Earlier today, Wendy Patton of Policy Matters Ohio joined Innovation Ohio, Ohio Women's Public Policy Network, Planned Parenthood Advocates of Ohio and For Ohio's Future for a press conference on how the AHCA would harm women's health. Patton drew her remarks from the following statement. View the press conference here.

By helping low-income people purchase insurance and those living in or near poverty to access health care through Medicaid, The Affordable Care Act (ACA) has been a remarkable demonstration of what public policy can do for public health and the well-being of Americans. The protections it offers to women prevent inequity in insurance coverage and assure that health care coverage includes essentials like preventative care, contraception and maternity benefits.

The recently-passed House health care plan (“American Health Care Act” or AHCA) rolls this back. It would have devastating consequences for the nearly 40 million women across the country who rely on Medicaid.[1]

As the debate shifts to the Senate, policymakers should reject any health bill that causes people to lose coverage, caps or cuts Medicaid, ends the Medicaid expansion, or takes away critical protections. Failing to meet these standards would harm millions of women and their families.

The House-passed bill, which President Trump supports, would slash Medicaid by more than $800 billion over 10 years by effectively eliminating the Affordable Care Act’s expansion of Medicaid to low-income adults and imposing a “per capita cap” on the program. 

Women would bear a disproportionate impact of these cuts, not only because they are the majority of Medicaid beneficiaries, but they are also the primary utilizers of family planning and maternity care benefits. They are also much more likely to use Medicaid’s long-term services.

Medicaid provides health care for nearly half of all pregnant women, supporting them through their pregnancies and ensuring that their babies have a healthy start. In fact, Medicaid financed 52 percent of births in Ohio in 2014.[2]

In addition, the Affordable Care Act’s Medicaid expansion covered many women without children, and offered continuous coverage to new mothers who had qualified while pregnant but would not have qualified after their pregnancy. Ending the expansion would take these benefits away for millions.

Eliminating the ACA’s Medicaid expansion would jeopardize coverage for more than 300,000 women in Ohio who gained coverage as a result of the expansion. 

The House-passed bill also includes several provisions that are especially harmful to women with private insurance. It would allow states to opt out of the ACA’s Essential Health Benefits standard, effectively allowing insurers to charge women much more than men by leaving many women without affordable access — or any access — to maternity coverage.[3]

It would give states the option of allowing insurers to charge far higher premiums to people who are pregnant, have had a C-section, or were treated for injuries resulting from domestic violence.

The House health plan undermines health care services to women in the following ways:

Changes to essential benefits – Under the Affordable Care Act, insurance plans were required to cover the following essential benefits: Ambulatory care (outpatient services), emergency care, hospitalization (inpatient services), maternity and newborn care, mental health, preventative care and chronic disease management, rehabilitation and habilitation services, laboratory services, prescription drugs and dental and vision services for children. Insurance would not be required to cover these services under the House health plan. States would define what services, if any, are mandatory to cover.

Changes to women’s health care: One of those essential services is maternity and newborn care. Prior to the ACA, 62 percent of plans on the individual market did not include these services. Maternity care coverage cost extra. Now, we may expect to see women paying more for this basic health care need if they are of childbearing age depending upon what state they live in.

The House plan would eliminate Medicaid funding for Planned Parenthood, which serves 2.5 million annually.[4]  Eighty percent of its clients have incomes of 150 percent of poverty or lower.  Eighty percent of clients use services to prevent an unplanned pregnancy. This institution has served women and families for 100 years. One in five American women have visited a Planned Parenthood clinic.[5]

The House health plan defunds Planned Parenthood by denying use of Medicaid funds to pay a health provider that provides abortion service, as a part of women’s health care. This service comprises just 3 percent of Planned Parenthood services and is not funded with government dollars. Under the House plan, Planned Parenthood loses 30 percent of funding if it does not stop providing abortion services.[6]  

The House plan places expanded restrictions on abortion coverage for both public and private insurance plans which could potentially dismantle insurance coverage for abortion.

Women would no longer be able to use tax credits to purchase insurance for plans that cover abortion, with exceptions for rape, incest, or life of the pregnant woman.

The loss of tax credits to afford policies covering abortion would make them too expensive for many individuals and businesses.

This cost-prohibitive provision would then drastically shrink women’s access to abortion coverage, and could lead to insurance providers dropping abortion coverage from their plans.

It would cause women to have to either buy an unsubsidized, far more expensive plan or purchase a separate “rider” on their healthcare plan for abortion coverage.

