December 1, 2016 — Under the new administration, women could lose health insurance protections established under the Affordable Care Act (ACA) (PL 111-148) and face higher costs for care, Kaiser Health News/NPR's "Shots" reports (Andrews, "Shots," Kaiser Health News/NPR, 11/29).
President-elect Donald Trump during his campaign said he would repeal the ACA (Women's Health Policy Report, 11/14). Further, Rep. Tom Price (R-Ga.), Trump's pick for Health and Human Services secretary, has in the past introduced legislation to repeal the law.
Moreover, KHN/"Shots" reports that the new administration could circumvent ACA policies by choosing not to enforce them or by writing new rules.
Benefits at risk
An ACA repeal could compromise the guarantee of maternity care coverage on the individual insurance market, KHN/"Shots" reports.
Under the ACA, maternity care is classified as one of 10 essential health benefits, meaning it must be covered. Prior to the law's implementation, it was uncommon for individual plans to cover prenatal care and delivery. According to an analysis by the National Women's Law Center, only 13 percent of individual market plans available to a 30-year-old woman living in a state capital offered maternity care in 2009, the year before Congress passed the ACA. Without such coverage, women could face high costs for maternal care, KHN/"Shots" reports: A 2010 study found that payment for a vaginal birth totaled more than $18,000.
In addition, preventive health services for women could also be at risk under the new administration. The ACA requires preventive services recommended by the U.S. Preventive Services Task Force to be covered without copayments or deductibles. Such services include screening for breast and cervical cancer and testing for the BRCA 1 and BRCA 2 genetic mutations, which increase a woman's chance of developing breast cancer.
Further, coverage of preventive services endorsed by the Health Resources and Services Administration (HRSA), including contraceptive coverage, could be endangered without directly changing or repealing the ACA. In 2011, the then-Institute of Medicine proposed a list of eight preventive services that it said insurers should cover without cost sharing. HRSA later adopted the list, which also includes requirements to cover annual well-woman visits; breast feeding support, counseling and supplies; counseling and screening for sexually transmitted infections; counseling and screening for domestic violence; and gestational diabetes screening.
According to KHN/"Shots," repealing or revising the ACA also could allow insurers to again charge women higher rates than men. According to the National Women's Law Center, 60 percent of the best-selling individual plans in 2009 charged a 40-year-old nonsmoking woman more than her male counterpart, even in plans that did not cover maternity care. The ACA eliminated this disparity by barring insurers from charging women more than men for the same services.
Gretchen Borchelt, vice president for reproductive rights and health at the National Women's Law Center, said, "Our concern is going back to a world where insurance companies are writing their own rules again, and returning women to those bad old days in health care and losing all the progress we've made."
Separately, Dania Palanker, an assistant research professor at Georgetown University's Center on Health Insurance Reforms, expressed concerns about how the new administration could substantively cut back coverage without changing or repealing the ACA directly. "A lot of the pieces of the preventive services benefits that clarify and make the coverage real and strong have been through (federal officials') guidance, and there is fear that could be changed," she said ("Shots," Kaiser Health News/NPR, 11/29).