Planned Parenthood Analysis of Graham-Cassidy Impact on Women’s Health

Sept. 19, 2017 – The Graham-Cassidy bill, crafted by a group of all-male politicians behind closed doors, has been denounced by Planned Parenthood and by a number of other health care groups, including the American Medical Association, American Cancer Society Cancer Action Network, the American Heart Association, and the March of Dimes.

And it’s no surprise. In addition to the dangerous policies we’ve seen in previous versions of Obamacare repeal (including blocking people from accessing preventive care at Planned Parenthood, ending nationwide protections for maternity coverage, and imposing a nationwide ban on private insurance coverage for abortion), the Graham-Cassidy-Heller bill goes much further than any other piece of legislation we’ve seen. The bill restructures the Medicaid program in a way that would eliminate health care coverage for millions of people — affecting women and children the most. Thirteen million women stand to lose their maternity care. Those who don’t lose their insurance will end up paying more in monthly premiums and out-of-pocket costs for less coverage. In fact, per Fitch Rating Agency, “the bill’s repeal of certain provisions of the Affordable Care Act (ACA) are more disruptive for most states than prior Republican efforts.”

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This bill doesn’t fix what’s broken. Instead, it entirely does away with the health care system millions of people rely on. The legislation is built like a time bomb — every year, it will bring more bad news for women.

Simply put, this bill would mean Americans pay more and get less, and women would pay the biggest price of all.

Let’s look at the specifics of the bill, and why the Graham-Cassidy-Heller bill is so bad:

1) BLOCKING CARE AT PLANNED PARENTHOOD. Many Medicaid patients already have limited options for care such as birth control, cancer screenings, and regular checkups. Preventing them from coming to Planned Parenthood would leave many with nowhere to go for basic reproductive health care. The American Medical Association (AMA) said that parts of the bill that block access to care at Planned Parenthood health centers violate longstanding AMA policy on patients’ freedom to choose their providers and physicians’ freedom to practice in the setting of their choice.

  • One in five women in America have relied on Planned Parenthood in her lifetime. More than half of Planned Parenthood’s patients rely on Medicaid for care, and 56 percent of Planned Parenthood’s health centers are in rural or otherwise medically underserved areas.
  • Under this bill, all Medicaid patients would be prohibited from coming to Planned Parenthood health centers for care — leaving many women with nowhere to go for basic care such as cancer screenings, birth control, STD treatment, and more. We’ve seen what happens at the state level when policies like this are put in place, and they’re devastating.

2) ENDING MEDICAID AS WE KNOW IT. Millions of women will lose access to health insurance altogether because of the deep cuts to the Medicaid program affecting one in five women of reproductive age.

  • Medicaid is the largest insurance program for women in this country. Women are the majority of Medicaid enrollees; in fact, two-thirds of adults with Medicaid coverage are women. Due to discriminatory systemic barriers, women of color disproportionately comprise the Medicaid population, with 30 percent of Black women and 24 percent of Hispanic women enrolled in Medicaid, compared to 14 percent of white women.
  • The Graham-Cassidy-Heller bill will completely eviscerate Medicaid, and drastically reduce the amount of funding that goes toward the program. The Medicaid cuts come in three devastating phases:
    • Stopping Medicaid Expansion: Starting this month (September 2017), Medicaid expansion will be stopped in its tracks — states will no longer be able to expand coverage to people who need it. States that expanded Medicaid cut the rate of uninsured women of reproductive age nearly in half between 2013 and 2015, meaning an end to this program would take women backward.
    • Slash the Medicaid Program: Starting in 2020, all Medicaid funding will be cut drastically. In its place, the Graham-Cassidy-Heller bill would provide small, temporary pots of money for states to use for health coverage and other health care purposes. These pots of money would be fixed amounts, which means that funding would not adjust for the higher costs states will invariably face due to things like enrollment increases as a result of a recession, or higher costs due to public health emergencies (like Zika) or natural disasters. States would be forced to either dramatically increase their own spending or to deny healthcare coverage to people who are struggling to get by.
    • Revoke Expanded Medicaid Coverage: By the end of 2026, Medicaid expansion will be completely shut down. The 11 million people who gained Medicaid coverage under the ACA would effectively be forced off of health coverage. For instance, before the ACA, a woman living in Ohio with HIV may not have qualified for Medicaid until she became sick enough to be considered disabled. The Medicaid expansion eliminated the requirements for low-income people to fit into certain categories, but under the Graham-Cassidy-Heller proposal, this woman would lose her coverage.

