KY Policy Blog

Proposed Health Care Changes Would Hurt Kentucky’s Moms

By Dustin Pugel
May 12, 2017

Women, and mothers in particular, are especially at risk of losing access to healthcare if the American Health Care Act (AHCA) becomes law. While millions of Americans stand to lose coverage, the AHCA is especially harmful to mothers who rely on coverage offered and protected by the Affordable Care Act (ACA) for pregnancy, birth, family planning and other needs, as recently reported by the Center on Budget and Policy Priorities.

Medicaid works for mothers

One core part of the AHCA that has nothing to do with the ACA at all permanently cuts the original Medicaid program through a mechanism called a per-capita-cap. By slowly squeezing the federal dollars for the Medicaid program over time, a per-capita-cap would threaten coverage for the most vulnerable, including pregnant women and children, threatening groups of people covered by Medicaid for over 50 years. Nearly 55 percent of all Medicaid enrollees in Kentucky are women, and 44 percent of all births in Kentucky are paid for by Medicaid.

The AHCA’s effective elimination of the Medicaid expansion further reduces access for women who gained coverage when eligibility was extended through the ACA to Kentuckians at or below 138 percent of the federal poverty level, or $35,218 for a family of three. Low-income women who did not previously qualify for Medicaid have been able to get to the doctor thanks to the expansion — and most state Medicaid programs offer services like pap smears, contraceptives and sexually transmitted disease testing. Moreover, women and their newborn children are healthier when mothers are getting regular care for conditions like diabetes and hypertension prior to pregnancies, and between giving birth and getting pregnant again. Taking away Medicaid coverage for women who are eligible under the expansion would make pregnancy and infancy riskier.

Allowing states to waive insurer requirements would risk coverage for women and mothers

The version of the AHCA passed by the House would allow states to waive two important patient protections known as Essential Health Benefits (EHBs) and Community Rating. EHBs require that insurance policies include healthcare services that are critical to women, especially maternity care and mental health treatment; between 5 and 25 percent of women who are pregnant, post-partum and parenting have some type of depression, and between 40 and 60 percent of low-income mothers have depressive symptoms. If the AHCA becomes law, insurers could decide to not include those benefits as part of the plans they offer, or return to placing annual or lifetime caps on specific kinds of benefits.  This applies to coverage women receive through work, as well as to people who purchase insurance on the exchanges.

The option to waive Community Rating means insurers could go back to basing insurance premiums on health history or status such as cervical or breast cancer, having had a C-section and others. By one estimate, annual premiums in Kentucky for pregnant women could rise by $15,660 and premiums for people with major depression (including post-partum) could rise $7,680. In many of these cases, while insurers would not deny someone coverage based on a pre-existing condition, the premiums would be so prohibitively high that they would effectively shut these women out.

As lawmakers move forward with decisions about how to transform America’s healthcare system, it is critical to the health and wellbeing of millions of Kentucky women and their families that the vital care afforded them by the ACA is protected. To do otherwise would be a giant step back for the women of our commonwealth.

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