National Partnership for Women & Families

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From the desk of ... Debra L. Ness

Replacing the ACA May Be High Stakes for Lawmakers – But It’s Even More Important to Women

February 1, 2017 | Health Care

Cross-posted to Medium

Thousands of news stories have documented the politics around repealing and replacing the Affordable Care Act (ACA). Every week, it seems, ACA opponents try out some new spin. Last week, they abandoned their “trust me” messaging to claim that Congress’ hasty repeal of the ACA — and Republican leaders’ chaotic musings about how to replace it — were actually a reluctant rescue mission, necessitated by the law’s failings.

Nothing could be farther from the truth. The ACA is working well, despite relentless attempts by opponents to undermine and repeal it. In less than seven years, it helped 20 million more people gain health coverage, many for the first time, bringing the country’s uninsured rate to its lowest level in history. It made it possible for millions of people with pre-existing conditions to get covered. It outlawed the once-common practice of discriminating in pricing on the basis of gender. It put the no-cost preventive services we all need within reach for millions.

As the hearing gets underway this morning in the Senate Health, Education, Labor & Pensions Committee, let’s remember how many women and families rely on the ACA, and what they have to lose if the law is repealed and so-called replacement proposals fail to retain its protections and benefits. The following are important issues to watch for at today’s hearing and in all debates about replacing the ACA.

  • The essential health benefits (EHB) requirement. The ACA requires most plans to cover a package of ten essential health benefits that explicitly includes maternity care. By requiring health plans to cover this package, the ACA guarantees coverage for maternity and newborn care (as well as preventive care, prescription drug coverage, emergency room care, pediatric care and more) for plans purchased on the health insurance marketplace.

    All current Republican replacement proposals would eliminate the national EHB requirement. Its exclusion could mean a return to the days when nearly nine in ten individual health plans failed to cover maternity care. Without a nationwide guarantee of coverage for essential health benefits, including maternity care, women would be left with a confusing patchwork of coverage that differs from state to state.

  • The requirement to cover preventive services with no cost-sharing. For women, one of the key features of the ACA is its guarantee of preventive services with no cost-sharing. As a result of this provision, 55 million women now have coverage for essential preventive services like well-woman visits, screenings for cancer and sexually transmitted infections, and birth control without cost-sharing.

    The Republican replacement proposals released to date would jeopardize this extraordinary public health achievement. For example, the bill released by Sen. Bill Cassidy (R-LA) would gut this guarantee by stating that it does not apply if an employer contributes to an individual’s Health Savings Account. Without a guarantee of preventive services without cost-sharing, women’s out-of-pocket expenses would increase dramatically and many would not be able to afford preventive care, including birth control.

  • Affordability and gender rating. Making coverage affordable is key. Without adequate financial assistance, women cannot afford the coverage they need and have come to rely on under the ACA. Premium tax credits and cost-sharing reductions have been critical to ensuring that millions of women, men and children are able to afford health coverage – some for the first time. And before the ACA took effect, 92 percent of the best-selling plans on the individual market charged women higher premiums simply because of their gender (a practice known as “gender rating”), costing women approximately $1 billion a year. The ACA put an end to this discriminatory practice.

The Republican replacement proposals threaten to undermine affordability and return us to the days when women were charged more than men for the same health insurance plans. For example, the Cassidy bill would spread fewer federal dollars over a larger population, making it more difficult for women and families to afford coverage. Similarly, the proposal previewed by Sen. Rand Paul (R-KY) would leave low-income women and families without the financial help they need to purchase comprehensive health plans. The replacement proposals would also roll back regulations, allowing insurers to inflate premiums, offering women less financial assistance and once again opening the door to discriminatory gender rating.

The ACA has been the greatest advance for women’s health in a generation, and women will suffer terribly if it’s repealed and replaced with an inferior law. For all the talk about the political winners and losers in this debate, what matters most is what happens to the women and families whose coverage and access to care are now at risk. Before Congress touches the ACA, it must first propose a comprehensive, thoroughly vetted, transparent replacement proposal that guarantees that coverage will be as affordable and comprehensive as it is under the ACA.

We urge you to use WeTweet.org to tell the lawmakers who represent you to stop attacking the Affordable Care Act and to ensure that any replacement plan fully addresses the needs of women and families.


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