BEYOND THE NUMBERS
Federal policymakers should consider a more practical gift than flowers or chocolate this Mother’s Day: they should support women’s health coverage by rejecting the House bill that repeals the Affordable Care Act (ACA) and cuts $839 billion from Medicaid, reducing enrollment by 14 million.
The American Health Care Act, which the House passed last week, deeply cuts Medicaid and effectively eliminates the ACA’s Medicaid expansion, while rolling back protections for women with private insurance. It would have devastating consequences for millions of women, including the nearly 40 million women who rely on Medicaid. Our new paper, with state-specific data, shows how Medicaid works for women and how the House bill would impair women’s coverage.
While the bill’s Medicaid changes would jeopardize care for all beneficiaries, they would disproportionately affect women — not only because a higher share of women than men rely on Medicaid, but also because of the specific services at risk. 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. It’s also the single largest payer of publicly funded family planning services, and it provides long-term services and supports to millions of older women and women with disabilities, which in many cases allow them to stay in their homes instead of an institution.
For women with Medicaid coverage, the House-passed bill would:
- Effectively eliminate the Medicaid expansion, which offers women continuous coverage before and after pregnancy. Pregnant women have historically been eligible for Medicaid at higher income levels than other adults but, before the Medicaid expansion, women often lost eligibility 60 days after childbirth. The Medicaid expansion allows states to give new mothers access to coverage before and between pregnancies and after childbirth.
- Cut and cap federal Medicaid funding for states, regardless of the cost of services they provide. Capped funding would jeopardize care for all Medicaid beneficiaries, particularly for groups and services that federal law doesn’t require states to cover. These include pregnant women with incomes above 138 percent of the poverty line ($16,643 for a single person or $28,180 for a family of three in 2017) and home- and community-based services that help women stay independent as they age or when they have a disability.
- Bar states from reimbursing Planned Parenthood for its prenatal care and family planning services for women with Medicaid coverage. Thousands of low-income women would lose access to care, and state and federal Medicaid costs for unplanned pregnancies would go up.
- Let states impose work requirements on Medicaid beneficiaries. Women make up almost two-thirds of the 11 million beneficiaries who risk losing coverage from a work requirement.
For women with private insurance, the House bill would:
- Let states opt out of the ACA’s essential health benefits standards, leaving many women without affordable access — or any access — to maternity coverage. Before the ACA, nearly two-thirds of people in the individual market had plans that lacked maternity coverage.
- Let states allow insurers to charge far higher premiums to women who are pregnant, have had a C-section or taken fertility drugs, have been treated for injuries from domestic violence, or have experienced other reproductive health problems.
The House bill would put health care out of reach for millions of women. It’s now with the Senate, which should use Mother’s Day to improve, rather than restrict, women’s access to essential care.