Restructures Medicaid. The AHCA restructures and slashes the Medicaid program, which will result in women, disproportionately women of color, losing critical access to care. Not only does the bill seek to effectively end the Medicaid expansion, which has provided coverage to at least 11 million people, it also makes substantial cuts in federal funds for the Medicaid program, which will make it impossible for states to continue providing the same level of coverage to the nearly 17 million women enrolled in Medicaid today. The “manager’s amendment” ends Medicaid expansion two years earlier (the end of 2017 as opposed to the end of 2019). Approximately 20% of women of reproductive age rely on Medicaid to access no-cost, critical reproductive health care such as birth control, lifesaving cancer screenings, and maternity care.
- Medicaid programs may scale back coverage of maternity care services (e.g., limiting the number of covered prenatal visits) and family planning services (e.g., refusing to cover IUDs and implants).
- Medicaid programs may reduce eligibility for pregnant women, cutting them off completely from critical care, like prenatal and postnatal care, which will further exacerbate health inequities in infant and maternal mortality.
- Medicaid programs may slash provider payments, further heightening existing barriers to women’s health care. Women often rely on their ob-gyns as their main source of care, yet most Medicaid programs already face a shortage of ob-gyns.
Requires Employment as a Condition of Medicaid Coverage. The “manager’s amendment” added a requirement that non-disabled adults without dependent children obtain work as a condition of obtaining Medicaid coverage. Such requirements are generally unnecessary and harmful, as nearly 60 percent of Medicaid enrollees who can work do, and if they don’t work it’s as a result of a major impediment. Work requirements disproportionately impact women as they account for 62 percent of Medicaid enrollees who are not working.
Creates a nationwide ban on abortion coverage. The AHCA is an unprecedented attack on abortion coverage. The AHCA prohibits financial assistance from being used to purchase a private plan on or off the Marketplace if it covers abortion. As a result, Marketplace plans will not be able to cover abortions, outside of rape, incest or life endangerment to the woman. More than one million women currently have access to Marketplace plans that cover their full reproductive health care needs, including abortion. Given this provision extends outside of the Marketplace, the number of women impacted could be far greater given that insurance plans, when not barred by state law, typically cover abortion. Women should be able to make their own decisions about pregnancy based on their own unique circumstances, and have the resources they need to exercise that decision with autonomy and dignity. Each woman -- no matter how much money she makes or how she gets her health insurance -- should be able to able to access the full-range of reproductive health care, including abortion.
Prohibits Excess Tax Credits from Going into HSAs. Under the initial version of the AHCA, money left over from tax credits (after paying for premiums) could be invested in an HSA and there was no explicit prohibition against using money in HSAs to pay for an abortion. The “manager’s amendment” would prevent tax credits from being deposited into HSAs. This is a backdoor way to ensure that women will not be able to use any tax credits deposited into an HSA to cover abortions. Please note: This change does not prohibit a HSA from reimbursing for abortion, only tax credits won't be able to be used from HSA to cover abortion.
The Facts on "Defunding" Planned Parenthood
FACT: The term “defunding” Planned Parenthood is a misnomer. There is no blank check that Planned Parenthood gets from the federal government, and it’s not a line item in the federal budget. Instead, this type of legislation would prevent millions of women who rely on Medicaid and/or other federal programs from accessing the health care provider that’s been there for them for decades. Federal law already blocks federal funding from going to abortion services. This legislation instead blocks people from accessing cancer screenings, birth control, HIV and STI testing, and other preventive and essential care at Planned Parenthood health centers.
FACT: Blocking access to Planned Parenthood is deeply unpopular. According to an independent poll released in January, 70% of American voters oppose blocking patients from accessing Planned Parenthood - including 50% of Trump voters. A February 2017 Des Moines Register/Mediacom Iowapoll showed 77% of Iowans support funding for Planned Parenthood’s preventive care, including 62% of Republicans and 62% of evangelical Christians. This goes along with 20 national polls that all show overwhelming support for Planned Parenthood.
FACT: Blocking access to Planned Parenthood hurts people in communities who are struggling to get by the most – especially those with low incomes and those living in areas with no other quality health care providers. This disproportionately impacts people who already face structural barriers to accessing care including people of color, immigrants, young people, and members of the LGBTQ community – with those whose identities overlap facing multiple barriers.
FACT: Support for Roe v. Wade is at the highest it’s ever been, according to Pew Research, with 7 out of 10 Americans saying they believe a woman should have the right to safe, legal abortion.
FACT: Other providers cannot absorb Planned Parenthood’s patient base if it is cut off from federal programs. Politicians who want to deny patients using Medicaid from going to Planned Parenthood often insist that other providers will fill the gap, but the experts at the American Congress of Obstetricians and Gynecologists and the National Partnership for Women and Families said it flat out: They can't. Even the executive director of the American Public Health Association has called such claims “ludicrous.”
FACT: Legislation denying access to care at Planned Parenthood was a health disaster in Texas. Two Texas public health investigators wrote in the Washington Post that when Texas passed legislation it was devastating – and shouldn't be repeated in the rest of the country. A significant number of women also lost or had reduced access to primary care providers as a consequence of limiting patient options.
FACT: When lawmakers in Louisiana, Ohio, and Florida tried to block access to Planned Parenthood in the past, they suggested women could go to “alternative” providers for reproductive health care, including dentists, food banks, nursing homes, ENTs, elementary schools, rehabs, and retirement homes.
FACT: Fifty-four percent of Planned Parenthood health centers are in health professional shortage areas, rural or medically underserved areas. Planned Parenthood health centers provide preventive health care to many who otherwise would have nowhere to turn for care.
FACT: Although Planned Parenthood health centers comprised 10% of the country’s safety-net centers that offered family planning care in 2010, they served 36% of patients served by such centers. In 21 percent of counties with a Planned Parenthood health center, Planned Parenthood was the only safety-net family planning provider; and in 68 percent of counties with a Planned Parenthood health center, Planned Parenthood served at least half of all safety-net family planning patients.
Planned Parenthood is the nation's leading provider and advocate of high-quality, affordable health care for women, men, and young people, as well as the nation's largest provider of sex education. With approximately 700 health centers across the country, Planned Parenthood organizations serve all patients with care and compassion, with respect and without judgment. Through health centers, programs in schools and communities, and online resources, Planned Parenthood is a trusted source of reliable health information that allows people to make informed health decisions. We do all this because we care passionately about helping people lead healthier lives.
March 21, 2017