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#Trumpcare - The New War On Women

Pregnancy, rape, breast cancer – being female is now a pre-existing condition.


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­It was a devastating blow to millions of Americans and will, according to many healthcare providers, quite literally kill people. When the House voted on May 4 to repeal and replace Obamacare, it also fired a new salvo in the decades-old GOP war on women. #Trumpcare targets some of the most vulnerable segments of the American population–disabled, poor/working poor, LGBT, people over 50 still years away from Medicare age. 

 

But it is women–52% of the U.S. population is female–who will be hardest hit by restrictions in the latest version of the American Health Care Act. 

 

The House of Representatives vote on the AHCA/Trumpcare, was close: 217 to 213. Every Democrat voted no, as did 20 Republicans. The bill now moves to the Senate where it only needs 51 votes to pass. The Senate is currently 52 Republicans, 46 Democrats and 2 Independents who regularly vote with Democrats. 

 

The bill is thought to face stiffer opposition in the Senate where more than half the Republicans represent states where Obamacare is highly popular and where premiums would rise significantly under the new bill. In Alaska, premiums would rise astronomically at more than $12,000, but in at least half the other states, premiums would rise by between $3,000 and $8,000–pricing many people out of the market altogether. 

 

 

The push to pass the bill came in response to President Trump’s failure to achieve any signature legislation in his first 100 days in office and his growing agitation over media attention to that detail. 

 

As a candidate, Trump promised to repeal Obamacare on day one of his administration. ACA/Obamacare has registered millions of Americans who previously had no health insurance and also made healthcare accessible to many people who had previously been unable to obtain it. The ACA forced insurance companies to stop charging women more for insurance, changed rules that had made being female a pre-existing condition, protected women and LGBT from being discriminated against, allowed those 26 and under to remain covered on their parents’ plans and most importantly for the one in six Americans with a pre-existing condition, banned insurers from dropping or failing to insure those who have a pre-existing condition. The ACA also banned lifetime caps on services, protecting chronically ill and disabled persons as well as those suffering from catastrophic health care crises from cancer to serious accidents. 

 

For reasons that have never been clearly explained by Republicans in Congress, objections to the ACA have always been in play since it was passed in 2010. The GOP has voted more than 60 times since then to repeal Obama’s health care reform, but the former president always vetoed those bills if they even made it to his desk. Efforts at repeal have come before the U.S. Supreme Court several times, but the law has been upheld.

 

 

Trump, whose visceral dislike of Obama is legendary, has fueled the anti-Obamacare sentiments over the past few years and made it a primary focus during his campaign. Yet he also acknowledges most of those who voted for him will be disproportionately impacted due to rising premiums. 

 

Nevertheless, the Republican-led Congress began the process of overturning Obamacare in January, upon being sworn in, fashioning a series of bills and seeking majority consensus. Then in March, the House tried to pass AHCA, a bill devised primarily by Speaker of the House Paul Ryan. That version of AHCA failed to gain enough House votes when some Republicans thought the bill didn’t go far enough to repeal and replace Obama’s signature health care initiative.

 

Amendments over the past weeks to make the revised bill harsher appeased the far right Freedom Caucus which had sundered the first vote, while a vague provision to create a fund for people at higher risk who were previously covered by the ACA’s various protective clauses lured more centrist Republicans who had also balked at the first version. The result was the close vote which President Trump declared a major victory.

 

 

That "victory" could cause as many as 52 million Americans to lose their health care, according to the March CBO (Congressional Budget Office) report on the first, less Draconian version of AHCA. It’s difficult to imagine how any women in the House could vote for the AHCA, which makes being female a pre-existing condition, but just as women voted for Trump, so too did they vote for AHCA. 

 

 

Some of the provisos are stunning. Rape and domestic violence are pre-existing conditions that could ban a woman from getting insurance. Pregnancy goes back to its pre-Obamacare status: not covered. Nor is pre-natal care. This from the same group of GOP lawmakers who are doing everything possible to restrict abortion rights. 

 

For years before Obamacare, insurers refusal to pay for preventative care like mammograms and PAP smears was thought to increase the number of deaths from women who couldn’t afford those tests–notably women of color and lesbians who had both the highest risk rates and the highest death rates. 

 

In the years since ACA was first passed, cervical cancer has been proven to be caused by the human papilloma virus or HPV, which is also the most common STD in the U.S. Testing for HPV, vaccinations for HPV for those who have yet to be sexually active and regular PAP smears have all resulted in lower death rates from cervical cancer, which afflicts mostly younger women and if caught early, is one of the most curable cancers. 

