The American Health Care Act is filled with discrimination and sexism
© Greg Nash

Discrimination and sexism have no place in health care. And yet, that is exactly what the American Health Care Act — the Republican proposal to repeal the Affordable Care Act (ACA) — has at its core. The bill would take us backward to time when women faced inflated health care costs and when people had few protections to ensure their access to reproductive care.

From paying higher premiums and high out-of-pocket costs for birth control to the  the exclusion of maternity care, for decades, women were paying more for their health care simply because of their gender. Up until seven years ago, it was perfectly legal in most states for individual health policies to use a “gender rating,” charging women more than men for the same coverage, even for policies that did not include maternity care. And there was no explicit protection for transgender patients from discrimination based on their gender identity.


Fortunately, the ACA — also known as ObamaCare — changed all that. The law recognized women’s healthcare needs, outlawed discrimination in health care, and people gained access to more affordable preventive care and more comprehensive reproductive care. 


Specifically, over 55 million women have gained guaranteed coverage of preventive services without co-pays, including birth control, under the ACA. In 2016, 6.8 million women and girls enrolled in marketplace health plans, many of them using tax credits and subsidies  to make the comprehensive coverage affordable. When it comes to level the playing field for women’s health, the impact of the ACA cannot be overstated: it stands as one of the most important legislative advancements for women’s health in decades.

Today, these enormous gains are under attack. The Republicans’ plan to repeal the ACA threatens to decimate access to healthcare for millions of people and to unravel the safeguards that ensure people can get the reproductive care they need, free from discrimination. Provisions in the ACA repeal bill promises to create chaos in our healthcare system, increasing costs for inadequate care and forcing millions to lose their coverage. 

The nonpartisan Congressional Budget Office (CBO) found that 24 million people would lose health insurance within 10 years under the bill. By cutting premium assistance, effectively eliminating Medicaid expansion, and converting Medicaid into either a per capita system or block grant, the bill targets low-income women and promises to cut of their access to reproductive care. Medicaid is a critical source of family planning services and covers half of all births in the United States. Twenty percent of women aged 15-44, equal to 12.9 million women in 2015, are covered by Medicaid. 

But if cutting off access to coverage is not enough, the bill goes to great lengths to specifically target reproductive health services for those who do manage to retain some form of coverage. For example, by prohibiting Medicaid reimbursements to Planned Parenthood, the ACA repeal bill would cut off millions of women from accessing breast and cervical cancer screenings, prenatal care, STD and HIV testing and prevention, and contraception.

Those who rely on Planned Parenthood for preventive care, birth control, and more—many times because it is the only provider in their community — will have to either travel hundreds of miles or simply forgo healthcare We know from experiences in states like Texas, where they slashed family planning and limited people from accessing their provider of choice, that the impact on women’s health from such policies is devastating. 

Unsurprisingly, Congressional Republicans also zeroed in on coverage of abortion care. After adding discriminatory provisions that would make it more difficult for a woman to access abortion care, the bill’s proponents revisited the bill this week to double-down on those restrictions. The ACA repeal bill stipulates that tax credits cannot be used to obtain a plan that covers abortion services, except in extremely limited situations. Of course, the intended effect will be to dissuade most private insurance plans on the individual market, and likely many employer-provided plans, from covering abortion care.

Women already face incredible hurdles when trying to access abortion care, not the least of which is being able to afford care. These coverage restrictions are cruel and nothing more than attempts to interfere with women’s constitutional rights and make abortion care out of reach, hitting low-income women, women of color, young people and immigrants hardest. 

Finally, the ACA repeal bill also penalizes women if and when they decide to become mothers. The ACA greatly expanded access to maternal healthcare, in large part by requiring individual plans to cover pregnancy, maternity, and newborn care and by expanding Medicaid. Yet it’s clear that many Republicans would rather not cover maternal care, and the ACA repeal bill would certainly succeed in cutting off this care for millions.

By turning Medicaid into a per capita or block grant system, states could very likely repeal regulations that protect guaranteed maternity coverage. This would reduce financial support to help people purchase coverage, meaning millions of women could find themselves pregnant with no access to healthcare.

Make no mistake, TrumpCare is dangerous for American women and anyone who needs access to comprehensive reproductive healthcare and will leave millions at risk. Our lawmakers in Washington should focus on finding policies that expand access to care — not take it away or put it out of reach.

Amy Friedrich-Karnik is the Senior Federal Policy Adviser at at the Center for Reproductive Rights.

The views of contributors are their own and are not the views of The Hill.