People are outraged that the American Health Care Act, which narrowly passed the House of Representatives yesterday and will now go to the Senate, cuts back explicit protections for people with pre-existing conditions.
Many groups have been compiling the conditions insurers looked for pre-Affordable Care Act when closely scrutinizing applicants' medical histories, and there's a long list of what insurance providers can define as a pre-existing condition. Democratic Senator Sherrod Brown of Ohio even tweeted a massive alphabetical list of them.
Though an AHCA amendment reads, “Nothing in this Act shall be construed as permitting health insurance issuers to discriminate in rates for health insurance coverage by gender,” it's hard to take this seriously when many pre-existing conditions disproportionately pertain to women, including postpartum depression, rape, surviving domestic violence and even C-sections.
We'll go into that in a bit, but first: But didn't proponents (like Paul Ryan) say the plan will continue to protect people with pre-existing conditions?
Well, proponents promised a lot of things that haven't quite panned out. So, short answer: No, the new bill doesn't guarantee protection.
Longer answer: The AHCA repeals the Affordable Care Act, which barred insurers from denying coverage to people with pre-existing conditions and charging sick consumers more for coverage. Under the new GOP proposal, the MacArthur amendment allows states to waive out of some Obamacare requirements, including the ban on insurers from charging those with pre-existing condition higher premiums.
States can make this change if they participate in the Patient and State Stability Fund and ideally set up high-risk insurance pools to help cover patients with preexisting conditions and who can't obtain traditional coverage. Republicans even tried to assuage fears by pouring an additional $8 billion into these high-risk pools that states could use if they wanted to.
But the thing is, states don't have to.
“The idea was people who fall through the cracks would have a high-risk pool. What happens though if a state uses their money for reinsurance (payments directly to insurers that cover expensive patients) instead?” Tim Jost, health law expert, told Vox.
Plus, high-risk pools are historically inadequate. They cost a ton of money and face funding challenges. According to Avalere Health, the $23 billion specifically allocated for helping people with pre-existing conditions would only cover about 110,000 people. If states choose to allocate all of the other available funding ($115 billion total), it would only cover 600,000 people. That's out of 2.2 million people currently enrolled in the individual market and have some form of pre-existing conditions.
OK, but c'mon, are C-sections really considered a pre-existing condition?
They have been in the past, and the reasoning behind the definition is troubling.
For instance, in 2008, a 39-year-old Colorado woman was turned down for health insurance because she had given birth through C-section.
"Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule (the insurance company) did not want to pay for it," the New York Times reports. "A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified."
Apparently, all moms don't deserve to have the same insurance rates or coverage because choosing or having to undergo a C-section birth (with its higher risks of hemorrhaging, post-surgery complications and other future complications) can be too expensive and problematic.
And we're talking about a huge group of moms here. According to the Centers for Disease Control and Prevention, 32 percent of deliveries in the U.S. are through C-sections. Often the procedure is necessary to ensure the safety of mom and baby.
"Do these mothers deserve to pay much, much more than they already are to have their babies because of something they couldn't control and wouldn't have chosen?" writes one mom, Katharine Stahl. "Because no one I know wants to have a painful surgery or a stomach full of staples unless that's the only way they can ensure the health of their babies and themselves. Punishing us by not requiring our insurers to cover that surgery seems, if not criminal, then most definitely immoral."
Women who undergo C-sections already face a stigma that they didn't birth "naturally." They feel their bodies have somehow failed them and they are less of a mother, despite the fact that it shouldn't matter that they birthed differently. Labeling C-sections as a pre-existing condition only serves to reinforce this stigma, and now as the ACHA inches closer to reality, it could very well happen again.