Friday Femorandum: Meet the New Trumpcare, Same As the Old Trumpcare

The big news this week was the US Senate’s latest tax cuts for the wealthy health care “reform” bill, which in addition to eliminating coverage for millions of poor Americans who get their health care through Medicaid and setting up a death spiral for the individual market will once again make being a woman a preexisting condition, effectively end private coverage for abortion care, and defund Planned Parenthood. Here are some details from the “Better Care Reconciliation Act”—drafted in secret by 13 Republican men—that are especially concerning for women and for anyone who benefits from access to reproductive health care (that is, everyone).

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Vox focuses on the BCRA’s elimination of the “essential health benefits” mandate, which required insurance companies to cover ten basic health care services, including mental health and maternity care. (Under the bill, governors in conservative states will be able to opt out of the essential health benefits requirement by virtual fiat, with no consultation with their legislatures). “f the Better Care Act passes, it could mean we could turn back to a time before the Affordable Care Act, when some 88 percent of plans on the individual market did not provide maternity coverage,” Vox reports.

The bill would also defund Planned Parenthood for one year by barring Medicaid recipients from using Planned Parenthood clinics. Given that half of Planned Parenthood’s patients use Medicaid, the one-year cut would represent a devastating blow both to the clinic network and to women on Medicaid who use the clinics for basic health care, including birth control and cancer screenings.

The New York Times reports that despite a tidal wave of individual contributions in the wake of the Trump election, Planned Parenthood’s funding falls far short of what it would need to serve the millions of Medicaid clients who come through its doors every year. “those new funds do not come close to compensating for the money that the bill would strip away. The national office and affiliates of Planned Parenthood together rely on reimbursements and grants from the government for more than 41 percent of their total $1.35 billion in revenue, according to the group’s latest annual report.

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Dame Magazine points out another way in which the Republican health-care repeal bill is particularly cruel to women. By allowing states to seek waivers from the requirement that insurers can’t deny access to health care because of preexisting conditions, the bill could make it impossible for women who report their rapes to get health care coverage. Or, conversely, it could create a perverse incentive for women not to report their rapes, for fear of losing coverage in the future:

When women report an assault, people often ask, “Why didn’t she report it?” and inquire what the victim was wearing or why she was in that place at that time. Those questions are just one aspect of blaming victims of sexual assault that frequently discourages people from reporting attacks.

The consequences of sexual assault qualifying as a preexisting condition will be widespread:

According to Rape, Abuse & Incest National Network, an American is raped every 98 seconds. One out of every six American women has been the victim of an attempted or completed rape in her lifetime. And those are the assaults on the record; many go unreported.

“People ask, ‘Why didn’t she report it sooner? Why was she doing this? Why did this happen?’” Jessica [who reported her rape] said. “So she gets punished for doing that. And then I’d be punished for doing what they ask people to do. The fact that I saw a therapist to try and get better shouldn’t penalize me if I have to go see a therapist again.”

Vox explains how allowing insurance companies to discriminate against people with preexisting conditions will mean financial ruin for many Americans, by creating a “death spiral in the health care system. Basically, by allowing states to opt out of requiring coverage for preexisting conditions, and by allowing insurers to offer bare-bones coverage that doesn’t include essential health benefits, the Senate bill sets up a two-tiered system in which healthy people with no preexisting conditions buy the cheaper, minimal insurance and everybody else is stuck buying the more expensive, more comprehensive kind. As more and more healthy people leave the comprehensive insurance market, that market will fill up with older, sicker people, driving up costs so far that none but the wealthiest can afford decent insurance.

Consider, for example, a family with a spouse or parent with cancer whose drug treatment costs thousands of dollars for their drugs. They think they have a victory in that under the Senate plan, their insurance company can’t explicitly charge them more because of their family member with a pre-existing condition. But, unfortunately for them, they find that they live in a state that allows insurers to offer plans that don’t cover prescription-drug costs. This family will face nothing but bad choices.

Because the skinny, incomplete plans are a non-starter for them, they can’t take the cheap option. But everyone who’s young or healthy does. The only people choosing the alternative, signing up for a plan that actually meets their needs, are those with serious conditions. This will further drive up the costs of these plans—the only plans that actually cover the treatment that seriously sick people need—and will further drive the young and the healthy away.

And of course, the bill takes direct aim at abortion services, by effectively “prohibit[ing] any health insurance plan, private or public, from covering abortion care,” Rewire reports.

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“The abortion restrictions in the House-passed AHCA mirror the ACA’s failed Stupak-Pitts Amendment, according to Guttmacher Institute Senior Policy Manager Adam Sonfield, who spoke with Rewire in the lead-up to Thursday’s reveal in the Senate. Senate Republicans also appear to rely on the Stupak-Pitts model,” Rewire reports.

“For the uninitiated, then-Reps. Bart Stupak (D-MI) and Joe Pitts (R-PA) in 2009 played into the GOP myth that taxpayer money is fungible. Their amendment sought to bar the ACA’s tax credits from subsidizing any health insurance plan that covers abortion, not just abortion care itself in compliance with longstanding federal policy. The amendment passed the House with the help of 64 Democrats,” but failed in the Senate, which passed the slightly less-restrictive [Ben] Nelson Amendment instead.

Bottom line: Republicans are going beyond banning direct federal funding for abortion, and are trying to stop all health insurers from covering abortions—a lack of coverage that will disproportionately impact low-income women.

The expanded abortion funding ban originated with the far-right Republican Study Committee in the House, which wrote that they would not support any health care bill that did not include cuts to Planned Parenthood and restrictions on federal support for plans that cover abortion. “The bill, they wrote, fulfills ‘an important conservative commitment to promote life and protect the unborn,'” the New York Times reports.



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