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Why the ‘Skinny Repeal’ Would Have Been ‘Awful’ for Women’s Health

In the early hours of Friday morning, the Senate failed to pass a bill to repeal the Affordable Care Act (ACA). This “skinny” version of a full repeal of Obamacare was going to be a controversial “first-step” that, if passed, would lead to what Republican leaders say will be a better plan in a House-Senate conference committee,

Titled the Health Care Freedom Act, this legislation would have removed the mandate that all individuals buy health insurance or face a penalty, repeal the employer insurance mandate for eight years, defund Planned Parenthood for one year while allocating more money to community health centers, and increase the amount of money people can save yearly in tax-free health savings accounts. It would have also allowed states to loosen some Obama-era regulations over the types of insurance they can sell.

While this version of the ACA repeal was lighter than some of the previous iterations attempted by Congressional Republicans, it’s still “awful for women,” Jamila Taylor, PhD, a Senior Fellow at the progressive Center for American Progress (CAP) and an expert on women’s health policy, told Yahoo Beauty.

The Congressional Budget Office (CBO) has estimated that the bill would have result in an increase in premiums by 20 percent and also result in the loss of healthcare to 16 million more Americans next year — and Taylor said that “a huge portion of these people are women losing access to healthcare.”

Here’s what key repealed provisions in the proposed bill would have meant for women’s health:

Individual and Employer Mandate Repeal 

By doing away with the mandate for all individuals to be insured or face a penalty fee and waiving requirements for employers to insure their employees, the skinny repeal effectively made the risk pools of those insured smaller. Experts expect younger and healthier people to leave the exchanges, increasing prices for those who may need it more. Taylor said the new bill will especially affect those “with pre-existing conditions like pregnancy or breast cancer.”

Furthermore, Taylor said, an analysis done by CAP found that the skinny bill would discourage insurance companies from participating in the individual marketplace, which in turn would result in an average increase of $1238 per year to insurance premiums next year.

“Any situation where people have to come out of pocket more to cover their healthcare costs is going to be harmful, and especially to low-income women and women of color,” said Taylor.

The destabilization of the individual marketplace caused by the skinny bill could have created a dynamic wherein women would have to choose between paying more to keep the comprehensive coverage they held under the ACA or switch to a bare-bones plan that will give them extra cash for the items needed to support day-to-day family life.

“Of course women, being the people we are, we are always going to choose our families first,” Taylor said. “If we have to choose between keeping ourselves healthy by having comprehensive health care coverage that may be more costly than that we were putting out of pocket before and the costs associated with taking care of our families, we’re going to choose things for our families. This is especially pertinent for moms and caregivers.”

One-Year Defunding of Planned Parenthood

The “defunding” of Planned Parenthood — that is, barring Planned Parenthood from being a participating provider in both the Medicaid and Title X programs and from being reimbursed by the government for services rendered under those programs — would have created a one-two punch.

With higher costs coupled with a lack of insurance coverage, people would have become more likely to become reliant on Planned Parenthood, which already serves over 2.4 million Americans at 650 affiliate health centers each year, providing basic preventive health care services including Pap smears, cancer screenings, contraceptive counseling and comprehensive annual exams.

In the 238 of the 415 U.S. counties with a Planned Parenthood health center in 2015, Planned Parenthood served at least half of the women obtaining publicly supported contraceptive services from a safety-net health center. One-quarter of all women in need of publicly funded contraceptive services live in these 238 counties.

An editorial published by the Washington Post on July 12 made clear just why defunding Planned Parenthood would prove catastrophic for women’s health. The move, they say, is nothing more than “magical thinking” that, in reality, would result in “millions of women [losing] access to critical health care.”

More Money for Community Health Centers

The bill would have injected $422 million into community health centers — which care for 25 million low-income patients at more than 1,400 centers — for 2017, according to CNN.  But health advocates argue that giving more money to these centers will not account for the loss of Planned Parenthood’s targets sexual and reproductive health care services.

The January 2017 Guttmacher report shows that Planned Parenthood health centers facilitate women’s timely access to a wide range of contraceptive methods more so than community health centers, while also serving a much higher volume of contraceptive clients.

Continued Threats to Medicaid

If the bill had left the Senate, it would have gone to conference, where the terms of a final bill to be voted on by the House would have be determined by negotiations with members of the lower chamber. So while the skinny bill may not have all of the components of some of the previous, headline-grabbing versions of the health care bills, provisions that affect women could still have been tacked back in.

These include cuts to Medicaid, barring Planned Parenthood from the Medicaid program, and eliminating key women’s health needs such as contraception coverage, access to maternity care, and mental health coverage.

“Medicaid is still at risk for being decimated,” said Taylor. “We need to continue to talk about that issue because it’s not going away.”

And any changes to the Medicaid program will disproportionately affect women, as the majority of Medicaid enrollees — 53 percent — are women.

“Medicaid has been so instrumental in ensuring access to family planning and maternity care” for black and Hispanic women, Taylor said. And with Medicaid paying for 75 percent of all publicly financed family planning services as well as ensuring coverage for pre- and post-natal care for mothers, black and Hispanic women who already face worse maternal health outcomes in the U.S. stand to be hit even harder should any cuts to the program be made.

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