Health Care: The Issue Of The Year For Moms And Moms-To-Be
Americans tend to disagree about whether health care is a fundamental right, but a January 2017 poll from the Pew Research Center shows that the majority of Americans — 60 percent, in fact — believe that the government should be responsible for making sure that all Americans have health care coverage. Unfortunately, that news does not seem to have reached the ears of members of Congress, who have spent most of this year systematically trying to dismantle the Affordable Care Act, or ACA — and proving that they don’t care if they jeopardize millions of Americans’ access to care in the process.
Perhaps no issue divides — and unites — Americans the way health care does. Because while health care is an issue that may impact every individual and family differently, it touches us all in some way: Within our own What to Expect community of moms and moms-to-be, 31 percent receive their insurance through Medicaid, Healthcare.gov or the ACA exchanges. Then there’s Natalie Weaver, whose 8-year-old daughter Sophia has Rett Syndrome and relies on Medicaid for around-the-clock life-saving care. There’s 24-year-old Alicia Woods, who’s uninsured and pregnant with her second child and lives in Texas — which has the highest maternal mortality rate in the United States. It impacts babies — born with birth defects or born too early — who reach lifetime caps (common in insurance plans before the ACA made that practice illegal) within their first months of life. Health care is an issue that impacts all healthy people too — those (including children) who may be fine today but may be unexpectedly diagnosed with a costly illness tomorrow.
In a time when rural hospitals are closing maternity wards every day (urban areas are too) and the maternal death rate in the U.S. is increasing while it declines in every other developed country in the world, our elected officials treat health care reform as a partisan issue to be batted back and forth like a game of political volleyball, rather than the life-changing issue it is.
First, there was the American Health Care Act (AHCA), introduced this spring. The AHCA proposed huge cuts to Medicaid, which, according to the Congressional Budget Office, would have resulted in 23 million people losing their insurance. The AHCA passed the House, but not the Senate; however, the Senate unveiled its own answer to the AHCA in the form of the Better Care Reconciliation Act (BCRA). The Senate’s BCRA included even more severe cuts to Medicaid (to the tune of $800 billion), cut subsidies to low-income families, barred Planned Parenthood from receiving any federal funding for at least a year, would have resulted in an estimated 22 million people losing their coverage and was condemned by almost every major medical group in the country, including the American Congress of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP). Yet the GOP pushed forward — essentially against medical advice.
Both bills would have left tens of millions without the medical care they need. Both bills would have disproportionately impacted women and their families — especially families with small kids or children with special needs. Both bills could have seen the cost of vital pregnancy care, which is already expensive, increase astronomically by allowing states to opt out of mandating insurance companies to cover pregnancy, and to discriminate against women who had a previous complicated pregnancy or a c-section.
But both versions of the AHCA bills were, in fact, a step above the the Graham-Cassidy bill, a last-ditch effort to repeal the ACA in September. The New York Times called the Graham-Cassidy bill the “worst yet,” and the bill lived up to that auspicious title (though it didn’t pass): It would not have only gouged Medicaid’s budget, but it would have carved it up in the form of fixed "block grants." Proponents of block grants tout them as a way to give states more control and reduce waste and inefficiency. Opponents argue that the grants are inflexible, don’t allow states to respond to "real-world conditions” — such as natural disasters — and would force states to cut Medicaid benefits, limit enrollees, and raise premiums and co-pays.
Any cuts to Medicaid will have an outsized impact on a large number of Americans, many of whom are pregnant women or women who are considering getting pregnant (Medicaid covers around half of all births in the U.S.), the elderly (Medicaid also covers most of the 1.4 million people in nursing homes, according to the New York Times), children, and both children and adults with disabilities. Medicaid cuts would hit women of color, who are disproportionately low income, particularly hard.
The threats to affordable, accessible health care have continued all year: In early October, the Department of Health and Human Services rolled back the ACA’s contraception mandate, instead offering employers an exemption that would allow them to opt out of covering birth control on the "basis of sincerely held religious beliefs or moral convictions." That same week, Congress let the federal funding for the Children’s Health Insurance Program (CHIP) expire, putting 9 million children at risk for losing their insurance. And just two weeks ago, President Trump issued an executive order saying that his administration was going to stop paying the health care subsidies that help low-income Americans who purchased their insurance on the marketplace with their out-of-pocket health care expenses.
This is to say nothing of the changes the current administration has made to ACA’s open enrollment — cutting the promotional budget for the ACA by 90 percent, shortening open enrollment by six weeks (this year, you only have from November 1 to December 15 to enroll in a new plan) and slashing funding for “navigators,” or trained workers who help people enroll for coverage. All of this will just make it harder for people to get the care they need in 2018. And people are understandably worried about what these changes mean for them. In a recent survey of What to Expect community members, 67 percent who purchase their insurance either through Healthcare.gov or the individual ACA exchanges said they’re worried they could lose their coverage next year. 46 percent worry about the cost of their insurance, regardless of whether they’re insured through their employer or they purchase it privately.
Lastly, under the guise of overhauling the U.S. tax code, the GOP has proposed eliminating the medical expenses deduction (something that will disproportionately affect people with disabilities, the elderly, or those with lots of medical bills), the orphan drug tax credit (which encourages pharmaceutical companies to research potential cures for illnesses that don't necessarily have big markets), the adoption tax credit (which many middle-class families rely on to recoup some of the expenses of adopting a child). It's hard to see how eliminating those deductions are going to help most Americans afford to pay their bills, health care-related or otherwise. Oh — did we mention that the Senate's budget proposal in October included possibly cutting $1 trillion from Medicaid?
When then-president Obama officially signed the ACA into law in 2010, he said, "The bill I’m signing will set in motion reforms that generations of Americans have fought for and marched for and hungered to see…Today, we are affirming that essential truth, a truth every generation is called to rediscover for itself, that we are not a nation that scales back its aspirations." But Congress has spent the better part of this year scaling back on its aspirations of ensuring that every American has access to the health care he or she needs.
It doesn’t have to be this way. We can fix this any time we want. For months, President Trump has said that he and his administration will prioritize health care reform; that Congress is in the process of giving "America the great health care it deserves." If that’s the case, now’s their chance to stop their attacks on the current law and prove they actually take health care reform as seriously as they say they do. Millions of us — including the 16 million women in our own What to Expect family — are depending on it.
The health care of our moms, babies, children and families isn’t a political issue — it’s a fundamental human issue.
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