So far, we know that about 24 million Americans stand to lose their health insurance coverage if the Affordable Care Act (ACA) is replaced with the American Health Care Act (AHCA). We know that most of those 24 million people will be low-income.
We also know that groups of people who experience significant health care disparities, such as lesbian, gay, bisexual and transgender (LGBT) people, and Black and Latino people, will be among those who risk losing the most if the ACA is repealed. To that list, we must add survivors of sexual violence.
Before passage of the ACA in 2010, sexual assault survivors who had sought medical care for their injuries could be denied health insurance coverage at a later date. The reason? Health insurers often categorized rape as a pre-existing health condition.
In one widely reported case, a 45-year-old woman met two men at a bar in Florida who bought her a drink. Hours later, she found herself lying by the side of the road with injuries indicating that she had been raped and that the men had spiked her drink. Her doctor prescribed a treatment of anti-viral, post-HIV exposure drugs to protect against HIV transmission.
When the woman lost her health insurance several months after the attack, she was unable to obtain new insurance due to the health care treatment she had received for the assault. She went without health insurance for three years.
Stories like these prompted the National Women’s Law Center to launch a campaign called “Being a Woman Is Not a Pre-Existing Condition.” It was so popular that then-House Speaker Nancy Pelosi adopted the phrase in her pro-health reform talking points with media, and the New York Times ran an explainer on the ways in which health insurers treated women as if they were just one giant pre-existing condition.
The AHCA initially retained the ACA’s ban on discrimination against people with pre-existing conditions. But an amendment to the AHCA bill offered last week by New Jersey Congressman Tom MacArthur and North Carolina Congressman Mark Meadows would make it easier for health insurers to deny coverage to people with pre-existing conditions.
By letting states waive the ACA prohibition on charging people with pre-existing health conditions higher premiums, protections for those who’ve previously been medically treated for sexual assault would be gutted.
Perhaps more alarming, though, is the MacArthur-Meadows amendment’s provision allowing states to also seek waivers from the ACA’s requirement that essential health benefits be covered by health insurance plans. Essential health benefits include preventive health care services that most of us take for granted. These include tests for blood pressure and cholesterol, mammograms, and vaccinations. Essential health benefits also include coverage for mental health care and substance abuse treatment.
Sexual violence survivors face acute treatment needs in the aftermath of an assault such as care for gynecological injuries, other physical trauma, sexually-transmitted diseases, and pregnancy. But sexual violence takes many forms: incest, ongoing sexual abuse outside of the family, sexual assault, sexual harassment or exploitation, and rape. Each of these types of assault puts the survivor at risk for various potential negative physical health and mental health outcomes.
For example, an adult survivor of childhood sexual abuse is at a higher risk for psychiatric disorders. Women and men who have survived rape as adults are at higher risk of post-traumatic stress disorder, depression, anxiety, and substance abuse — any of which can significantly interfere with daily living. No one can deny that there is a direct line between having survived sexual violence, and an increased risk of physical and mental health problems.
The mental health impacts of sexual violence are deep and often longstanding. Survivors need long-term access to nonjudgmental health and mental health services to reduce their suffering and mitigate as much as possible the stress that recovery from sexual violence puts on intimate family relationships, and obligations related to school and work.
It is hard to see any good coming from this latest attempt to repeal the ACA and all of the care it has brought to survivors of sexual violence.
Gina Scaramella is the executive director of the Boston Area Rape Crisis Center, the largest such center in New England.
The views of contributors are their own and are not the views of The Hill.