Not Going Back: The Affordable Care Act and Medicaid

This series is based on a full-length feature appearing in the Winter 2016 issue of Ms. Subscribe today to get a copy and become a member of the Ms. community!

Though Trump has backtracked slightly on the issue since the election, we still expect an all-out effort by Republicans to repeal the Affordable Care Act (ACA).

Women, in particular, have a lot to lose if the ACA is repealed. The ACA prohibits insurance companies from charging women more than men for health insurance, a practice called gender rating. Before the ACA, women purchasing individual private insurance were forced to pay about $1 billion more per year for health plans identical to men’s, and the majority of these policies (around 88 percent) did not cover maternity care. The ACA also requires most insurance plans to cover a broad range of preventive services for women, including well-woman visits, mammograms, domestic violence screening—and, yes, maternity care.

The ACA’s contraceptive coverage is also at risk. Under the ACA’s preventive health services package, insurance companies are required to provide FDA-approved birth control methods—birth control pills, IUDs, injections— without copays or coinsurance. That means that if you are insured your perscription birth control is free. Millions of women have used the birth control benefit. Just in 2013, women saved $1.4 billion in out-of-pocket costs for birth control pills alone.

Even if the birth control benefit is not done away with entirely, the TrumpPence administration could attempt to eliminate coverage for those who work for, and are insured through, religiously affiliated nonprofits like hospitals and schools. These employers are already not required to provide birth control as part of their health insurance if they register their religious objection by submitting a form to the Department of Health and Human Services. This procedure enables their employees to still obtain free birth control, but the objecting employer does not pay any of the cost.

A number of religiously affiliated nonprofits have sued the federal government, claiming that this accommodation was unduly burdensome. The Supreme Court has declined to rule on the question, leaving those cases pending in the courts. All the Trump-Pence administration has to do is simply stop defending those lawsuits—and they would be threatening the coverage for an entire category of workers and their dependents.

If Republicans do repeal the ACA, they seek to replace it with a series of plans that increase out-of-pocket costs and decrease health benefits, especially for low-income and older individuals. House Speaker Paul Ryan (RWis.) has already suggested radical changes for Medicare recipients, more than half of whom are women. The ACA strengthened Medicare— the public health insurance program for seniors and adults with permanent disabilities—by increasing the program’s fiscal solvency, lowering prescription drug costs and expanding the range of preventive services covered, at no additional cost to beneficiaries.

Under the Ryan plan, however, Medicare would become totally privatized: Seniors would receive vouchers to purchase insurance on the commercial market. If the cost of insurance were to exceed the voucher amount, seniors would have to pick up the tab themselves. But there’s another problem. Without the ACA and its prohibition of discrimination on the basis of age or preexisting condition, people over 65 will likely have a hard time finding anyone to sell them health insurance in the first place.

Trump has also promised to blockgrant Medicaid, radically changing the Medicaid system and putting the basic health care needs of the millions of women and children who depend on the program at risk. Right now, anyone who is eligible for Medicaid is guaranteed coverage. The costs are shared by the states and the federal government, with the lion’s share paid by the federal government. Under a block-grant system, states would receive a fixed lump sum of money for Medicaid, and any costs above this amount would have to be paid for by the states themselves. Congressional Republicans also want to cut Medicaid funding, so the block grants would likely provide less money overall, which would almost certainly necessitate cutbacks in services or eligibility.



Gaylynn Burroughs is policy director at the Feminist Majority Foundation.