3) FORCING WOMEN TO CHOOSE BETWEEN BEING WITH THEIR NEWBORN OR KEEPING THEIR INSURANCE. This cruel provision could force women back to work only 60 days after having a baby, or else they lose their health insurance.

  • For women who are actually able to keep their Medicaid coverage, starting just next month (October 2017), mothers of newborns may be forced to find a job within 60 days of giving birth or lose their health insurance.

4) WOMEN WILL PAY MORE FOR LESS. Under this bill, women will lose critical nationwide coverage protections for maternity coverage, prescription drug coverage, and mental health services. Whether a woman has coverage for this services will depend on what state she lives in. And no matter where she lives, the cost of insurance will increase.

  • Maternity coverage could be gone for millions. States can immediately seek to waive nationwide protections for maternity care, prescription drug benefits, and mental health care.
    • Before the Affordable Care Act, millions of women didn’t have insurance coverage for maternity care or other basic care. This bill again puts the maternity coverage of approximately 13 million women at risk. Without insurance, a vaginal birth can cost $30,000 and a C-section can cost $50,000 in out-of-pocket expenses.
  • Increasing the Cost of Private Insurance. In addition to kicking millions of women off of Medicaid, the bill simultaneously makes it harder to afford private insurance. Beginning in 2020, the bill completely eliminates ACA tax credits to help people afford private insurance.
  • Increased costs. Under the ACA, even as premiums have risen, enrollees were insulated from the rising costs. For instance, in 2016 and 2017, enrollees eligible for tax credits on average saw only a $1 to a $4 per month increase in monthly premiums. Eighty-five percent of people purchasing coverage on the marketplace receive a tax credit to purchase insurance. These millions of people would no longer be insulated from rising costs because the tax credits would be repealed. Studies show that women are more likely than men to forgo care because of cost.
    • The increased costs of care would disproportionately impact women, particularly women of color, given the inequities in earnings for women. This is particularly true for the 15 million households — disproportionately led by Black and Latina women — where women are the head of households. People of color — even those who are insured — already report less confidence in being able to afford care.
  • Women with pre-existing conditions, which includes pregnancy, will be charged more. Insurers get to unilaterally decide what is considered a pre-existing condition and thus, who they can charge more for coverage. Before the ACA, people who had a baby, a C-section, breast cancer, or even an eating disorder, anxiety, depression, or substance abuse were deemed to have a pre-existing condition. Sixty-five million women were considered to have a pre-existing condition.
    • While women can not be denied coverage based on pre-existing conditions, insurance companies will once again be permitted to charge them more for health care coverage. For many, the Cassidy-Graham-Heller proposal could mean that your health insurance isn’t just more expensive, it’s completely out of reach. Insurance companies could charge patients $28,660 more for having breast cancer, and $142,650 more for cancer that has metastasized. Just giving birth would allow insurers to charge a woman an additional $17,320 per year (compared to a similarly situated person who has not given birth), and it’s important to remember: four out of five women will give birth in her lifetime.
    • People with serious illnesses will again face barriers to insurance coverage, life-saving treatments and care. For instance, people living with HIV have historically experienced barriers to accessing care in part due to discrimination by insurance companies who refused to cover them or their care, and today, the majority of people living with HIV do not have their HIV under control with treatment. The bill would mean that once again people living with HIV could be priced out of care. African-American and trans women are the women most likely to have HIV and would be the most impacted by exorbitant premium costs.
    • Black and Latina women face higher rates of many chronic illnesses, meaning these exorbitant costs will hurt the health and financial security of women of color the most. For instance, Black women are the group of people most likely to die from breast cancer. The ability to charge people more based on pre-existing conditions would permit insurers to charge a breast cancer survivor $28,660 more annually for insurance coverage. Without healthcare coverage, racial disparities in breast cancer rates could persist or even widen.

5) IMPOSING A NATIONAL BAN ON PRIVATE INSURANCE COVERAGE FOR ABORTION. The Graham-Cassidy-Heller bill will force private insurance plans to drop coverage of abortion almost immediately. In 2018, tax credits cannot be used to pay for a plan that include abortion coverage outside of the instance of rape, incest, or life endangerment.

  • For the two-year period in which tax credits are still available to purchase health insurance coverage (the credits will be repealed in 2020), individuals will be prohibited from using their financial help to purchase a plan that covers abortion. At least 870,000 women will lose access to ACA marketplace insurance plans that cover abortion.

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