What Sexual Violence Survivors Lose Once Obamacare Is Repealed

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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.

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.

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