What’s more, private insurers could once again charge people more based on their health status, and they would not be required to cover 10 essential health benefits, like maternity or mental-health care, as they are under Obamacare.
It’s here that women—no matter their income level, age, or childbearing preferences—would really feel the effects of Graham-Cassidy. Currently, contraceptives are required to be covered without a co-pay under Obamacare, but the bill would allow states to waive that requirement, which also covers other types of preventive services. That means birth control might no longer be free for women who buy their health insurance on the individual market. Women on Medicaid would not be able to use their Medicaid plans to visit Planned Parenthood clinics for birth control and other services for one year, potentially resulting in the closure of Planned Parenthood clinics.
“For pregnant women, there are a lot of screening services that are covered as part of preventive services—anemia screening, breastfeeding-support services, depression screening, folic acid, screening for gestational diabetes,” said Alina Salganicoff, the director of women’s health policy at the Kaiser Family Foundation. “All of those are covered without cost sharing. If a state chooses, that could also go away in the individual insurance market.”
If a woman on the individual market got pregnant and didn’t wish to be, Graham-Cassidy would ban her plan from covering abortion. If she worked for a small business, her company would no longer receive tax credits if their plan covered abortion.
Under the bill, states could also waive the requirement that maternity care be covered on individual plans. Before Obamacare, 75 percent of plans on the individual market excluded maternity coverage, 45 percent excluded substance-use treatment, and 38 percent excluded mental-health care, according to the Kaiser Family Foundation. In those states, women who were pregnant or planned to get pregnant could buy expensive riders to have their prenatal care and deliveries covered. Women suffering from postpartum depression, meanwhile, sometimes needed an extra mental-health rider on their plan, in states that didn’t require mental-health benefits. Graham-Cassidy would bring back this reality.
“The states might be looking for ways to scale back coverage and give insurers flexibility,” Salganicoff said. “The goal of Republican plans is to make insurance more affordable and allow people to tailor their benefits. But if you tailor this in this way, it’s antithetical to insurance. The people who buy maternity coverage are the ones who are going to use it.” So insurers know to charge a lot for it.
Though Graham-Cassidy’s waivers would only apply to individual-market plans, a state’s decision to tweak its essential health benefits could affect employer plans, as well. Under Obamacare, out-of-pocket medical expenses are capped and there are no annual or lifetime limits on the medical expenses insurers are required to cover.