Heading into the 2018 midterm election cycle, health care is, quite reasonably, a top issue for women voters. According to a Henry J. Kaiser Family Foundation poll released in July, 29 percent of women voters say health care is the “most important issue” for 2018 candidates to discuss in their campaigns. Among men, health care took second place behind jobs and the economy, with 21 percent rating it their top issue.
The Affordable Care Act (ACA), also known as Obamacare, calls for universal health coverage—either through an employer, Medicaid, Medicare or federal or state health exchanges in which low-income people qualify for subsidies to help cover the cost. The ACA banned “gender rating,” or charging women higher premiums than men, and required insurance companies to cover people regardless of their preexisting conditions. It also implemented 10 essential preventive health benefits that insurance providers are required to cover—including birth control, cancer screenings such as Pap smears and mammograms, vaccines, well-woman checkups and STD testing—without copays or deductibles—and requires that all health insurance coverage must include maternity and prenatal care, mental health and substance abuse treatment and prescription drugs.
But the ACA is not just “some sort of add-on that you can excise” or a collection of changes, notes Sara Rosenbaum, a professor at the George Washington University Milken Institute School of Public Health. President Obama’s signature health law is, she says, “woven into the very fabric of American health care at this point”—from the way employer-sponsored health insurance works to its expansion of Medicaid benefits to millions of low-income people who would not have qualified for the program otherwise.
Massive public opposition and women-led grassroots organizing has blocked Congress—thus far—in its multiple attempts to dismantle the ACA. But the Trump administration has managed to damage the health law even without a full repeal.
In 2017, Trump signed an executive order expanding which kind of employers and insurers can use religious or moral beliefs as grounds to not offer coverage for birth control under their insurance plans. In June, the Justice Department said it would not defend the law against a court challenge by 20 state attorneys general who are attempting to throw out the individual mandate that requires individuals to have insurance coverage, along with protections for those with preexisting conditions, which ensure that providers offer everyone coverage, regardless of their medical history.
And in August, the administration announced a new regulation that allows companies to sell junk insurance: a longer-lasting version of the old “short-term, limited duration” policies. Under Trump’s rule, insurers can sell worthless policies that exclude the essential health benefits, including maternity coverage and prescription drugs; discriminate based on gender and preexisting conditions; have steep out-of-pocket costs; and place annual and lifetime limits on coverage.
The new rules will cause “more women to fall victim to predatory practices and [put] millions of people at risk of purchasing skimpy, junk plans that leave them in the lurch when they need coverage the most,” wrote Debra L. Ness, president of the National Partnership for Women and Families, in a complaint filed with the Trump administration. And because these plans attract healthier individuals, their presence in the marketplace is likely to drive up prices in the ACA exchange, further weakening the health care law.
Tammy Boyd, director of health policy and legislative affairs for the Black Women’s Health Imperative, says her organization’s top issues ahead of the midterm election include reproductive health, breast and cervical cancers, diabetes and maternal mortality in the black community—all issues that are in harm’s way under the Trump administration. Breast and cervical cancer screenings are currently covered without copays or deductibles as a preventive health benefit under the ACA. Boyd fears that without having adequate insurance for those screenings, more black women will miss out on preventive medical care and only see a doctor once their condition has worsened.
Meanwhile, Speaker Ryan has proposed $537 billion in cuts to Medicare, the insurance program for adults 65 and older; and block grants and spending limits for Medicaid, which provides health care to low-income children, pregnant women, seniors and people with disabilities. Under the Medicaid expansion, this benefit was extended to low-income adults earning 133 percent of the federal poverty level or less than $12,140 a year who are not seniors or disabled. Thirty-four states have approved the Medicaid expansion and now provide it.
Earlier in the year, the Trump administration’s Centers for Medicare and Medicaid Services gave the nod that states can apply for permission to implement work requirements for non-disabled beneficiaries under Medicaid. So far, Arkansas, Indiana, Kentucky and New Hampshire have received approval for these requirements. Women who are caregivers for children or other family members, women with disabilities or serious illnesses who may not be exempt, and women who work inconsistent hours in low-wage jobs are likely to be among those adversely impacted, according to a report by the Center on Budget and Policy Priorities.
“The administration has already done things to make insurance far less affordable for people, and of course to prevent the poorest people, including a lot of women, from getting access to Medicaid,” Rosenbaum says.
The thought of health insurance without coverage for contraception, mammograms and childbirth? Plainly, it makes us sick.