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We Need To Talk About PMDD & The AHCA

With the American Health Care Act, Republican House members seem to have pulled together every controversial effort to undermine women’s health in one bill. The version passed by the House earlier this month would approve state efforts to cut healthcare costs by removing prenatal and gynecological care as benefits that insurers must offer on every plan, while gutting Medicaid funds available to cover low-income applicants. The AHCA cuts special education funding and coverage for mental health. And, by allowing profit-focused insurers to write the rules on coverage costs, the bill could bring back the days when it was perfectly legal to hike an applicant’s rates for anything from pregnancy to symptoms or procedures related to rape. But what about conditions that were officially accepted after the Affordable Care Act was enacted? For example, will premenstrual dysphoric disorder (PMDD) be a pre-existing condition under the AHCA?

Premenstrual dysphoric disorder (or PMDD) is related to PMS, but far, far worse. It’s described as a syndrome where the hormonal changes that come with a woman’s period trigger debilitating physical and emotional symptoms. In the 14-17 day span following ovulation, women with PMDD often experience severe depression, anxiety, panic attacks, and insomnia along with the physical symptoms often associated with PMS.

In an NPR report, one sufferer characterized the experience as being “like PMS on steroids.”

But while premenstrual syndrome is quite common — some 85 percent of women suffer at least one one common PMS-related ailment, according to the U.S. Department of Health and Human Services’ Office of Women’s Health — the odds of being diagnosed with PMDD are far lower. For an official diagnosis, a woman would have to meet three criteria, according to the NPR report: She would have to experience five or more of the full list of symptoms of PMDD, the symptoms would have to last for at least two months in a row, and she must report that she isn’t depressed at any other time — just the days leading up to her period. It’s probably no surprise, then, that only around 1 percent of women ever get a formal PMDD diagnosis.

Pre-ACA, PMDD may not have been considered a pre-existing condition, simply because doctors were slow to admit that it existed at all. Before 2013, medical literature was vague on diagnosing PMDD, tossing it into an ill-defined, catch-all category of “not otherwise specified” conditions. Of course, that didn’t stop pharmaceutical companies from cashing in. Beginning in 2000, the FDA began approving drugs to treat PMDD in women — some 13 years before it was officially recognized as a treatable disorder. But that’s a rant for another day.

Whether PMDD — or any medical ailment — will be considered a pre-existing condition under the AHCA is all guesswork at this point. As BuzzFeed noted, there isn’t an official list of what will or won’t qualify as a pre-existing condition should the bill be enacted. The legislation leaves it up to states to seek waivers to get around the rules on charging more for people with health conditions. And the law seems predicated on the idea that few states, if any, will actually seek that authority. In states that do, though, the insurers will get to decide for themselves which conditions will mean charging patients more for coverage, BuzzFeed reported.

So far, the best advice for people with pre-existing conditions is to stay insured. That means not losing employment that offers health insurance and not dropping your privately purchased insurance. Of course, that’s easier said than done in many cases; As insurers pulled out of the ACA marketplace last year, premiums rose by 20 percent to 100 percent or more in some states. Still, an insurance lapse of 63 days or longer means that companies can raise prices on applicants looking to re-enter their plan in order to cover the company’s potential risk.

And that means, should the AHCA become law, profit-minded insurers will have incentive — and a legal green light — to target those with chronic health conditions, like PMDD. It’s an ugly, awful situation.