This week was a heart-wrenching week for many, myself included. I watched with baited breath as the procedural vote happened on the floor of the Senate, checking a livefeed at work as often as I could. I saw votes cast in real time. Then, the vote-a-rama. And, finally the so-called “skinny repeal”. As a political scientist, I’m currently baffled by the radical change in Washington taking place in terms of how rules are used. In reality, the actual change that is made or not made in the same – mostly status quo and slow as molasses. Still, this use of a somewhat rare thing on a policy issue rather than the budget or debt ceiling was odd. And, moreover, the health care of so many people hung in the balance -30 million or more with one option and 16 million with the “skinny” repeal.
While health the loss of insurance and essential benefits affects us all, women are more at risk than men if key parts of the Affordable Care Act are eliminated. Various versions of a “repeal” or “repeal and replace” have put women’s lives at risk and have risked the health of babies. In the end, policing women’s health care is, essentially another form of body policing. No other industrialized country (and many industrializing countries) puts women in such precarious situations (minus Ireland in the instance of abortion services).
Essential services and rights are guaranteed in America by the Affordable Care Act (known colloquially as Obamacare). There are a number of protections that specifically target women:
- Insurance must cover maternity and obstetric care. Before the ACA, plans provided by employers could simply exclude this coverage, leaving you insured for everything but one of the most expensive health events of your life (and your baby’s). The day a woman gives birth is potentially the most dangerous in her life. Being uninsured or underinsured during pregnancy has led women to choose homebirths with CPM’s or direct-entry midwives who do not possess any formal medical training. These sorts of homebirths are a concern for health outcomes. And, since women who are most at risk of being uninsured or underinsured are more at risk of complications from pregnancy, such as high blood pressure, this is potentially more dangerous. I’ve addressed this topic previously in support of Medicaid expansion.
- Medicaid expansion is providing important benefits to women. It’s not perfect but Medicaid helps women who are at a higher risk for developing complications receive excellent care. According to the Kaiser Family Foundation, about half of all births are covered by Medicaid. That is because pregnant women are considered to have a special condition that grants them Medicaid while, in states without Medicaid expansion, households without kids are ineligible for Medicaid (barring disability). Medicaid expansion in many states has provided more rights to pregnant women. Some states are more generous than others with expansions. Still, however expansion happens, it means more women have health care access, allowing them better, safer birth choices and prenatal care. Health outcomes in women on Medicaid and those on private insurance are not only very close but they are significantly better than health outcomes in uninsured women. In the end, this helps us all by keeping down the cost of care as it prevents more catastrophic health events for mother and baby. Likewise, babies benefit. Studies show that babies and children covered by Medicaid have much better health outcomes than uninsured children and that their outcomes are commensurate in many ways with children on private insurance.
- Breastfeeding rights, support, and pumps. Moms have more options than ever with feeding. Before the ACA, women were refused the right to breastfeed at work and now a large number of women are guaranteed the right for time and a space to pump. They also receive free breast pumps from private insurance care (and many women also receive these in states with Medicaid expansion). Lactation services are also covered by many plans.
- Coverage of essential women’s health services. Need a mammogram, pap, or yearly checkup? Done. Prior to the ACA, you most likely had to pay for all of this and your insurance company could simply refuse to cover any of it (see 1). Well-baby care is also required to be covered. My kid’s first year of appointments and all her vaccines are 100% covered. We have never been billed for any of it.
- Insurance companies may not discriminate against you as a woman by charging you more for care. This is a big deal. Prior to the ACA, insurance companies could legally charge women more than men.
- Unless your employer is religious-exempt, you have free access to contraception. My IUD was totally free. The first time, even with insurance, I paid $300.00 to have it. This was still cheaper than my pills (not covered by insurance on the plan I was under) had been. Contraception is shown to have huge impacts on teen pregnancy rates and helps women who are either not emotionally capable or financially capable of having a child at that time avoid pregnancy.
- While not part of the ACA, the attacks on health care have targeted women’s health providers (most notably planned parenthood). The skinny repeal was only 8 pages long (and as someone with a lot of work experience reviewing legislation, I can say that is really a short bill) but 1.5 pages of it were basically devoted to defunding any providers who provided abortion services. Federal funding cannot be used to fund abortions. Still, they want to do away with providers who give women this choice.