What The AHCA Means For Sexual Assault Survivors

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The House of Representatives passed the GOP's health care bill, known as the American Health Care Act, on May 4, and it basically makes being a woman a pre-existing condition. The bill removes the Affordable Care Act's essential health benefits, and implementation of the AHCA could make surviving sexual assault a pre-existing condition, thus creating a domino effect that might lead to even more survivors not reporting rape for fear of losing their health insurance. While Democrats unanimously rejected it, the bill passed with a 217-213 vote with only 20 Republicans opposing it.

"The result of this [bill] potentially could be that not only are even more women left without insurance, but then going forward women will be extremely reluctant to report any of these assaults if they know they could lose their insurance," Dr. Lauren Streicher, associate clinical professor of obstetrics and gynecology at the Feinberg School of Medicine, Northwestern University, tells Bustle. "There’s a lot of hidden issues in the new bill."

Sexual assault survivors are already the only violent crime victims who are forced to shoulder medical costs that are associated with crimes committed against them. A recent study reports that currently rape survivors often must pay an average of $1,000 out of pocket just to get medical treatment. If the AHCA — with its stipulation that states may waive Affordable Care Act protections for pre-existing conditions — makes it through the Senate, survivors could be forced to incur all costs associated with their assault. Why? Because depending on the actions their state takes, they may not be able to afford insurance due to being charged hefty premiums for pre-existing conditions they obtained as a result of being assaulted.

While injuries from sexual assault is just one of the "pre-existing conditions" that won't be covered if Obamacare is repealed, some of the other items on the list can be the result of a sexual assault, like mental health issues and STD treatment, and those won't be covered either. People took to Twitter with the #IAmAPreexistingCondition hashtag in protest on the heels of the GOP "victory."

The New Normal Under Trumpcare

While many on social media lament that the bill couldn't possibly pass the Senate, let's not forget we live in a new world where the unthinkable is not only possible, it's reality: A world where Donald Trump is president, and to many it feels like The Handmaid's Tale is an eerie premonition instead of something that could never happen in America. Welcome to the new normal.

Many people didn't think Trump could possibly be elected president, but as Hännah Ettinger wrote in her essay "I Grew Up In A Fundamentalist Cult — ‘The Handmaid’s Tale’ Was My Reality":

I was raised to be a helpmeet in a world like Offred’s, and watching (white, middle class) liberals around me be shocked and unnerved by the election results has been curious for me. Didn’t they know this has been in the works for decades? I didn’t come out of nowhere, and neither did Trump, and nor did The Handmaid’s Tale.

The so called "moral majority" Ettinger refers to in her essay is seeking to strip 24 million Americans of their health care, and if passed, the AHCA would allow states to opt out of the ACA rules that keeps insurance companies from charging higher premiums to those with pre-existing conditions, or denying them insurance altogether, according to the New York Times.

But, fear not my friends. If you "lead a good life" then you have nothing to worry about.

That's right, Mo Brooks, a Republican congressman from Alabama told CNN that people with pre-existing conditions should pay more to keep costs low for “those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy,” the New York Times reported. He later backpedaled, saying, "In fairness, a lot of these people with pre-existing conditions, they have those conditions through no fault of their own. And I think society, under those circumstances, needs to help. The challenge, though, is that it's a tough balancing act between the higher cost of these mandates which denies people coverage because they can't afford their health insurance policies... and having enough coverage to help those people truly in need." But the underlying point is still his first one: The belief that health care should only be provided to those who "deserve" it based on a very particular system of morality — an ultra-conservative Christian one.

Silencing Survivors

This "good lives" statement is one of the hidden issues in the bill Dr. Streicher refers to. While I would hope Brooks didn't mean to imply that women who are raped don't lead good lives, that's exactly what his blanket statement and tunnel-vision thinking does — it basically implies that anyone who gets sick or injured brought it on themselves, which is ridiculous.

This short-sightedness puts sexual assault survivors, who have already suffered a horrific trauma, in a terrible position. Because a sexual assault can have life-long ramifications, many survivors may feel forced to choose between seeking both treatment and justice, or keeping their health insurance.

"When we look at this, there are really two categories," Dr. Streicher explains. "There are the physical injuries that occur as a result of a rape, which are things like sexually transmitted infections, pregnancy, and physical trauma to the genital tissue. Then there are also physical injuries that can occur as part of any violent act — for instance, someone could get shot when they are raped. In addition to this, we have long-term psychological ramifications of women who are assaulted that fall under the mental health umbrella, which is also not covered. That includes things like anxiety, depression, PTSD, and sexual dysfunction."

"Under the umbrella of pre-existing conditions — it’s a lot more than I think comes to mind for most people. I think most people might think, 'Oh, she has an STD she’s going to have to deal with,' and even if that’s true, that’s just one piece of the physical and emotional long-lasting ramifications," Dr. Streicher says.

Statistics from the Rape, Abuse and Incest National Network (RAINN) state that sexual assault is already grossly underreported with only 310 reports for every 1,000 rapes. The additional barrier of forcing survivors to shoulder the financial burden of the crime could lead to even fewer survivors coming forward, or seeking medical treatment at all.

RAINN also notes that reporting an assault can help some victims begin to heal. If survivors are forced to choose between health care and reporting, this path to healing can be taken away from them.

Doctors Find Their Voice

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Pregnancy is another thing some sexual assault survivors face, and under the AHCA, maternity care and abortions might not be covered.

"The AHCA is also a targeted attack against reproductive health. It blocks Medicaid patients from using their insurance at Planned Parenthood health centers, which are the only source of health care for many Americans, as well as an essential provider of family planning services that help avert unintended pregnancies," Dr. Diane Horvath-Cosper, Advocacy Fellow at Physicians forReproductive Health, said in a statement provided to Bustle. "The bill allows states to opt out of covering essential medical benefits including maternity care, which is one of the highest medical expenses families can incur. It includes financial disincentives for private insurance plans to cover abortion care, which is a fundamental, necessary component of reproductive health care."

So let's dissect this for a minute. If you are raped, not only could you lose the right to basic physical and mental health care post-assault, if you become pregnant as a result, you also might not have access to maternity care if you decide to continue to the pregnancy. If you want to terminate, however, you could lose access to safe and affordable abortions. Can someone tell me how this bill is not a blatant punishment for sexual assault survivors?

While it has largely stayed out of the public discussions about the AHCA, the New York Times reported that physicians, hospitals, and insurance companies are now uniting to oppose the bill.

"To me, this is not a reform,” Michael J. Dowling, the chief executive of Northwell Health, a large health system in New York told the New York Times. “This is just a debacle.”

Dr. Horvath-Cosper said she is afraid for her patients, and called on physicians to speak out.

"I am terrified for my patients and for the health of this country. As a physician, I know that patients and families suffer when they are unable to obtain comprehensive, compassionate health care," she said in a statement to Bustle. "Congress should be ashamed to pass legislation that puts health care out of reach for millions of Americans. As this bill moves on to the Senate for consideration, physicians must continue to fight for the health and well-being of all of our patients.”

It's hard for me to stomach that even one person voted to pass this bill, and it makes me think of the quote from Mahatma Ghandi, "The true measure of any society can be found in how it treats its most vulnerable members."

America, I am ashamed. We have to do better.