On Thursday, Republicans in the House of Representatives succeeded at something they'd failed at less than two months ago — they passed the American Health Care Act (AHCA). Since the previous attempt to repeal and replace the Affordable Care Act (ACA and also known as Obamacare) failed, Republicans added some extra provisions aimed at getting the votes of hard-line conservatives who had rejected the initial version of the bill. And, as Thursday showed, that worked.
The most noticeable change in the new version of the health care bill is in allowing states to waive requirements that insurance providers don't charge people with pre-existing medical conditions more than others. As multiple sources reported, the MacArthur-Meadows Amendment could return the health insurance market to the pre-Obamacare situation where sexual assault victims were often denied health insurance.
To understand what it really means for sexual assault to be classified as a pre-existing condition, it's worth looking back at what kind of problems sexual assault survivors faced before the ACA was passed in 2009.
"Insurance companies denied women insurance coverage because of a physical injury, such as a broken arm because of domestic violence," Rachel Easter, Counsel on Reproductive Rights and Health Team at the National Women's Law Center, tells Bustle. "But also we know that insurance denied individuals coverage because they received counseling after sexual assault, or because they took preventive HIV medication after a rape because they didn't know if their rapist was HIV positive."
Easter points to the specific case of Chris Turner, a woman from Florida who was drugged and raped on a business trip. Her doctor put her on anti-HIV medication, not knowing if her rapist had carried the disease. When she tried to get health insurance in order to cover counseling, she found that she couldn't buy it — her risk of HIV being treated as a pre-existing condition. Turner went on to become a major advocate for her cause and helped ensure that this treatment of sexual assault survivors was changed under the 2010 health care bill.
"We used to, for example, not test people for HIV at the time they were going through their rape forensic evidence collection exam specifically for that reason."
According to Gina Scaramella, Executive Director of the Boston Area Rape Crisis Center, being denied coverage was so common before the passage of the Affordable Care Act that survivors were often worried from the moment of reporting an assault.
"People were very pained by decisions about coming forward at all — as always — but certainly about any medical decision making," Scaramella tells Bustle. "We used to, for example, not test people for HIV at the time they were going through their rape forensic evidence collection exam specifically for that reason."
Beyond the issue of sexually transmitted diseases and infections, sexual assault leaves most of its victims requiring serious long-term care. "Most sexual assault doesn't result in significant physical injuries. It results in more mental-health injuries than physical," Scaramella says. "People need access to therapy, and they need it to be covered in their health insurance or they can't access it — which has huge implications for not just mental health but health."
Scaramella says that the changes in pre-existing condition coverage under the ACA were also part of a larger change in the past few years over how sexual assault survivors are treated. She credits that not just to the health care bill, but in some ways to how the Obama administration treated the issue. "The barriers that existed before the ACA were higher for everything," she says. "It's probably hard for people to remember how different it was in the mid-1990s to come forward versus now. The whole cultural context of being a survivor, of talking about the issues, of needing support, were completely different back then. Everything was a barrier."
But sexual assault advocates are determined to fight and make sure the Obama administration's work to improve the physical and mental well-being of survivors is not undone with the AHCA.
"We are going to fight it in the Senate," Easter says of the bill. "We are hopeful that it will not pass because it is so egregiously bad."