Why The New Senate Health Care Bill Is Bad For Moms And Families
UPDATE: Earlier this week, the Senate unveiled a second draft of its health care bill. While the new draft doesn't differ fundamentally from the original version of the BCRA, it does include an amendment championed by Senator Ted Cruz (R-Texas) that changes the bill in a few ways.
Here's how the Cruz Amendment (as it's being called) will impact the bill: Insurers would not be required to offer plans that are not compliant with the Affordable Care Act (AKA Obamacare) as long as they offer at least one compliant plan on their state exchange. This means that as long as they offer one insurance plan that includes essential benefits coverage — which includes maternity care, prescription drug coverage, and mental health services — on the state exchange, they can provide so-called "skinny" plans that do not include those services outside the exchange, which could impact people who buy their insurance through the individual market.
The second draft does earmark more money than the original bill for the opioid crisis and high-risk pools. However, the new draft does not make any changes to Medicaid, meaning that the cuts in the original bill (detailed below) would stay in place if this new version passes the Senate.
What You Need to Know About the Senate Health Care Bill
On Thursday, the Senate unveiled the Better Care Reconciliation Act (BCRA), its answer to the American Health Care Act (AHCA), which was passed by the House in May. Initially, Senate Republicans insisted that the BCRA would be a complete overhaul of the AHCA; however, the New York Times reports that the BCRA essentially maintains the structure of the AHCA and includes only "modest adjustments."
Here are five key aspects of the BCRA and what they mean for moms and families.
1. The bill includes huge cuts to Medicaid. The AHCA aimed to strip $880 billion from Medicaid over the next 10 years; the BCRA basically does the same thing. The Senate bill begins to phase out the Medicaid expansion in 2021, but it also puts the entire agency on a budget. What does that mean? It means that instead of an open-ended commitment from the federal government to fund Medicaid at any level necessary — which, until now, is how Medicaid has been run — each state will receive one lump sum of money per year or per enrollee.
Medicaid currently covers around half of all births in the U.S. as well as two-thirds of people in nursing homes, children, people with disabilities and those living at or near the poverty level. Make no mistake: These Medicaid cuts will have a huge detrimental impact on a large portion of the American population.
2. The cost of pregnancy could get a lot more expensive. Under the Affordable Care Act, insurers are required to provide certain key health care services — known as essential benefits — including prescription drug coverage and maternity and newborn care. Similarly to the AHCA, the BCRA will allow states to seek a waiver to get out of providing those essential benefits, and insurers won't be required to provide comparable plans or ensure that their plans cover as many people as they did previously.
If maternity, newborn and mental health care are no longer considered essential benefits, insurers can scale back on the kinds of services they provide, which will likely increase costs for new moms and families with complicated pregnancies, preterm births and sick babies, as well as for moms who experience postpartum depression, anxiety or mood disorders. This isn't necessarily to say that every state or individual insurance company will refuse to cover these essential benefits; however, depending on what state you live in and who you're insured by, it does mean maternity and newborn costs could increase significantly.
3. The bill strips federal funding for Planned Parenthood for a year. Like the House bill, the BCRA excludes Planned Parenthood (PP) — which is the nation's largest network provider of women's health care — from Medicaid for at least one year (75 percent of PP's federal funding comes from Medicaid).
Opponents of PP have long argued that the organization shouldn't receive any federal funding at all because it provides abortions. To be clear: The Hyde amendment already prohibits Planned Parenthood from using federal Medicaid funds for abortion. This will do nothing but cost the federal government money — in 2015, the CBO estimated that de-funding Planned Parenthood will actually cost the government $130 million over the next 10 years — and prevent thousands of people on Medicaid from being able to access Planned Parenthood for birth control, cancer screenings, pap smears and other important health services. It's also important to note that poor women in the U.S., who would be hit hardest by these cuts to Medicaid and Planned Parenthood, are disproportionately women of color.
4. It also cuts subsidies to low- and middle-income families on the individual market. Currently, people who earn less than 400 percent of the poverty line ($47,550 for individuals; $97,200 for a family of four) and purchase their own health insurance are eligible for certain subsidies. The BCRA would change that in a couple of ways: First, it will limit the people eligible for subsidies to those making up to 350 percent of the poverty line. According to Vox, this means that fewer middle-class people will be eligible for those subsidies.
Second, it will allow people below the poverty line to qualify for tax credits. Under the ACA, those people aren't eligible for subsidies, because they were expected to receive care through the Medicaid expansion; however, in 2012, the Supreme Court ruled that the Medicaid expansion was optional. People living in Texas, Florida, Alabama, Missouri and the 15 other states that opted out of the Medicaid expansions may get some financial help in the form of credits when they file their taxes, but not on monthly insurance costs or out-of-pocket health care costs.
5. The bill won't allow insurers to reject those with pre-existing conditions. However, as mentioned above, it does allow states to waive essential health benefits — so it will allow insurers to offer less comprehensive policies, meaning that it's possible people with pre-existing conditions won't have all their care or treatment covered.
What Happens Now
Multiple medical organizations have condemned the bill. The American Congress of Obstetricians and Gynecologists (ACOG) strongly urged legislators to reject the BCRA, with ACOG president Haywood Brown saying in a statement that the bill will "severely limit access to care and turn back the clock on women's health."
The American Academy of Pediatrics (AAP) went even further: "The bill fails children by dismantling the Medicaid program, capping its funding, ending its expansion and allowing its benefits to be scaled back," AAP president Fernando Stein wrote in a statement. "The bill fails all children by leaving more families uninsured, or without insurance they can afford or that meets their basic needs. This bill fails children living in or near poverty, children in foster care and children with complex health care needs whose parents have private insurance — all of these children depend on Medicaid, and if this bill passes, Medicaid will no longer be there for them."
And as Heidi Murkoff, author of What to Expect When You're Expecting, puts it, "Comprehensive, quality, affordable preconception, prenatal, postpartum, maternal mental health and newborn care for every mom and every baby is a fundamental human right. As members of the same human family — not as members of political teams in a political game — it’s up to us to fulfill that right, without exception."
According to the New York Times, Senate Majority leader Mitch McConnell wants to hold a vote before the Fourth of July recess, but it's likely the bill will change before then. It already faces opposition from Rand Paul and Ted Cruz, who both argue the bill doesn't go far enough in repealing the ACA, and it also faces opposition from senators Rob Portman (R-Ohio) and Shelley Moore Capito (R-West Virginia), who both pushed for more funding for the opioid crisis.
If it passes the Senate, it will go to the House and then to President Trump. In the meantime, be sure to familiarize yourself with the details of your family's health insurance and how your coverage might be affected by a new federal health care act, and contact your elected representative in the Senate about any concerns you might have. If and when new federal health care legislation is passed, you will need to have a clear understanding of what it will mean for your medical care and expenses.
How Will the Cost of Pregnancy Be Affected by the American Health Care Act?
What the New American Health Care Act Could Mean for Moms and Babies