On Thursday, while the internet was stricken with waves of anxiety, the House of Representatives passed a bill that would repeal and replace the Affordable Care Act (ACA) in a narrow victory of 217 to 213. It was a stunning comeback from their crushing defeat this past March, when they were forced to pull the legislation from the House floor, realizing they didn't have enough votes to pass it. After tweaking some provisions, they managed to get more moderate Republicans on board and squeaked the bill through. No House Democrats voted for the bill and 20 House Republicans also voted against it.
Now, the bill goes to the Senate, where it faces a significant challenge. Because House Republicans rammed the bill through before the nonpartisan Congressional Budget Office had even assessed its cost and impact, the Senate is likely to meet it with more skepticism, although they still have a Republican majority. Of the myriad issues with repealing the ACA and replacing it with the GOP-devised American Health Care Act (AHCA), there are, of course, a host of problems that hit marginalized populations —including women, sick people, trauma survivors, and low-income folks — the hardest. Here are some specific ways this bill goes above and beyond to deny care in the most anti-feminist way possible.
Discriminating Against Pre-Existing Conditions
The ACA revolutionized health care in America, in part because it introduced a ban on insurance companies denying people coverage on the grounds of having a pre-existing condition, which might mean costlier care. The AHCA guts this with a provision allowing states to get waivers from the U.S. Department of Health and Human Services that would let insurance companies charge higher premiums for folks with pre-existing conditions once again.
It's mind-boggling to have such textbook ableism baked right into our proposed health care plan, but punishing sick people for being sick seems to be something House Republicans are fine with.
As Michael Hiltzik pointed out in a column for the LA Times:
Rape And Domestic Violence Are Considered Pre-Existing Conditions
And now the government & health insurance companies want to tell them that, essentially, they're too damaged to be worthy of health care.— Jessica Price (@Delafina777) May 4, 2017
Under the AHCA, rape and domestic violence fall under the purview of "pre-existing conditions" insurers might be able to discriminate against. Before Obamacare, it was relatively common, although since insurers weren't required by law to disclose why they were denying someone coverage, we have no way of knowing how widespread the practice was. Some states banned insurers from denying coverage based on abuse status pre-Obamacare, but not all of them have such bans in place. In the absence of Obamacare's pre-existing conditions provisions, Americans are yet again in danger of being denied health care simply because they were survivors of abuse.
The Medicaid Overhaul
The AHCA halts the ACA's previous Medicaid expansion plan and it cuts existing Medicaid by $800 million in favor of giving tax cuts to the wealthy, leaving low-income folks even more vulnerable to health issues. Not only would this place Americans on Medicaid in danger of losing their existing coverage, it could also dramatically reduce the types of health care they have access to, such as mental health and substance abuse treatment. Again, punishing low-income people, who are already more susceptible to illness by virtue of being low-income, by stripping them of health care access is a stunningly anti-feminist display of classism baked right into the bill.
Rollback Of Essential Health Care Benefits
Under the ACA, states were required to cover "essential" health care services as part of Medicaid, and employer plans were required to cover them for people who got insurance through their place of work. Under the new AHCA bill, however, states would be allowed to define "essential" care however they wanted and could effectively do away with, as Planned Parenthood outlined in the tweet above, "ambulatory care, emergency services, hospitalizations, maternity and newborn care, mental health and substance abuse, prescription drugs, rehabilitative services, lab tests, preventative services and chronic disease management, and pediatric services."
Planned Parenthood Loses Funding For One Year
Unsurprisingly, the AHCA strips Planned Parenthood of its funding for one year, but as long as Republicans remain in control of Congress, this provision could be renewed every year. Furthermore, the AHCA bans premium subsidies from being spent on plans that cover abortion. So if you live in a state that guarantees abortion coverage as part of all health care plans, such as New York or California, you wouldn't be able to receive your usual insurance premium tax credit, because they cover abortion as a requirement.
In essence, the GOP health care bill actively punishes women for being women, yes, but it also employs ableist, classist provisions which punish the sick, disabled, mentally ill, traumatized, and most vulnerable low-income populations. Women have a lot to worry about simply being women, but we mustn't forget how our problems under the AHCA are compounded for those with multiple intersecting marginalized identities.