In a weekend interview with The Washington Post, Donald Trump described the as-yet undefined Republican replacement for the all-but-doomed Affordable Care Act in a series of glowing superlatives: The new system will be "much less expensive and better" than president Obama's signature health care law, he said; it will ensure "insurance for everybody" and they'll all be "beautifully covered." But although the president-elect promised that he and his party are in the final stages of readying the plan for its big unveil and they have already taken concrete steps in dismantling the ACA, actual specifics are practically nonexistent in the public realm. So, because the 2010 law offered so many essential protections for growing families, it's now unclear what kind of health insurance parents will buy if and when Obamacare is repealed.
Last week, both chambers of Congress passed measures to start rolling back big chunks of the law that has made medical care available for some 20 million people. And in a rare press conference Wednesday, the president-elect promised a weary nation that the full repeal and much-hyped replacement would happen more or less simultaneously — and soon. But the near-constant GOP talk of very little substance on this topic has left all but, presumably, the Republican political elite in the dark about how Trump will keep his pledge to retain the popular aspects of the ACA — like allowing adult kids to stay on their parents' insurance plans until they're 26 and outlawing insurance companies' discrimination against people with pre-existing conditions — while obliterating the parts people don't love as much (but which keep the entire system from collapsing).
And one of those so-called pre-existing conditions, of course, is pregnancy. Before the Affordable Care Act passed during Obama's first term as president, private insurers could inflate prices for coverage if a woman was pregnant — actually, they could charge women more just because of the very fact that they were women and had the capacity to get pregnant. Without the protections afforded by the ACA, maternity care will no longer be one of the 10 essential health benefits that insurance companies must cover under the law, meaning that accessing care before and after the birth of a baby may once again come with an astronomically high price tag.
The end of Obamacare could very well also mean the end of cost-free breast pumps for new moms, as well as the mandate that all employers with 50 workers or more must provide the space and time for new parents to express milk while on the job. The idea of birth control without a co-pay will more than likely be a distant memory once conservatives rework health care coverage in this country. Without the protections that put women and their partners in control as they decide when and how to grow their families, parents will likely have to search long and hard to match ACA-levels of protection, coverage, and equality (again, depending on what replacement Republicans ultimately come up with).
And while the Republican-controlled executive and legislative branches have the numbers and the political will to do away with the ACA very, very soon after Trump takes office Jan. 20, some members of Congress are urging caution. No one wants to be responsible, of course, for explaining to their constituents why they voted to take away their health insurance without having a plan in place to make sure they are still covered under another system.
"I'm very concerned on the policy side specifically, that the replacement occur either simultaneously or as close to simultaneously as possible," Republican Rep. Charlie Dent of Pennsylvania told CNN after the House vote to begin the process of doing away with the ACA, which he did not support. "If we don't provide a credible replacement plan, my main concern is that there would not be gaps in coverage for people who are currently subsidized. Also concerned about how the insurance markets might react."
No matter what, a change to the way the health insurance market has operated for the past six years will introduce a significant transitionary period with lots of turbulence along the way. The switch will be much easier and less painful if the GOP takes into consideration the unique needs of parents, as President Obama did, when crafting their replacement.