Sexual assault should never be considered a pre-existing condition

In the current American Health Care Act (AHCA) repeal proposal, which was passed by the House of Representatives last week, sexual assault could potentially be seen as a pre-existing condition. This means insurers could elect to deny coverage or charge much higher premiums to individuals who have been sexual assaulted at some point across their lifespan.

This is upsetting to me and I’d like to explain why. Sexual assault is pretty common in our country. While we could quibble over the exact definition, typically sexual assault is defined as any sort of sexual activity between two or more people in which one of those people is involved against his or her will. This can include, but is not limited to, unwanted touching, grabbing, oral sex, anal sex, sexual penetration with an object and/or sexual intercourse.

{mosads}It is estimated that one in four women and one in six men have experienced some form of sexual assault at some point in their life. I know. It sounds unbelievable. Jaw-dropping, in fact. But it’s highly likely these numbers are within the ballpark.


The statistics on how common sexual violence is comes primarily from two sources: (1) cases reported to law enforcement and (2) victimization surveys.

These sources give us a snapshot, but likely not the whole panorama of true prevalence. Why? Well for one, most of us don’t come forward and acknowledge to law enforcement that we’ve been attacked. In fact, less than one in six women report their rape experiences to the police. Also because of perceived stigma, shame and fears of people judging us, we don’t always indicate on surveys, even anonymous ones, our true sexual assault histories.

When trying to make the case that it’s terribly unfair, and in my mind, inhumane to make sexual assault history a pre-existing condition, let’s look at one example of sexual assault survivors — those who experienced child sexual abuse.

In a nationally representative sample of community-dwelling adults, 13.5 percent of women reported childhood sexual abuse. Even after researchers controlled for other childhood adversities (such as children’s experience of verbal or physical abuse, their parent’s mental health problems or substance abuse), childhood sexual abuse was associated with the subsequent onset of 14 mood, anxiety and substance use disorders among women.

What does this mean exactly? Well, childhood sexual abuse, whether experienced alone or in combination with other childhood adversities, was associated with substantial increased risk of serious psychopathology. And while likely translates to the need for more healthcare services for these women, it is ludicrous to think that they who have born this brunt should have to pay more or be excluded from insurance because of it. Haven’t they suffered enough?

Many of them already blame themselves for having such histories — they think they brought it on themselves, see their character as deeply flawed. Telling them they have to pay more or be denied insurance reduces empathy and engenders blame for crimes they did not commit.

As a psychologist who has conducted research and worked clinically with trauma survivors over the past 20 years, I have a message. For all the mothers, daughters and sisters out there who have experienced sexual assault, for all the fathers, sons and brothers, for all the family members and friends, for all current and former patients, know that this: This is not OK.

Know that you are not alone, that sexual assault is not your fault, and know that I feel your pain in this marginalization, betrayal and violation once again. I wish I had the power to protect you from this. I wish I could wrap my arms around you, lay your head on my shoulder and take your head, and tell you that everything is going to be OK.

But we don’t know that this is true. What I can promise you is that I will stand with you and we will find ways together to have our voices heard. 

Joan Cook is a psychologist and associate professor at Yale University who researches traumatic stress and clinically treats combat veterans, interpersonal violence survivors and people who escaped the former World Trade Center towers on 9/11.

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

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