 Changes to community ratings: In the most basic sense, community rating means insurers cannot charge people different premiums except for adjustments based on age and cost-of-living adjustments in different locations. The ACA prohibited insurers from charging people higher premiums for coverage based on their health, a practice referred to as “medical underwriting.” The House health plan allows states to waive rules prohibiting disparate treatment of pre-existing conditions. There are two stipulations:

First, states could waive community rating only if they had a program in place for people with pre-existing conditions. These include high-risk pools, subsidies and a program to reimburse insurers for sicker patients. Similar mechanisms that existed before the Affordable Care Act covered few people and were underfunded, The New York Times reported. Further, under the house plan, the bar for participation is low – it requires taking advantage of the modest funding for risk stabilization, but without definition of that participation.[7]

Second, people who have maintained continuous health coverage are not to be subjected to disparate treatment. However, many people with pre-existing conditions experience a gap in coverage over a two-year period due to job changes, other life transitions, or periods of financial difficulty. [8]

Changes to the Medicaid program: Medicaid is crucial to maternal and child health care in the United States, supporting more than half of the births in Ohio. 

Research shows Medicaid can reduce infant mortality for women who face high risk. Infant mortality decreases for young pregnant women enrolled in Medicaid because prenatal care tends to start earlier.[9]

Family planning services reduce infant mortality by helping women plan for pregnancy and space births properly.

Treatment for breast and cervical cancer improves maternal health by addressing the two most common forms of cancer in women. Cervical cancer can leave the cervix weakened, causing premature birth. 

These three measures, taken together, are considered important health interventions for developing nations. Ohio has Third World levels of infant mortality in some neighborhoods, so employing strategies used in developing nations makes sense.[10] However, the House health bill eliminates the Medicaid expansion.  It freezes enrollment in 2020, and allows no new entrants. The Medicaid population is not static: it serves the working poor, which means that people enter the program when they lose a job and leave as income rises. Because it serves as a safety net to a changing population, the freeze will rather quickly end the expansion.

This would cause great harm in Ohio. The 2009 task force report on Ohio’s high infant mortality rate highlighted the relationship between the health of mothers and the health of babies: “Infant deaths are at the heart of our inadequate health care system. Why should any infant die because their mother had no health insurance before she became pregnant, had little access to treat anemia, depression, asthma, diabetes or hypertension, or to safely space her last pregnancy? Infant deaths are preventable if we realign our priorities and our financial incentives.”[11]

The House health bill not only ends the Medicaid expansion, but it breaks the flexible financial partnership between state and local government in providing health coverage through Medicaid. It would change from a mandatory program based on eligibility to a block grant or per-capita cap program, designed to dwindle – like the TANF program – over time.[12]  As funds become tight in states like Ohio, with an aging population, state lawmakers will be forced to cut eligibility and benefits. In Ohio, two-thirds of elders in poverty are women; seven of 10 in Medicaid-supported nursing home or community based services are women nationally.[13]  The need for and cost of care for elderly and disabled people is higher than for others. State lawmakers may seek to more aggressively curtail coverage for the most expensive groups.

As the debate shifts to the Senate, policymakers should reject any health bill that causes people to lose coverage, caps or cuts Medicaid, ends the Medicaid expansion, or takes away critical protections. Failing to meet these standards would harm millions of women and their families. 

Contact: Wendy Patto, 614.221.4505

1] Hannah Katch, Jessica Schubel and Matt Broaddus, “Medicaid Works for Women — But Proposed Cuts Would Have Harsh, Disproportionate Impact,” Center on Budget and Policy Priorities, May 11, 2017.   [2] Kaiser Family Foundation Medicaid Budget Survey at http://kaiserf.am/2r3zlnQ  [3] Ohio Medicaid Group VIII Assessment at http://medicaid.ohio.gov/portals/0/resources/reports/annual/group-viii-assessment.pdf   [4] CNN, “Planned Parenthood by the Numbers,” at http://www.cnn.com/2015/08/04/health/planned-parenthood-by-the-numbers/   [5] Clare Coleman, “Five Myths about Planned Parenthood,” The Washington Post, April 5, 2011 athttps://www.washingtonpost.com/opinions/five-myths-about-planned-parenthood/2011/04/14/AFogj1iD_story.html?utm_term=.a3982717728a   [6] Paige Winfield Cunningham, “Planned Parenthood defunded for one year under GOP health bill,”The Washington Post, May 4, 2017 at https://www.washingtonpost.com/news/powerpost/wp/2017/05/04/planned-parenthood-defunded-for-one-year-under-gop-health-bill/?utm_term=.0861d5a068fe   [7] Linda Qiu, “Pre-Existing Conditions: Evaluating Competing Claims,” New York ITmes, May 3, 2017 at  https://www.nytimes.com/2017/05/03/us/politics/health-care-fact-check-preexisting-conditions.html?_r=0   [8]Id.   [9] Wendy Patton, “Cuts to Womens Helath Care could Cost Young Lives,” Policy Matters Ohio, May 2015 athttps://www.policymattersohio.org/press-room/2015/05/07/ohio-budget-proposals-could-worsen-infant-deaths-report-says   [10] Id.   [11] Id.   [12] Wendy Patton, House Plan to Repeal the ACA Would Hurt Ohio, Policy Matters Ohio, March 2017 athttps://www.policymattersohio.org/research-policy/pathways-out-of-poverty/basic-needs-unemployment-compensation/house-republican-plan-to-repeal-the-aca-will-hurt-ohio   [13] Klatch et.al., Op.Cit.