It’s less than two weeks into this new administration and already, people’s rights are being trampled left and right. As people’s rights and wellbeing are being attacked from multiple fronts, we must prepare to take on the assaults that have yet to come, while still beating back the ones that have already started.
At a time like this, the threat of repealing the Affordable Care Act (ACA), also known as Obamacare, may not feel like a top priority. But from Trump’s first executive order and the administration pulling advertisements for ACA enrollment, to what is happening in Congress—it’s clear that repeal is still a top priority for this administration. And as we have covered previously, there is a lot at stake.
So we are continuing this week with our Worst Throwback Thursday Ever blog series—highlighting the challenges faced by women in trying to get affordable health care services and coverage before the passage of the ACA. And what you may not know is that before the ACA, the state in which you lived dictated the availability, cost, and quality of your health insurance. The state in which you lived even determined whether you were protected from discrimination in health care coverage.
Before the ACA, health insurance standards and protections varied widely from state to state.
The regulation of insurance has traditionally been a state responsibility. Prior to the ACA, few states limited what individual insurers could do. Unlike employer-sponsored health insurance, which was subject to many state and federal protections, the vast majority of states subjected the individual insurance market to few, if any, such protections.
Because the regulations imposed by particular states varied a great deal, there were dramatic differences between individual health insurance markets from state to state. Basically, the availability, prices, and quality of your health insurance coverage in the individual market all depended on where you lived.
Here is just a short list of the ways in which your zip code determined whether you could get affordable health insurance that met your needs prior to the ACA:
- In 2012, only 9 states required all insurers on the individual market to cover maternity care. That meant maternity care was largely unavailable in the individual market, with only 12% of plans across the country covering it.
- As of 2010, it was legal in 6 states and D.C.to deny a person coverage because they were a survivor of domestic violence;
- Women were charged wildly different prices than men for the same health coverage based on whether their state limited gender rating—for example, a 40 year-old woman in West Virginia could be charged $478 more for her health plan than a 40 year-old West Virginia man, but if the same woman lived in Arizona, she could be charged up to $955 more than an Arizona man;
- Whether you could be denied coverage altogether because of a pre-existing condition, or denied coverage for a period of time was determined by state law—although all 50 states allowed some kind of pre-existing condition exclusion, whether you were locked out of coverage for 6 months or 24 months or indefinitely depended on your state.
The Affordable Care Act changed the state-by-state variation in insurance, establishing a nationwide marketplace of affordable, comprehensive health insurance.
The ACA instituted nationwide standards to require all plans to include maternity coverage and coverage for other services women need, prohibit insurance companies from discriminating against women based on pre-existing conditions, ban the practice of gender rating, and so much more. These nationwide standards and protections changed the state-by-state nature of health insurance, protecting and promoting women’s health and coverage regardless of their zip code.
*One important caveat: the Affordable Care Act treats coverage of abortion differently – and worse – than other benefits. It leaves to states the decision whether to allow insurance coverage of abortion in the state marketplaces. Twenty-five states have banned insurance coverage of abortion in the marketplaces, leaving a woman’s ability to get insurance coverage of abortion dependent on her zip code.
If the ACA is repealed, we will be thrown back to a time when the ability to get affordable, comprehensive health insurance coverage depended on your zip code.
ACA repeal would once again kick it back to the states to determine how to regulate health insurance. In fact, the main goal of one “replacement” proposal is to allow states to choose which ACA protections and standards to keep, and which to jettison. ACA repeal would force us back into state-by-state fights to protect access to health care.
Not only has the past taught us that this state-by-state system will greatly affect women’s health insurance—usually to women’s detriment—we are already seeing states preparing for potential ACA repeal in significantly different ways.
Some states, like Connecticut, Oregon, New York, and Hawaii are stepping up to protect their constituents’ access to affordable health care by introducing legislation to adopt the ACA’s ground-breaking birth control benefit into state law, or by introducing bills to ensure insurance companies cannot reinstitute discriminatory insurance practices that were prohibited by the ACA. In these states, even if the ACA is repealed, these laws, if passed, would continue to protect women’ health care and coverage.
On the other hand, some states are planning to roll back all the progress the ACA has made for women’s health and economic security if the ACA is repealed. For example, Virginia has introduced a bill that, if the ACA is repealed, would reinstate all the old, pre-ACA insurance provisions in Virginia that were detrimental to women’s ability to get affordable health insurance coverage.
We can’t go back to a time when a woman’s health care is unfairly dictated by her gender and zip code. We shouldn’t have to fight state by state to get the health care and health insurance we need. We shouldn’t be scared to move for work, or school, or any other reason because of what it would mean for our health insurance. But as past experience and actions from states like Virginia show, that’s exactly what we will face if the ACA is repealed.
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