The American Health Care Act is a disaster for women. But it may get even worse.

By Jamila K. Taylor and Maura Calsyn

This week, in an attempt to woo extreme House Republicans to line up in support of Speaker Paul Ryan’s plan to repeal the Affordable Care Act, or ACA, Republican leadership proposed various sweeteners to the bill. Two proposals being considered — one eliminating the Affordable Care Act’s requirement that insurers provide coverage of essential health benefits, one of the Act’s most popular provisions, and the other proposing a Medicaid work requirement for some people with Medicaid — would be devastating to millions of women.

Make no mistake: Speaker Ryan’s American Health Care Act, or AHCA, was a disaster for women from the moment it was introduced. But House leaders appear committed to making the final version even more harmful to women.

Eliminating essential health benefits would create a “pregnancy tax”

The ACA requires that all health plans in the individual and small group market cover 10 essential health benefits, or EHBs. These benefits include maternity care, mental health services, prescription drug coverage, and more. Before the ACA, most plans in the individual market — meaning insurance obtained directly from insurers, and not through your job — lacked coverage for many of these services. In 2011, people insured in this market lacked key benefits:

  • 62 percent had plans that didn’t cover maternity care
  • 34 percent had plans that didn’t cover substance use treatment
  • 18 percent had plans that didn’t cover mental health
  • 9 percent had plans that didn’t cover prescription drugs

Republican leaders have offered to repeal the EHB requirement to gain support from the so-called Freedom Caucus. This would allow insurers to drop coverage for maternity care, and instead require women to pay separately for additional coverage.

Maternity coverage increases premiums slightly, from $8 to $14 per month. So stripping maternity coverage out of the standard benefit package would lower premiums by just a few dollars. But it would drastically shift these costs to women of child-bearing age — either through dramatically higher premiums for a maternity care rider, which could be $15,000 extra a year, or by making maternity care essentially an out-of-pocket expense, which could reach $30,000 to $50,000 per pregnancy. So to lower their premiums just a small amount, GOP lawmakers have created what is essentially a “pregnancy tax” on women who may wish to become mothers.

Speaker Ryan’s American Health Care Act was a disaster for women from the moment it was introduced. But the final version may be even more harmful to women.

Stripping the EHB requirement from the bill could also create additional gaps in the ACA’s consumer protections. The law prohibits insurers from imposing so-called lifetime and annual limits on consumers, which used to allow the insurer to simply stop paying for care after that limit was reached. The law also prohibits insurers from placing annual limits on specific benefits that are EHBs. Each of these protections, are, in some way, linked to the EHB requirements. Depending on the final bill, this could expose women and their families to even greater financial risk.

The Medicaid work requirement jeopardizes the health and well-being of women, including new mothers and their babies

The Medicaid work requirement in Speaker Ryan’s bill would, among other things, allow states to force new mothers on Medicaid to find work within 60 days of giving birth, or risk losing their health insurance. Requiring new mothers to find work within just days of giving birth isn’t just bad policy — it’s irresponsible and endangers the health of both mother and child. Not to mention that requiring a mom to return to work just 60 days after welcoming a new child is far short of the 90-day standard put forth in the federal Family Medical Leave Act.

Anyone who is a parent or has been around a new baby knows what a vulnerable time the first several weeks post-birth are for a mother and infant’s health. To require new mothers to be pounding the pavement looking for work within days of a new baby’s arrival is cruel and counterproductive.

Research has shown that the health and well-being of moms is directly linked with the health and well-being of the child. This can be a key indicator in a child’s health from infancy into adulthood. Furthermore, when new moms experience stress and depression, which can be brought on by the pressures of seeking employment within a few short months after the birth of a child, it has a direct impact on the socioemotional and cognitive development of their children. New moms are particularly fragile and prone to depression within the first few months after giving birth.

Moreover, the Medicaid work requirement is another example of lawmakers playing doctor and interfering with critical health decisions. Decisions about when a new mom should return to work should be made in consultation with her doctor, not determined by politicians.

Finally, the high cost of child care in the United States is out of many families’ reach, which can in turn impact a mother’s ability to find work within a few weeks after giving birth. Families can pay an average of $1,487 per month for the care of an infant and toddler. Without access to high-quality, affordable child care, low-income moms may struggle to find the care for their children required to enter the workforce.

It’s not just new mothers who could face the choice between caring for a loved one or losing their Medicaid coverage. States that impose work requirements could also drop Medicaid coverage from a person who stays home to care for an ailing partner or parent. And parents of older school-aged children are not exempt from this requirement, unless their child meets very strict disability criteria.

Taking a bad bill and making it much, much worse

The proposed changes to the AHCA would take the legislation from bad to worse. The earlier version included a robust plan to gut the Medicaid program, defund the trusted and essential health care provider Planned Parenthood, restrict private insurance coverage of abortion, eliminate cost-sharing subsidies that can help lower out-of-pocket costs, and more.

Not only would this bill cause millions of women and children to go uninsured, it would be particularly devastating for low-income families. Putting the health and well-being of those most vulnerable in our communities in even greater risk is nothing short of cruel. It’s also a testament to the empty values on which the congressional majority and President Donald Trump rest their governance.

Update (3/24/17): On Thursday, House leadership again proposed revisions to the Republican health care bill. The latest version of the bill, which House leadership is forcing members to vote on mere hours after the text was finalized, remains an attack on women’s health.

The final version does, in fact, eliminate the essential health benefits standards, allowing insurers to drop maternity care as well as coverage for other services. And because of the way the bill is drafted, it also allows health plans — including those offered by employers — to impose annual and lifetime limits on coverage.

It seems that House leaders realize how terrible their plan is for women, because the final bill includes a small pot of money that states can use to provide treatment for maternity care and treatment for opioid use disorders and some other categories of behavioral health services. But this funding is vastly insufficient, and pits two groups of patients against each other to compete for this meager pot of money.

Our quick calculation is that the legislation’s allocation of $15 billion over 7 years would cover maternity care for less than 143,000 women a year if all of the funding goes to maternity care, leaving none for treatment of opioid addiction. That is far short of the 4 million births each year in the U.S.


Jamila K. Taylor (@drtaylor09) is a Senior Fellow at the Center for American Progress (CAP), where she serves as an expert on domestic and international women’s health, reproductive rights, and reproductive justice. Maura Calsyn is the Managing Director of Health Policy at CAP.

Emily Gee, the Health Economist for the Health Policy team at CAP, contributed research to this piece.