Don’t panic, but get angry about the GOP health care bill

If you are anything like me, you watched intently as the United States House of Representatives voted on the hotly contested American Health Care Act (AHCA). One of the more troubling provisions of the bill is the MacArthur Amendment, which would permit states to waive certain Affordable Care Act requirements to encourage fair health insurance premiums; this amendment specifically targets those with preexisting health conditions.[1]

The bill barely passed through the House. My first reaction was outrage, but on reflection I remembered that it still has to get through the United States Senate which will be no easy task. Although the Republican Party controls the Senate, they do so by only four members, leaving little leeway for error. Additionally, there is a divide between the Republican senators on how to alter the current Affordable Care Act which suggests that reaching a majority vote would not be a given. Regardless, the Senate will not be able to begin review of the AHCA without a report from the Congressional Budget Office on the long term cost and effects of the law.

Moreover, not everyone would be subject to the preexisting condition limitation. Here are the broad categories of those who would be affected:

1) those who live in a state that would seek a waiver;

2) those who would have a lapse in health coverage for longer than 63 days and have a preexisting condition; and

3) those who purchase their insurance in the individual market (rather than through an employer).

As it stands under the Affordable Care Act, the insurance provider cannot take into account a person’s health status in determining premiums, but with the MacArthur Amendment there is the potential to consider a person’s health status in drafting the insurance policy. A potential consequence is that healthy people would be motivated to join insurance plans based on their healthy condition, while the sicker people would have to turn to community-rated plans which could face higher health insurance premiums.

It is a universal truth that health care is expensive. The million dollar question is how to implement health care without expanding the deficit. There is no perfect solution for health care, and I do not pretend to have one. However, I do know that the burden of health care costs should not be paid for on the backs of those who need access to health care the most.

While it is unlikely that the current version of the bill will pass through the Senate, and the number of people who would be affected is undetermined, it is crucial to note that the MacArthur Amendment is detrimentally harmful for women, particularly as it pertains to victims of rape and domestic violence, as well as those who have been or will be pregnant. Each of these circumstances does not exist in a vacuum and has medical and financial consequences that follow, and labeling those circumstances as “preexisting” has dire financial repercussions. I will address each individually.

Survivors of rape require several modalities of treatment. Preliminarily, they require sexually transmitted disease testing and pregnancy prevention, as well as post-exposure prophylaxes which can be costly. One study estimated that a 28-day regimen for AIDS prevention can cost up to $1,000. Rape survivors may also have physical injuries from the rape requiring treatment. A 1999 study from Johns Hopkins University reported that between 50 to 95 percent of rape survivors develop post traumatic stress disorder. In addition, up to 50 percent of rape victims lose their jobs or are forced to quit due to the severity of their reactions, thereby worsening their financial situation. A 1996 study from the Department of Justice estimated that the cost of rape for victims annually is $127 billion.

Domestic violence survivors fare no better. They often suffer from depression and alcohol abuse, and are at a greater risk of developing sexually transmitted diseases and unwanted pregnancy. Other physical effects of domestic violence include vision loss, arthritis, chronic pain, ulcers, and stammering. A 2003 study by the Center for Disease Control estimated that the cost of partner violence is $5.8 billion annually, with $4.1 billion of those costs reserved for medical and mental health services.

Lastly, women have the option to have cesarean childbirths, but the procedure is not without risk of health complications. There is a greater likelihood of infection or a need for a blood transfusion, and cesarean deliveries have the potential to damage the bladder or cause placenta complications, all of which could require supplemental treatment. In sum, survivors of rape and domestic violence and those that incur pregnancy will all have the potential for auxiliary treatment, which costs money. Labeling these conditions preexisting increases the likelihood that those women will be the ones to bear the cost.

To reiterate, I do not believe that the AHCA will be signed into law in its current form. Nonetheless, it is imperative that we are aware that once again, women’s access to health care has been put on the chopping block. The bill ALSO attempts to withhold federal funding from Planned Parenthood, which I have previously discussed. What to do about this? Again, there is no right answer, but stay informed; contact your senator and make yourself heard. More importantly, know that a (slim) majority of elected officials passed this bill through the House of Representatives. If your congressperson voted for this bill and you disagree with it, keep this in mind when he or she is up for reelection. The House of Representatives has demonstrated that they are willing to compromise a woman’s access to affordable health care, but it is our responsibility to hold them accountable.

[1] The amendment states “Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.” This implies that a consumer can still receive access to health coverage with a preexisting condition, but that this access would come at a potentially higher cost. This risk was mitigated under the Affordable Care act with the individual mandate that required all people to purchase health insurance.