Tuesday, March 21, 2017

GOP Pushing Women Over the Cliff (Again)

Repealing the Affordable Care Act will hurt women far more than it will men
Women have lower incomes and greater health care needs and expenses than men have.

 The goal of the ACA  was to insure everyone -- either through Medicaid or through private health insurance using tax credits and subsidies for those with low income.  4 in 10 of those pregnancies ended in abortion.

Looking at Medicaid and Women
Before the ACA in most states low-income women could be covered by Medicaid only if they were pregnant or disabled, if they had kids younger than 18, or were over 65. If they didn't fall into these categories they weren't covered. Even mothers whose kids might qualify for Medicaid often couldn't get it for themselves.

The original idea was to require all states to have expanded Medicaid, a federally funded program that allowed coverage not only for kids, the disables, and pregnant women, but for nearly any adult whose income was 138% of the poverty level ($15,800 in 2017) or below. Above that level, subsidies and tax credits would allow people to purchase private health insurance on the exchange.

However, the Supreme Court pushed back against the requirement that all states should have expanded Medicaid.  As a result, 19 states rejected it, so the old Medicaid rules generally still hold in these states. Here, most adults, even single mothers, aren't insured unless their poverty levels are abysmal. On average in states that did not take expanded Medicaid, on average, she can't be covered by Medicaid until her income falls below 44% of the poverty level. (All kids are covered under a special program that no one is touching so far.*)  But it gets worse in specific states. 

Examples of Non-Expanded and Expanded Medicaid in Two States
Let's look at two states: one that takes funding for expanded Medicaid (New York) and one that does not (Texas), using an example of a single mother with two kids.

·      In Texas she wouldn't be covered unless her income is less than $230 a month – a whopping $2,760 a year. When her income pops above this exorbitant level, she isn't eligible for Medicaid or even subsidized health insurance on the exchanges until she hits the poverty level itself.  More than two and a half million people – half of whom are women -- have fallen through this crack.  Of those, 26% live in Texas.  At 21%, Texas has the highest rate of uninsured women in the country.

·      In New York State, which has expanded Medicaid, that mother will qualify for Medicaid if her monthly income is $2,349 or $28,180 annually.  If her income nudges above that level, she then becomes eligible for the tax credits and subsidies under the health exchange market place. In addition, a woman on Medicaid in New York gets a number of benefits that her counterpart in Texas doesn't, such as family planning services, including birth control, prenatal care, and psychiatric help.

The Health Exchanges and Women
If a single adult isn't eligible for Medicaid --  regardless of whether she's in an expanded state or not -- and her income falls below 400% of the federal poverty level ($47,550) she can qualify for tax credits on the health exchange marketplace. In a 2014 survey nearly all women in the health market place fell into this category. About three-quarters of women have income levels below 250% ($29,700), in which cases out of pocket costs may be limited or eliminated. 

Covered Benefits for Women

Under Medicaid.  Twenty-eight states have established programs that use Medicaid funds to cover the costs of family planning services, although not abortions, and most states have limited Medicaid programs to pay for breast and cervical cancer treatment for low-income women.

Under the Health Exchange Market Place.  Under the ACA, all private insurance plans must cover birth control without charging a co-pay.  This is a very popular program, with over 77% of women and 64% of men reporting support for no-cost contraceptive coverage. It has saved women $1.4 billon in out-of-pocket costs since its implementation. 

How the GOP Will Harm Women

The Impact of the GOP American Health Care Act.  Under the GOP bill within a few years no Medicaid plan would have to cover any of the benefits now funded under the ACA. The GOP bill would also defund Planned Parenthood specifically, whose health centers provide care to 2.5 million patients, many of whom are on Medicaid and many who live in areas that have no other source of preventive care. Finally, as introduced, AHCA includes no less than four abortion coverage restrictions that, combined, would effectively end coverage in the individual health insurance market and would undermine coverage in employer-sponsored insurance plans.

Impact of Tom Price's Regulatory Decisions.  As for the private plans, they have their hatchet man: Tom Price, our new secretary of Health and Human Services.  Without any Congressional action Price has the regulatory power to cut off coverage for essential benefits for people on private insurance plans, including maternity care and, of course, contraception. And Price has been quite open about his hostility to contraception. He’s received a zero rating from Planned Parenthood and a 100 percent rating from the National Right to Life Committee.
·      He voted against a law barring employers from firing women for using birth control or having an abortion.
·         He has voted to terminate a program that subsidizes contraception for low-income women. And he really hates the Affordable Care Act regulation that requires insurance plans to cover contraception without a co-pay.

He can get rid of this and other benefits by issuing a sweeping exemption” or he could “get rid of the requirements altogether. All he has to do is redefine "preventive care" and knock out reimbursement for any benefits he wants, including birth control.

Gender Rating. Price is also in favor of lifting the ACA ban on gender-based premium pricing, a pre-ACA common practice in the individual insurance market that allowed insurers to charge women higher premiums based on their gender. At that time women were paying $1 billion more annually for health insurance than men did.  Price said healthcare reform should allow states to choose if they want to charge women more for coverage.

The ACA isn't perfect.  It must be noted that although the rate of uninsured women dropped after the ACA from 17% to 11% by 2015, 11.2 million women under 65 still remained uninsured, mostly comprising low-income, immigrant, and minority women, and single mothers. There are still too many women not being covered and premiums and deductibles are still too high for too many.  But it's a path for women.  whereas( And ) the GOP plan is a cliff. And Tom Price, along with the rest of Republicans, would like to push a lot of women over it.

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