On Thursday morning, the Senate released its version of a health care bill that aims to repeal and replace parts of the Affordable Care Act. Initial reports of the bill have focused on the fact that the bill has some "heart," and will likely attract some moderate Republican senators needed to pass the bill. But do not be fooled: the Republican health care bill will negatively affect pregnant women.
The bill does seem more forgiving than the version of the American Health Care Act that passed the House of Representatives in May, because it doesn't entirely get rid of protections for people with preexisting conditions, like the House's bill. But it slashes Medicaid, defunds Planned Parenthood, and most importantly, cuts the ACA's Essential Health Benefit protections, which require that standard services, such as maternity care, newborn care, lab tests, and certain prescription drugs, among other things be covered by insurers. So pre-natal well visits and medications would no longer be covered.
In what will likely be a sticking point for Democrats, the bill also restricts any tax subsidies going to people with health plans that possibly include coverage for abortions, unless it's to save the life of the mother. So the bill hurts pregnant women on both ends — those who wish to carry a fetus to term or those who would like to choose to terminate their pregnancy.
Here are some specific ways pregnant women would be affected.
It Cuts Maternity Care As An Essential Health Benefit
Under Obamacare, certain health care services were guaranteed to be covered for plans bought in the marketplace. The Senate bill would slash this program, so pregnant women would no longer have access to guaranteed prenatal care and vitamins for their baby. Emergency care, laboratory tests, hospital care, preventative care, and mental health care coverage are also no longer considered essential and could cost more with an individual health care plan.
It Restricts Lower-Income People From Enrolling In Medicaid
Women who are in lower-income brackets and are not enrolled in a group plan through an employer would no longer be able to enroll in Medicaid, at all, if they are pregnant. So if a woman without a group plan becomes pregnant, she would not be able to get insurance for the duration of her pregnancy. Afterwards, having been pregnant could be considered a preexisting condition, which would possibly be protected in the Senate bill (but not the House health care bill).
The Cost Of Pregnancy Complications Would Go Up
Complications during pregnancy could also be more expensive. For example, if insurers are allowed to charge higher premiums for prenatal care, they could essentially price expecting families out of coverage altogether. Pre-ACA, 62 percent of enrollees who did not have group plans had no maternity coverage, which means that women who aren't getting prenatal care and end up in the hospital for any reason at all would be entirely out of luck.
Families could be charged more by insurance companies for any emergency service or procedure, such as delivering a baby in breech.
Women who become pregnant who also suffer from mental illness or addiction would also not be able to access care with their individual health plans.
Same Goes For A C-Section Or Vaginal Delivery
C-sections, including the actual procedure and the days-long stay in the hospital for recovery, would no longer have to be covered or could cost more under the new health care bill. Same goes for the time spent in a hospital for a vaginal delivery. Back in 2013, experts estimated that vaginal deliveries cost Americans about $30,000 and C-sections about $50,000 (without complications). Both group plans and marketplace plans could have higher deductibles for these types of hospital stays.
Newborn Care Would Also Get More Expensive, Too
Under the Senate bill, much like under the House's health care bill, well baby visits would also not be covered, since essential health benefits would no longer be protected.
It's not just the baby who would be at risk, but the mother, too. Mental health care, such as counseling for postpartum depression, would not be considered essential care either.
This bill is troublesome for one more reason. The Senate tweaked the House bill in just enough ways to get enough votes to pass it, making it more about getting a Republican "win" and repealing Obamacare to stick it to Democrats rather than about providing quality health care for Americans. Luckily, if passed in the Senate, the bill would still have to be reconciled with the House's health care bill, passed, and then passed onto the president. There's time to fight for your maternity care. Just not a whole lot of it.