Last week, House Republicans passed a new health-care bill that would repeal and replace the Affordable Care Act. Vermont senator Bernie Sanders called it “one of the most disgusting pieces of legislation ever passed.” Now, the future of health care is in the hands of the Senate, and so far it’s not looking pretty. More than a dozen senators were chosen to be a part of a working group on the issue—and it wasn’t until they garnered criticism that they even invited a female lawmaker to be a part of the conversation.
Although senators have suggested they’re starting from scratch, it’s unknown if they’ll draw any inspiration from the House bill. And should the current version of the American Health Care Act (AHCA) become law, the impact would be huge on women, especially if they ever plan to have children. Here's what you need to know:
The biggest concern is that tens of millions of people would lose coverage, thanks to the loss of subsidies and cuts to Medicaid, which, according to the Congressional Budget Office, would amount to $839 billion over 10 years. “Medicaid is the biggest funder of pregnancies in the country,” says Benjamin Sommers, an associate professor of health policy and economics at the Harvard T.H. Chan School of Public Health. “It’s the single biggest insurance type that people have when they give birth.”
If funding to the program is slashed, “expect to see more women who are only going to qualify for Medicaid when they are pregnant and 60 days after the baby is born,” Sommers says. According to a recent study he co-authored, about half of the women who had Medicaid at the time they gave birth between 2005 and 2013 had a gap in coverage in the following 12 months.
Coverage disruptions can adversely affect women and their infants. “Uninsured women may struggle to manage existing chronic health issues and common pregnancy-related conditions such as pain and urinary incontinence, many of which persist through the year after giving birth,” the research states. There’s also always a risk for undiagnosed postpartum depression, which affects an estimated 13–19 percent of U.S. women after giving birth and could impact a child cognitively, behaviorally, and socioemotionally.
Even people who do maintain coverage under the AHCA may find their plans aren’t as comprehensive as they thought. Thanks to an amendment tacked onto the GOP bill about a week before the House voted, states could opt out of making insurance companies offer what are called essential health benefits, which includes maternity care.
In essence, the bill takes us back to pre-ACA days. “Most people don’t know this,” Sommers explains, “but if you got your insurance directly from the insurance company—you went through an insurance agent and bought insurance because, let’s say, you didn’t get it through your work or you were self-employed—before the ACA, about 60 percent of those plans…didn’t cover maternity at all.”
That means families will have to cover the costs associated with prenatal care and delivery out of pocket. According to a 2013 report, the average payment for prenatal care and delivery among women with commercial insurance in 2010 was $18,329 for a vaginal delivery and $27,866 for a cesarean section. And that’s if there are no complications.
"There are a lot of reasons to be concerned about coverage going forward if this becomes the law,” Sommers says, and women and their families will have to have some difficult conversations about whether or not they can even afford to have a baby."