Trumpcare: Return Of Rape & Domestic Violence As Pre-Existing Conditions

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On May 6, the Washington Post published a disconcerting piece denying that the House-passed Trumpcare bill would ultimately lead to discrimination against victims of rape, sexual assault, or domestic violence. Even the headline (“Despite critics’ claims, the GOP health bill doesn’t classify rape or sexual assault as a preexisting condition”) is a masterpiece of contortion; while technically true, it is misleading readers about the bill’s real-world impact.

The rest of reporter Michelle Ye Hee Lee’s piece is no different: “The AHCA does not specifically address or classify rape or sexual assault as a pre-existing condition,” she writes. “It also would not deny coverage to anyone because of a pre-existing condition” (emphasis mine).

That’s true. There’s no language in the bill declaring rape, sexual assault, or domestic violence to be pre-existing conditions. And the bill does, indeed, require insurance companies to offer coverage to everyone, even if they operate in a state that has opted out of the Affordable Care Act’s (ACA) consumer protections for pre-existing conditions and essential health benefits.

But under the GOP bill, insurance companies would be allowed to both price some sick people out of the market and refuse to cover essential services that people might need. For all practical purposes, this takes us back to the pre-ACA world. A cancer patient who is offered insurance with a, say, $10,000 per month premium that doesn’t cover hospitalizations or cancer drugs is, practically speaking, no different than a patient not offered insurance at all.

Meanwhile, the Wall Street Journal reported on May 12 that the House’s language gutting protections for pre-existing conditions could survive in the Senate.

We know what the impact on women would be because we have a number of concrete examples from the pre-ACA days: A woman in Florida is raped, prescribed anti-viral drugs as a prophylactic against HIV, and then can’t get insurance for three years until she can prove she is HIV-free. Another in New Mexico is beaten by her spouse, loses consciousness, then can’t get insurance when she reports her medical history. A third in Colorado has a cesarean section and can’t get coverage unless she agrees to be sterilized.

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