 

Under AHCA, all such testing reverts to optional coverage. Gynecological diseases like endometriosis, which impacts millions of girls and women, is now also an optional coverage. More than a million people have HIV/AIDS in the U.S., which was also a pre-existing condition prior to the ACA. Early testing and drug cocktails have made HIV more of a chronic illness than the death sentence it was in the 1980s and 1990s, but it is still regrettably common. Bisexual and gay men are the most impacted, but women of color have the second highest incidence of new infections. Trans women are disproportionately impacted by the disease as well, according to the Centers for Disease Control. 

 

 

Chronic illnesses that afflict women more than men, like lupus, multiple sclerosis and rheumatoid arthritis–diseases with a hefty price tag for treatment and which are severely disabling–are among the pre-existing conditions that will not longer be covered.

 

Mental illness was finally being covered by most health care plans under the ACA.

One in five Americans has faced depression and/or anxiety.

Millions suffer from biploar disorder, eating disorders, addictions–all addressed by the ACA, all now excised by the AHCA. Opiod addiction was a major point of discussion during the election and is now pandemic in the U.S. 

 

These mental health supports are especially vital for women who have experienced sexual assault. Those services are also essential for lesbians, bisexual women and trans women who are subject to the intense pressures of homophobia and transphobia which can make daily life almost unbearable and have been known to force women into unhealthy behaviors like substance abuse and also push some women to attempt suicide.

 

The AHCA sunders all such mental health coverage. This is a disastrous and devastating bill for all Americans, but particularly women.

Older women will face what House Minority Leader Nancy Pelosi has termed an "age tax"–women over 45 will see their premiums rise by at least $12,000 per year.

Pricing them out of the market when they are reaching an age when they most need health insurance, as breast, lung and colon cancers are most common in women over 45. 

 

 

The ACA has insured more than 20 million people since it was signed into law in 2010, with the majority in the years since most of the benefits became final. According to healthcare.gov which manages ACA sign-ups, 11 million people signed up in 2016 alone and the single highest enrollment day was December 15, 2016 when nearly 700,000 people signed up.

 

How fearful were people of this day, when the Republicans would try and take away the health care of millions? If Obamacare is unpopular with GOP lawmakers, it is definitely popular with average Americans. Ironically, a higher percentage of sign-ups were in red states than blue states.

 

Haunting ACA since its inception has been its cost. While plans for the majority of Americans became less expensive as government subsidies kicked in to lower premium costs, for many middle-class people rates went up. And for 2017, rates were expected to peak as some health insurance providers withdrew from the program, causing rates to soar. These premium costs were cited by a significant percentage of voters in November as a reason to vote against Hillary Clinton, a strong proponent of the ACA and health care reforms.

 

Those who have benefitted the most under the ACA were women, who have traditionally been charged more for health insurance than men. LGBT people have benefitted greatly from the ACA, as have working class and working poor families.

 

 

But if costs were the impediment to embracing ACA, there’s no sense of the long-term costs of the AHCA, either. Allegedly premiums will be lower for younger people under 35, but that doesn’t guarantee they will actually buy insurance, because there is no mandate, like there was under the ACA. And placing all older and sicker and pregnant Americans into high risk pools benefits only the insurance companies, not the people who Trump promised would be "so happy" with his "so great" plan. (Trump’s press conference after the vote made clear he hasn’t seen the bill and has no idea what’s in it or how many people will lose their insurance–something he promised would not happen.)

 

Response to the passage of Trumpcare was immediate on social media. Twitter–the most political of social media sites–took outrage viral with a hashtag #IamAPreexistingCondition, where people posted their photos and their conditions.

This was mine: 

 

Some of these tweets showed babies in hospital cribs. Others showed women bald from chemotherapy. Still others showed men who were vets. And many–too many–signaled that the author of the tweet was certain she or he would die without the ACA protections they so desperately need. 

 

It was hard to read these tweets and not worry that some, especially those already fragile from mental illnesses finally covered by the ACA, might take their own lives. Georgia congressman and civil rights legend Rep. John Lewis said, 

 

He is right. For decades insurance companies had quietly expelled the chronically ill from their rolls. Hospitalizations, new diagnoses, even catastrophic injuries all led to either premiums that were too high to be affordable or simple cancellation of coverage.

