What Sexual Violence Survivors Lose Once Obamacare is Repealed

On Thursday, two House committees approved the American Health Care Act to uproot President Obama’s Affordable Care Act. While Democrats have been proposing new amendments, the Republican majority has been quick to shut them down.

Some major changes include defunding Planned Parenthood, rolling back Medicaid coverage, and eliminating private insurance coverage of abortions. All three deeply affect low income families and women but also victims of of sexual violence and assault.

For instance, The Washington Post reports the new bill would remove mental health and substance abuse coverage serving over 1.3 million Americans. Both types of services fall under the requirement for essential services. Once passed, essential services won’t be a federal requirement and states will decide individually to keep mental health included in medical coverage. Sexual violence survivors, for instance, rely on mental health services for counseling and emotional support. Without access, they can risk suffering from poor mental health in the aftermath of an incident.

As a result, many wonder what healthcare will look like for sexual violence survivors in the years to come. Which policy details could be dissolved next? Plus, I haven’t even mentioned how many victims have spoken out against the president elect’s inappropriate and violent behavior against women.

Pre-existing conditions

Under the Affordable Care Act, health insurance companies are prohibited from denying those with a pre-existing condition. The legislation also explicitly outlines the definition of a pre-existing condition as “any condition you had before your coverage started,” according to Healthcare.gov. For example, pregnancy services are covered on the day your plan begins, no matter what.

Without this detail, long-term health problems as a direct result of rape or even rape itself could be deemed a pre-existing condition. Insurance companies have the power to deny coverage for services related to the pre-existing condition. They could even drop patients’ plans entirely because of it, too.

“From the health perspective, there are a lot of acute and long-term consequences of sexual assault,” explains Jhumka Gupta, a faculty member at George Mason University. ”Sexual assault can be a one-time incident, but it can also be a chronic incident.”

As a social epidemiologist, Gupta studies how violence and gender discrimination affect public health. In addition to legal support and advocacy, she stressed survivors’ immediate need for health care access to sexually transmitted disease testing, mental health counseling and treatment for any immediate injuries. A one-off incident of violence can lead to lingering, dangerous medical problems.

“There is research linking sexual violence to poor reproductive health, being at an increased risk for sexually transmitted infections, unplanned pregnancy, poor mental health and other injuries which could be deemed a pre-existing condition,” she stressed. “This prevents a sexual violence survivor from obtaining health insurance and could also raise her premiums.”

Gender discrimination

Before ACA protection, insurance companies could use rape as a basis to deny coverage. PolitiFact reports six states, as of 2010, didn’t have laws protecting survivors from such discrimination. The states included Idaho, Mississippi, North Carolina, South Carolina, Vermont and Wyoming.

However, blatant injustices certainly weren’t exclusive to those states. Back in 2009, the National Women’s Law Center launched “Being a Woman Is Not a Pre-Existing Condition”. The campaign speaks to the culture of misogyny within the healthcare industry. A report released at the same time cites that in 2009, only 13 percent of health plans available to 30-year-olds provided maternity care.

Christina Turner, a survivor and then Tampa-based health insurance agent, spoke at the launch event on October 9. According to NWLC, Turner sought counseling and anti-HIV medication after being raped in 2002. She started calling Florida insurance companies about a hypothetical rape survivor—essentially describing her situation without explicitly saying so—needing insurance, but companies refused coverage. If she attached her name to the situation, she would have jeopardized and forfeited her own health plan.

Prior to 2010, insurance companies could also charge more for women, even without including maternal care in their policies. NPR reports women were collectively paying $1 billion more than men every year for health insurance premiums. The stigma stems from the idea women are larger consumers than any other gender because of their ability to get pregnant.

Contraceptive mandate

The ACA also requires specific preventative services for women. These include general screenings for conditions women are at an increased risk for, including domestic and intimate partner violence. Planned Parenthood, for instance, provides many of these services for low income women and families.

“[With the general screenings,] the health care provider can connect women experiencing violence with necessary health and social services,” Gupta explains. “Often, women who experience intimate partner violence are isolated. Often, the healthcare provider is the one person outside of the family to have contact with her. By screening, doctors are in a powerful position to connect women to resources.”

In August 2011, contraception was added to the ACA’s list of preventative services. Private insurance companies now must cover birth control in their policies without charging a copay or raising deductibles. According to the U.S. Department of Health, the updated guidelines expanded healthcare access to 47 million women, who could then choose their own birth control methods.

“More researchers are talking about reproductive coercion, where there is pressure to become pregnant and/or destruction of birth control methods, not allowing a woman to use birth control,” Gupta mentions. “The ACA could cover birth control methods in a woman’s control, such as an IUD.”

Without the ACA, health coverage will become significantly more costly for women’s services. Co-pays for birth control will skyrocket. Forbes explains women spent $1.4 billion in copays alone in 2013. Maternity care expenses are also expected to increase drastically.

Further budget cuts

As Trump’s team prepares to slash government spending by $10.5 billion, The Cut reports 25 grant programs created by the Violence Against Women Act of 1992 could soon disappear. This includes programs dedicated to reducing sexual assault, stalking and other types of violence. Some were created in response to the Reauthorization of the Violence Against Women Act in 2013, which expanded protection to Native Americans, immigrants and the LGBTQIA community.

Likewise, cutting grant funding seizes any progress in violence prevention. Nonprofits won’t have the financial resources to continue research. This directly affects Gupta’s work, since she collaborates with community partners to study the social impacts of sexual violence.

“We need more research and programming to stop the victim blaming from happening and destigmatize sexual assault,” Gupta added. “There are some public health programs that do that on a smaller scale, but we need to be implemented more widely.”

In the meantime, these changes won’t take effect until next year. Gupta strongly recommends sexual violence survivors and those with chronic medical conditions take action now to prepare for what’s to come in the near future.

“We’re at a point where politicians are reinventing the definition of sexual assault,” she said. “Try to be seen as soon as possible. Establish a plan with a healthcare provider. Get tests done in case coverage is cut off. If possible, get prescriptions filled. Get copies of your medical records.”