Co-authored by Dr. Ifeyinwa Asiodu, assistant professor, University of California, San Francisco; Dr. Kimberly Baltzell, associate professor and Director of the School of Nursing Center for Global Health, University of California, San Francisco; Amy Chen, senior attorney, National Health Law Program, Los Angeles, CA; Dr. Meghan Eagen-Torkko, certified nurse midwife and assistant professor; University of Washington, Bothell; Dr. Liza Fuentes, public health scientist; Elizabeth Ghedi-Ehrlich, Director of Policy and Women’s Health and Equity, Scholars Strategy Network; Dr. Cynthia R. Greenlee, independent historian; Dr. Monica R. McLemore, assistant professor, University of California, San Francisco, and research scientist with Advancing New Standards in Reproductive Health; and Dr. Diana Taylor, professor emerita, University of California, San Francisco.
In Congress’ latest attempt to dismantle the health insurance system relied upon by more than 20 million Americans, a Senate bill proposes allowing health plans to deny coverage for existing basic health benefits, including pregnancy and newborn care and prescription drug access. The Graham-Cassidy bill also guts Medicaid and basic family planning care.
As healthcare providers, researchers, attorneys, and advocates, we are alarmed by the destruction — to individuals, families, our national wellbeing and health-care infrastructure — that will result should the Graham-Cassidy bill (set for a Senate committee hearing on Monday, Sept. 25) become law. We are especially concerned about the catastrophic impact it would have on reproductive health and justice.
Given the bill’s provisions, it should not be surprising that Graham-Cassidy would be especially devastating for maternal-child health. Medicaid finances more than half of all births in the country and accounts for 75 percent of all public dollars spent on family planning. Moreover, one in five of all women of reproductive age (15-44), nearly one-third of Black women of reproductive age, and more than one-quarter of Latina women of reproductive age are enrolled in Medicaid.
This is basic math: Graham-Cassidy will harm much of the U.S. population, many of whom already struggle to get quality, affordable care in a country that is among the world’s richest. The priorities of Congress are shamefully misplaced. Consider that the United States already has the highest rate of women who die during pregnancy or childbirth among developed countries — and by a lot. Our maternal mortality rate is 50 percent higher than the United Kingdom’s and nearly 300 percent higher than Spain’s. The disparities within the United States are also tragic: Black women are twice as likely to die during pregnancy or birth as white women. Thus, on this standard measure of population health, we are doing horrendously. If the Graham-Cassidy bill is passed, these health outcomes will worsen, and resource-poor, low-income, and marginalized women and families will be harmed.
The bill is, in fact, antithetical to reproductive justice, a human rights framework developed by Black women more than two decades ago. Under this idea—which has flourished into an important movement including nonprofits, advocates, and healthcare providers—every person has the rights to 1) determine if and when they will have a baby and the conditions under which they will give birth; 2) determine if they will not have a baby and exercise options to prevent or end a pregnancy; and 3) parent the children they already have with the necessary social support in a safe environment and healthy community without fear of violence from individuals or the government.
In its current form, Graham-Cassidy undermines these basic rights by trying to repeal major provisions of the Affordable Care Act (ACA) and dismantling the many benefits necessary to improve reproductive outcomes in the United States through:
Loss of insurance: First and foremost, any ACA repeal proposals could strip coverage from an estimated astonishing 30 million Americans. By repealing the ACA’s premium and cost-sharing subsidies and imposing age-based tax credits, ACA-repeal bills would make it more difficult for all but especially working women and families to afford health coverage.
In 2016, 6.8 million women and girls enrolled in health plans through the health insurance marketplaces created by the ACA. In the majority of states, the ACA made it possible for more than 80 percent of women of color ages 18-64 to be insured. Graham-Cassidy would roll back these important advances.
Medicaid cuts: Graham-Cassidy eviscerates Medicaid, slashing our nation’s health care safety net without doing anything to improve the program’s quality or efficiency.
No pre-existing conditions: Graham-Cassidy also allows states to waive protections for people with pre-existing conditions and thereby would exacerbate existing health inequalities. Currently, ACA marketplace health plans are prohibited from denying coverage or increasing premiums based on prior health conditions, including pregnancy and childbirth.
New barriers to birth control: In 2013 alone, women saved more than $1.4 billion in out-of-pocket costs on oral contraceptives. Without the ACA’s contraceptive mandate, millions of women will be forced to pay out of pocket for contraception in most circumstances. To make matters worse, the proposed bill also defunds Planned Parenthood, which provides millions of people with access to vital preventive services like contraception, STI testing, and breast and cervical cancer screenings. By undermining women’s access to these preventive services Graham-Cassidy is putting women’s financial stability and health at risk.
No guaranteed maternity coverage: In addition, the Graham-Cassidy guts the ACA’s Essential Health Benefits (EHB) provision, which granted all women access to maternity coverage on the individual market.
Graham-Cassidy is a disaster for women’s health and health equity. Our families and communities deserve better.
Members of the public and organizations can email comments or testimony for Monday’s (9/25/17) hearing on the Graham-Cassidy bill to GCHcomments@finance.senate.gov. Deadline: Monday at 1 p.m. EST.