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Women and Kids Could Pay More for Health Care Without Obamacare

Photograph by Twenty20

Maternity care—including prenatal care and childbirth—is required to be included as a health benefit under the Affordable Care Act. But that and many other woman-focused health care services could disappear from coverage lists or cost you more if the health care law enacted by President Obama is repealed under Donald Trump’s administration.

President-elect Trump’s choice for Secretary of Health and Human Services, U.S. Rep. Tom Price (R-Ga.), certainly doesn’t look good for the future of the Affordable Care Act, as he’s been a vocal critic of the law, and has introduced legislation in the past trying to repeal and replace it. He’s voted dozens of times to repeal the federal law since 2010.

If confirmed by the Senate, Price is likely to be involved in repealing and replacing the health care law and would also oversee social programs such as Medicare, Medicaid, the Children’s Health Insurance Program, and authority over government health agencies such as the FDA and CDC.

Why should this concern all women? Price has voted repeatedly against reproductive rights, federal funding for groups like Planned Parenthood, parental leave for federal employees and prohibiting job discrimination based on sexual orientation, just to name a few things. So he doesn’t exactly seem to have our best interest in mind.

Historically—even in recent years prior to the Affordable Care Act being passed as law—women have been discriminated against when it comes to health care coverage.

MATERNITY CARE

The National Women’s Law Center found that before the federal health care law was passed in 2010, only 12 percent of individual coverage plans available to a 30-year-old woman living in a state capital offered maternity benefits.

Although some plans offered riders for maternity care, the Center’s study found that insurance companies offering the riders often paid a fixed amount—and sometimes that amount was only a few thousand dollars. Women with insurance still paid an average $3,400 out-of-pocket, according to a 2013 report on maternity costs from Childbirth Connection.

The average cost for pregnancy and newborn care for a vaginal delivery was about $30,000 and $50,000 for a C-section, one report found, and insurance carriers were barely paying out an average around half of the cost. Meaning moms and dads have to figure out how to pay the rest.

Before the Affordable Care Act was passed as law, insurance companies could actually get away with discriminating against women in a practice called “gender rating,” where women were charged premiums higher than men for the same health care plan, and sometimes even the same services.

In fact, the National Women’s Law Center reviewed the best-selling health plans in each state capital in 2009 before the Affordable Care Act was passed and found that a disturbing amount of plans—95 percent—practiced gender rating. Women collectively paid around $1 billion more than men each year in individual health plan premiums, although they had identical health plans. The Affordable Care Act banned that practice, preventing gender discrimination against women.

PREVENTIVE CARE

Many women’s health benefits were previously not covered as well, or only offered with co-pays or if a deductible was met.

The Affordable Care Act made a number of preventive care services available to women such as well-visits, gestational diabetes screening, domestic violence screening and counseling, FDA-approved birth control methods, contraceptive education and counseling, breastfeeding support, supplies and counseling, sexually transmitted infections counseling, HIV screening and counseling, HPV testing, mammograms and colonoscopies.

More than half of women surveyed in a 2009 study said they avoided or delayed seeking preventive care due to the cost of healthcare.

To be sure, the Affordable Care Act has plenty of room to improve, and even President Obama has acknowledged this on many occasions. But as he said during an event in Florida in October, they've been making improvements along the way based on what works (and what doesn't) and it's sort of been like buying a starter home. "It's a lot better than not having a home, but you hope that over time you make some improvements," Obama said.

KIDS' HEALTH CARE

If your own health care isn't what you're worried about as a mom, the Affordable Care Act also outlawed pre-existing condition exclusions for children.

Before the ACA, parents who had children born with serious illnesses or suffering from childhood illnesses that required multiple surgeries or courses of treatment could previously be denied care or coverage because they either hit a lifetime cap for their child, or the illness was considered a pre-existing condition that excluded them from eligibility of coverage. And since 2014, insurance companies cannot limit annual insurance coverage with a dollar amount.

For parents with older children, the ACA helps keep children in college and until age 26 insured under the parents' insurance policies. (Trump has actually said he thinks allowing young adults to stay on their parents' health plans is a good thing.)

WHAT'S NEXT?

Senate Republican leaders say they will immediately move to start repealing the Affordable Care Act in January after Trump takes office, despite the fact that they have not come up with a concrete plan to replace it.

Sen. Mitch McConnell (R.-Kentucky) told the New York Times on Dec. 6 that "the Obamacare repeal resolution will be the first item up in the new year."

This doesn't mean that the ACA would immediately go away, though; Congress could go with a "repeal and delay" strategy, according to the New York Times, that would delay the effective date that the law would go away so there's time to work on phasing it out and phasing in a new plan. Although many health policy experts say the law has been beneficial, Senate Republicans have said their timetable will be "very aggressive" after Inauguration Day to begin repealing the health care law.

A study released this month from the nonpartisan Urban Institute found that as many as 30 million Americans could go back to being uninsured if Congress repeals the ACA but doesn't replace it or the replacement legislation stalls. As a result, the Urban Institute says by 2019, there could potentially be more uninsured Americans than before the ACA became law in 2010.

The World Health Organization has urged President-elect Donald Trump to expand Obamacare and ensure all Americans have access to healthcare, but that seems unlikely to happen. How much of the law might still exist or change, or when, is still unclear.

Insurance companies, trade groups and lobbyists have expressed concerns as well. Some insurers have left the marketplaces already because they were losing hundreds of millions of dollars, and the rest say they need to know that the government would continue to offset some costs for low-income people before they decide to stay in the marketplace. Many have also raised premiums sharply already. Insurance companies are asking the government to extend a deadline coming up in the next few months to decide whether they'll stay in the state marketplaces for 2018 and beyond.

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