Is Sexual Assault Really A Pre-Existing Condition?

On Thursday, 217 House Republicans voted to repeal the Affordable Care Act, commonly referred to as Obamacare. As part of the GOP's "repeal and replace" strategy, the House offered up the American Health Care Act, which puts pre-existing conditions front and center of the health care debate once more. In the days since the House vote on the AHCA, several social media posts have claimed a number of pre-existing conditions in the AHCA could prevent a woman from getting health insurance, such as domestic violence and rape. But is sexual assault really a pre-existing condition? According to a fact check by the Associated Press, it's far more nuanced and complicated than it seems, and an issue of semantics rather than health care policy.

When the ACA became law in 2010, insurance companies were no longer allowed to deny coverage or charge more for pre-existing conditions. However, in the MacArthur Amendment of the Republican health care bill, states can apply for waivers for plans on the individual market under the ACA. If a person lapses in coverage for 63 or more days and has a pre-existing condition, this waiver allows health insurance carriers to charge that person higher premiums based on their health status.

While the reasoning behind pregnancy being considered a pre-existing condition (however ridiculous it may seem) might make sense to some, the same can't be said for sexual assault or domestic violence.

As CBS News reported, health insurance carriers define pre-existing conditions by the condition itself, not by how someone got sick or injured. In other words, if a person has been sexually assaulted and develops PTSD, it's the PTSD that's the pre-existing condition — not the assault.

The same can be said of anyone who seeks mental health services or medication for depression and anxiety related to a rape or assault: Just seeking out those services can be considered a pre-existing condition, which is why so many mental health groups have rejected the Republican health care bill. So again, this is more of an issue of semantics rather than policy; The bill doesn't name sexual assault as a specific pre-existing condition — because technically, it's not. "Being sexually assaulted can make it easier for health insurance companies to charge your more" is the most accurate way of relating sexual assault and pre-existing conditions — but it's a bit clunky.

Semantics aside, the bigger issue is that the AHCA just made it harder for sexual assault victims to report and seek treatment for their assaults. It's distressing enough that out of every 1,000 rapes, 994 perpetrators will go free, according to RAINN. But if the AHCA becomes law, victims may now find it harder to seek out the post-trauma support they need if it means getting treatment for rape and sexual assault could put their health insurance coverage in jeopardy.

Under a state waiver via the MacArthur Amendment, a sexual assault could have dire and devastating consequences that extend far beyond just the physical assault itself. According to RAINN, nearly 40 percent of sexual violence victims experience work or school problems, including "significant problems with a boss, coworker, or peer." A 2003 report from the U.S. Department of Health and Human Services found that "women raped by an intimate partner lost an average 8.1 days from paid work."

With these two statistics in mind, it's not difficult to imagine someone losing his or her job after being sexually assaulted, and with it their ability to pay for their health insurance. And if that lapse in health insurance coverage crosses that all important 63-day mark in the MacArthur Amendment, any treatment a victim may have received following their assault could make it prohibitively expensive for them to purchase health insurance in the future.

According to RAINN, more than a third of women contemplate suicide — with another 13 percent attempting suicide — following a rape. With such life-threatening consequences, lawmakers should be doing everything they can to support victims of sexual assault, not make their lives that much more difficult.

So is sexual assault really a pre-existing condition? No — but under the Republican health care bill, sexual assault survivors will be victimized a second time by exorbitant health care premiums just because they sought treatment.