The Affordable Care Act changed women’s health care in some big ways: It stopped insurance companies from charging women extra, forced insurers to cover maternity care and contraceptives and allowed many women to get those contraceptives (as well as a variety of preventive services, like Pap smears and mammograms) at zero cost.
Now Republicans have the opportunity to repeal that law, also known as Obamacare. But that doesn’t mean all those things will go away. In fact, many will remain.
Confused? Here’s a rundown of how this bill would change some women-specific areas of health care, what it wouldn’t change, and what we don’t know so far.
What would change:
There are restrictions on abortion under current law — the Hyde Amendment prohibits federal subsidies from being spent on abortions, except in the case of pregnancies that are the result of rape or incest or that threaten the life of the mother. So while health care plans can cover abortions, those being paid for with subsidies “must follow particular administrative requirements to ensure that no federal funds go toward abortion,” as the Guttmacher Institute, which supports abortion rights, explains.
But the GOP bill tightens this. It says that the tax credits at the center of the plan cannot be spent at all on any health care plan that covers abortion (aside from the Hyde Amendment’s exceptions).
So while health care plans can cover abortion, very few people may be able to purchase those sorts of plans, as they wouldn’t be able to use their tax credits on them. That could make it much more expensive and difficult to obtain an abortion under this law than under current law.
Planned Parenthood funding
This bill partially “defunds” Planned Parenthood, meaning it would cut back on the federal funding that can be used for services at the clinics. Fully 43 percent of Planned Parenthood’s revenue in fiscal year 2015 — more than $550 million — came from government grants and reimbursements.
Right now, under Obamacare, federal funds can be spent at Planned Parenthood, but they can’t be used for abortion — again, a result of the Hyde Amendment and again, with the three Hyde Amendment exceptions. But this bill goes further, saying that people couldn’t use Medicaid at Planned Parenthood.
To be clear, it’s not that there’s a funding stream going directly from the government to Planned Parenthood that Congress can just turn off. Rather, the program reimburses Planned Parenthood for the care it provides to Medicaid recipients. So this bill would mean that Medicaid recipients who currently receive care at an organization that provides abortions would have to find a new provider (whom Medicaid would then reimburse).
Abortion is a small part of what Planned Parenthood does: The organizations says it accounted for 3.4 percent of all services provided in the year ending in September 2014. (Of course, some patients receive more than one service; Planned Parenthood had around 2.5 million patients in that year. Assuming one abortion per patient, that’s roughly 13 percent of all patients receiving abortions.)
Together, providing contraception and the testing for and treatment of sexually transmitted diseases made up three-quarters of the services the organization provided in one year.
That means low-income women (that is, women on Medicaid) could be among the most heavily affected by this bill, as it may force them to find other providers for reproductive health services.
Of the other government money that goes to Planned Parenthood, most of it comes from Title X. That federal program, created under President Richard Nixon, provides family planning services to people beyond Medicaid, like low-income women who are not Medicaid-eligible. Earlier this year, Republicans started the process of stripping that funding.
What wouldn’t change (yet):
Republicans have stressed that this bill was just one of three parts, so it’s hard to say definitively what wouldn’t change at all as a result of their plan. But thus far, here’s what is holding steady:
Maternity and contraceptive coverage
Because this was a reconciliation bill, it could cover fiscal-related topics only. It couldn’t get into many of the particulars of what people’s coverage will look like, meaning some things won’t change.
The essential health benefits set out in Obamacare — a list of 10 types of services that all plans must cover — do not change for other policies. Maternity care is included in those benefits, as is contraception, so plans will have to continue to cover those. The GOP bill also doesn’t change the Obamacare policy that gave women access to free contraception, as Vox’s Emily Crockett reported.
In addition, maternity and contraception are still both “mandatory benefits” under Medicaid. That doesn’t change in the GOP bill. (Confusingly, the bill does sunset essential health benefits for Medicaid recipients. But because there is overlap and these particular benefits remain “mandatory,” they aren’t going away.)
However, all of this won’t necessarily remain unchanged. In response to a question about defunding Planned Parenthood this week, Health and Human Services Secretary Tom Price said that he didn’t want to “violate anybody’s conscience.” When a reporter asked how this relates to birth control, Price did not give a definite answer.
“We’re working through all of those issues,” he said. “As you know, many of those were through the rule-making process, and we’re working through that. So that’s not a part of this piece of legislation right here.”
So this is something that could easily change in the second “phase” of the health care plan, when rules are changed.
“Preventative services [the category that includes contraception] hasn’t been touched, but we expect those to be touched probably via regulation,” said Laurie Sobel, associate director for women’s health policy at the Kaiser Family Foundation.
The end of gender rating
Prior to Obamacare, women were often charged more for the same health plans as men. The rationale was that women tend to use more health care services than men.
However, Obamacare banned the practice, and that ban seems unlikely to change, as the GOP cites nondiscrimination as one of the bill’s selling points:
“Our proposal specifically prohibits any gender discrimination. Women will have equal access to the same affordable, quality health care options as men do under our proposal.”