 

Thus, that ACA proviso changed the lives of millions of Americans with diabetes, asthma, auto-immune diseases, cancer. Now those people–tens of millions–are back at risk. Trump had said in a November 2016 interview with Lesley Stahl on 60 Minutes that he wanted to keep parts of Obamacare–notably protection for people with pre-existing conditions and coverage for kids and youths up to the age of 26.

 

Now we know that like so many other things Trump has promised Americans, he did not tell the truth. The ripple effect of the May 4 vote will be felt immediately among those most fearful of losing their coverage. But it’s difficult not to think of issues seemingly unrelated to health–like the young college student who is raped on campus but realizes that she might jeopardize her whole family’s health insurance if she reports her rape.

 

I thought of this prior to Thursday’s vote.

 

 

Cancer rates for women are on the rise with lesbians especially at risk. ACA has prioritized preventative care. Younger women have often gone without health insurance because of affordability. Lack of health insurance has meant myriad illnesses, especially gynecological cancers, have gone undetected. Prophylaxis like the HPV vaccine which prevents cervical cancer is more available thanks to ACA.

 

The ACA protects LGBT patients from discriminatory practices based on their health status, such as being HIV positive or having Hep C. There are no limits on medical coverage based on health status, such as monthly or annual limits on HIV medication.

 

The ACA prohibits discrimination, so LGBT people are protected from discrimination by federal statute on the basis of sex stereotyping or gender identity, which means gender-non-conforming women and trans persons can feel safer to access medical services. Because homophobia and transphobia are such stressful factors in the lives of LGBT people, they are more prone to self-harm in all its forms, including addictions to tobacco, alcohol and drugs.

LGBT health disparities such as increased tobacco use and risk of obesity are addressed under the ACA through wellness and prevention treatments such as screenings, blood tests, counseling, and other services for no additional costs to the monthly premium.

 

Speaker Ryan has been Obamacare’s most assiduous foes over the years, especially since he ascended to Speaker. News reports prior to the vote from CBS and CNN described Ryan as "almost giddy" with anticipation of Trumpcare being passed.

 

 

Almost giddy at the prospect of taking health insurance from 24 million people immediately, 52 million over time. And pricing millions more out of the market altogether.

 

Congress is on vacation for the next week—home to face the response to their vote. News reports–my own included–have indicated that a large swath of Americans don’t realize they will be impacted by Trumpcare. But a Wall Street Journal article May 4 made it clear than even those who get coverage through their employer are at risk of losing it. 

 

In December 2016, the Kaiser Family Foundation, a large non-partisan, non-profit healthcare think tank, reviewed the issues in overturning the ACA and their findings were alarming–again, especially for women. 

 

In their review, the KFF lists all 50 states and the number of people who will lose coverage due to pre-existing conditions. The numbers range from 94,000 in the least populous state, Wyoming, to over five million in California.

The total: 52,240,000.

And that does not include the millions who will lose coverage simply because they are covered through subsidies by ACA."This is a conservative estimate as these surveys do not include sufficient detail on several conditions that would have been declinable before the ACA (such as HIV/AIDS, or hepatitis C). Additionally, millions more have other conditions that could be either declinable by some insurers based on their pre-ACA underwriting guidelines or grounds for higher premiums, exclusions, or limitations under pre-ACA underwriting practices."

 

Like pregnancy, breast cancer, endometriosis, rape.

 

The KFF also notes that well over half of all Americans has a family member with a pre-existing condition. What’s more, most insurers have expanded their list of what constitutes a pre-existing condition since the ACA. The range can run from the seemingly benign – allergies – to the more dramatic, cancers and auto-immune disorders.

 

Fifty-two million Americans–the same number the CBO came up with in March–would mean one in six Americans would lose health insurance with the repeal of ACA.

 

What happens next is Trumpcare goes to the Senate and then back to the House. So there are a few weeks to call and plead with your senators who now hold America’s fate in their hands. But what we know now is that people will die. Babies. Women over 50. Lesbians. People with HIV, cancer, mental illnesses. 

 

Wouldn’t it be better to fix what’s wrong with the ACA than kill people? Those tweeting their fear and desperation on #IamAPreexistingCondition –myself among them–say yes.

 

Our lives and those of so many others now hang in the balance, awaiting the Senate’s review. It’s a perilous and discomfiting limbo and at the end, we could all be in a hell of the GOP’s making.

 

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