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Trying to Balance on a Two-Legged Stool: If the Tax Bill Takes Away a Key Piece of the Health Care Law, Women Will Lose Access to Affordable Health Care

High out-of-pocket costs, debt, bankruptcy—this is what the health care market was like for many women and families before the Affordable Care Act (ACA). The Senate tax bill being pushed by Republican leadership and President Trump – which is up for a vote today or tomorrow – could send us back to those days.  That’s because it would eliminate the ACA’s individual responsibility provision, a.k.a. the individual mandate.

The individual responsibility provision is a key piece of the ACA – we often refer to it as one leg of a three-legged stool.

Leg one is Insurance Market Reforms: The law has reformed the health insurance market, including by barring discriminatory practices, like charging women more for health coverage than men—also known as gender-rating—which 92 percent of the most popular plans practiced pre-ACA, costing women approximately $1 billion a year.

Leg two is the individual personal responsibility provision (a.k.a. the “individual mandate”): The ACA requires most individuals to enroll in health insurance coverage or pay a penalty. This ensures that both healthy and sick people participate in the health market, broadening the health insurance risk pool and keeping costs under control.

Leg three is premium tax credits and cost-sharing reductions: These make health insurance and health care affordable for the vast majority of Americans, and are especially important to women.

But, the Senate GOP Tax Bill would topple the 3-legged ACA stool by eliminating the ACA’s individual responsibility provision.

Estimates show that repealing the individual responsibility provision would cause an estimated 13 million individuals to lose health insurance coverage and raise premiums in the individual market by 10 percent over the next decade. Costs would skyrocket because most healthy individuals would go without coverage rather than pay high costs. Those who desperately need health insurance coverage – like the over 65 million women with pre-existing conditions – would be burdened with high costs.

Because women earn less than men on average and are more likely to live in poverty, higher health care costs will disproportionately impact them, leaving a woman unable to get the care she needs. Pre-ACA, women were more likely to go without care due to costs than men, with women of color more likely to be uninsured because of cost barriers, leaving them vulnerable to a lifetime of illness. Women should not be forced to make tough choices like paying for necessities such as food or rent or paying for health insurance coverage.

The Senate already rejected an attempt to repeal the ACA’s individual responsibility provision this summer. Now, the GOP is trying to sneak in a repeal of a vital piece of the ACA in its tax bill.  They don’t seem to have heard the message that they can’t keep playing politics with women’s health, not in an ACA repeal bill and not in a tax bill that would topple one of the ACA’s most important provisions and jeopardize women’s health and economic security.