When Republicans talk about what they hate about the ACA, they always mention that, because of the ACA, Americans don’t have any choices about what is covered under the plans they are buying and that they should be able to choose what they cover. They want customers to be able to purchase their insurance, basically à la carte, which no insurance company offers. They don’t want their health insurance to be like a cable bundle with channels you don’t watch just so you can get HBO to watch “Game of Thrones.” But why? What coverage should be a choice? You never hear a non-diabetic say that they don’t want to pay for insulin. You never hear about someone with a healthy heart saying that they don’t want to pay for a transplant. You never hear someone say that they’ve never known anyone who had to have their gall bladder removed so they don’t want to pay for any of those. No, you only hear one complaint about what they don’t want to pay for, and that is women’s health.
When I was 20-something, single, childless, and self-employed in the mid-1990s, I was able to purchase a catastrophic insurance policy for myself that was $99 per month, but that did not include any medical care for my girl stuff. I’d been having periods since I was 12. When I was in high school, the nurses in the office knew I was getting ready to start my period because I’d end up in the office with cramps so bad I was throwing up. Then my cycle went all screwy and irregular. When I graduated from high school my doctor (and my mom) put me on birth control pills to control all of those issues and they worked. But when I had to purchase my own insurance (which I had to do before I turned 26) that care was out.
If I wanted my lady-bits covered, I would have to add the maternity plan for another $350 would have been added to my monthly premium for my $99 catastrophic plan. $350! No baby plans in sight at the time, but without that maternity rider, I couldn’t get a PAP, and I couldn’t get the birth control pills I was taking, neither of which had anything to do with baby prep. If I did have a baby though, the baby would be covered (considered a catastrophe), but prenatal care and delivery costs would not. If I got cervical cancer that would have been covered, but I would not have been able to prevent the pregnancy or get an early diagnosis on the cancer without coming up with an extra $350 per month. That was the 1990s, my rent was $350! The ACA says no, being a woman is not a chronic condition. A woman should not have to purchase special insurance, more expensive insurance just because she has a completely different biological make-up than men. She shouldn’t have her employer, or the government telling her that she can or cannot have medical care, or have things that she needs for her body.
We know Hobby Lobby took the ACA to court because they didn’t want to pay for birth control for their employees. They had a religious objection to paying for something that prevented conception, but thought it caused an abortion I guess. (If they have a problem with preventing conception, I’m sure they have some male employees with sticky sweat socks who should be fired). Really, they just prevent ovulation, there’s nothing to fertilize in the first place. Maybe they thought that would be seen as giving women permission to have sex. What the counter argument fails to ever mention is that for some women, they are taking “birth control pills” not to control birth or conception, for some other medical conditions unique to women that are managed by the pill.
But, the pill is only part of it. We also have to get PAP smears once a year, typically starting when we’re teenagers. The lovely mammogram is in there too, which now we can get for free with ACA as part of the wellness exams. Before, with the employer provided insurance, my mammograms were about $400 out-of-pocket. Men don’t typically have to get prostate exams until their 50s and those exams don’t involve smashing anything into a machine to take a picture. Though, I bet if they did, they’d be free with no objections.
Then what happens when we do get pregnant? Well, there’s that whole prenatal thing that Rep. Shimkus (R-IL) was talking about last week (moron). That involves monthly, then weekly trips to the doctor, ultrasound tests, amniocentesis tests, gestational diabetes tests, and for some, prescription medications or vitamins. Then come things we don’t expect, like maybe a miscarriage that requires a hospitalization, and in some cases an induced delivery or D & C. There are other complications that can put us on bed rest, our blood pressure can get so high we can require medications. Without prenatal care and monitoring both mothers and babies are at serious risk. A mother without insurance who’s not getting prenatal care may never hear the word “preeclampsia”. Then there’s the birth! The drugs, the nurses, the doctors, the stays in the hospital. I had two c-sections so I had operating room costs, a lengthier stay in the hospital, and follow-up examinations. I had my tubes tied that added costs to the surgery. Did Hobby Lobby ever complain about those? Then I had follow-up exams with the doctors to make sure everything got put back together correctly. Not to mention that the entire process takes up the better part of a year, and requires weeks out of work. (That kind of coverage is a whole other story).
Yes, women have an entirely different biology and physiology which requires a completely different kind of medical care, and that care is expensive. We also start purchasing feminine products from the time we’re teenagers, and finding a decent bra can be a $50+ endeavor. Our bodies are complicated, and because of those complications, our costs are higher. Before the ACA, being a woman was a pre-existing condition. Without the mandates, that’s what it becomes again. Funny how those who are pro-life want to cut funding for prenatal care.
Back to the ’90s for a second. We know I had heavy periods and a funky cycle that I was controlling with the pill. We also know that I needed cancer screenings once a year. We also know that I couldn’t afford an extra $350 a month. What’s a girl to do? Oh yeah, Planned Parenthood! For two years, I got my heavy period and cycle regulation pills as well as my cancer screenings from Planned Parenthood. No charge. I did not have to go without necessary medical care just because I couldn’t afford it. This Trumpcare plan cuts Planned Parenthood funding too. Planned Parenthood does not get reimbursed by Medicaid for abortions — never has — never will. They get reimbursed for the things I needed that I couldn’t afford through conventional insurance plans.
By removing the mandates for required elements in the plans, and by cutting funding to Planned Parenthood, medical conditions unique to women, exclusive to women, the chronic condition of being a woman is an unmanageable financial burden. Even if we can’t be denied coverage, it doesn’t mean that coverage isn’t going to add additional costs to the plans. They like to throw around the word “access” but access isn’t the same as coverage. To paraphrase George Takei, “I have access to Ryan Reynolds, but it doesn’t mean he’ll cover me.” Republicans do not consider caring for the unique needs of women as a part of the “general welfare” and so every path to affordable care for women is cut off, from the top down. If a man doesn’t need it, a man shouldn’t pay for it.
Make no mistake, when the Republicans are saying that people should be able to choose what’s on their plan, they mean that they shouldn’t have to pay to cover “maternity” care, which is code for women’s health.
My 12-year-old daughter started her period last year. It’s irregular. We’re thinking that in the next couple of years she might need to go on the pill to get it straightened out. I hope she can. I hope we can provide that for her. I hope she has choices. For right now though, she has a president who would rather grab pussies than care for them, and a Republican congress that just doesn’t care at all.