What Losing the Affordable Care Act Means to Us: Women and Reproductive Health

Testimony from women at different stages of life highlights the uncertainty of women’s healthcare without the Affordable Care Act.

Despite widespread criticism, the Affordable Care Act (ACA) has achieved significant progress for women and their reproductive health. The legislation has provided no cost sharing for all preventive visits and services, and has helped to lower costs and improve women’s health.

The ACA requires insurers to cover all preventive services that are recommended by the United States Preventive Services Task Force. Although this provision is applicable to both men and women, it is clear that women are the main beneficiaries.

The law also prevents insurers from charging higher premiums for women than men, which used to be a common practice. Women are now able to obtain 1 of the 18 FDA-approved birth control options with no cost sharing, including hormonal methods, implanted devices, emergency contraceptives, and surgical sterilization.

The recent election has left many people feeling uncertain about the future of their healthcare, because President-elect Donald Trump frequently pledged to repeal the Affordable Care Act during the months prior to the election. While Trump has since backtracked on the campaign rhetoric and expressed willingness to maintain certain popular provisions of the ACA, the muddled future of the law still creates uncertainty for women, and what it could mean for their reproductive health.

With Mike Pence as the vice president-elect, some women are very concerned for the future of their healthcare, and fear that they will have less control over their health.

Nicole Boily-Keuscher, a mother of 2 young boys, told AJPB.com that she believes the ACA was a step in the right direction for the country, and she worries that the repeal may disproportionally affect young women.

“I am worried that young girls out there may not get services, because it may not become available to them. I think one of the best things to come from the ACA is that all preventative care is covered,” she said. “I know if it is not, people will stop going to the doctor, and they will not spend the time because they will be worrying more on how much things will cost.”

This is a common worry among women who are facing major healthcare changes due to the potential changes. Prior to the ACA, Anna, a recent college graduate did not have health insurance, and was unable to benefit from the services that are now offered to her.

“Before the Affordable Care Act, I had no health insurance. I had no permanent gynecologist that I could establish a relationship with because I was always using women's health clinics, such as Planned Parenthood,” Anna told AJPB.

She was unable to receive check-ups and other preventive services, but since purchasing a plan through the marketplaces, Anna is able to receive annual visits and necessary services without cost sharing. Because of the tremendous strides the health law has made for women, there is a very real fear that this progress will be taken away with the impending repeal.

“I am afraid that women are going to have to pay copays for annual pelvic exams and lab work, as well as prescriptions. Since most birth control pills are free, but do require an office visit, women are more inclined to go to the doctor, have their exam, and get birth control pills,” Anna said. “I am worried that if the whole process is not free-of-charge, women will be less inclined to be on birth control, and have a check-up that can discover potential cancers, abnormalities, and infections.”

She also expressed concern that the government will completely defund Planned Parenthood due to a small portion of the services they provide. However, that could end in unfortunate situations for women in low-income areas who rely on the clinics for check-ups, birth control, and preventive services.

Victoria Earl, a woman in her 20s, told AJPB that she thinks the ACA has also helped her tremendously.

“After the ACA was implemented, the copays on my visits/birth control lowered in price,” she said. “As someone who does not live with their parents, I found great comfort in knowing that I could afford to take better care of myself and still pay the rent and bills.”

She also said that repealing the ACA may affect the ability of women to receive necessary services, and they may have to make a difficult choice about whether to pay for healthcare services or other bills instead.

“My biggest concern moving forward is how long will I have healthcare for? If I lose my health insurance, I lose the comfort and ease of taking care of myself,” she said. “I'd find myself having to choose between a visit to the doctor or being able to eat. That's not a choice anyone should have to make.”

The future of maternity services is also concerning to women of all ages. While Elizabeth Wagner, a mother of 2 young girls, does not plan on having more children in the near future, she worries that other women will not be able to access the same maternity services she previously received.

“I had great care during both my pregnancies. I had to pay 1 copay at my first appointment, and then only had to pay for ultrasounds until after the birth of my daughters. My plan even covered most of my hospital expenses,” she told AJPB. “I was fortunate both of my pregnancies were planned; I had insurance and savings. I worry that women will not have access to affordable contraception, and then potentially not have access to the OBGYN care needed.”

Prior to the implementation to the ACA, Elizabeth had private health insurance that did not cover the cost of oral contraception. While the cost was only about $50 per month, it can become burdensome when faced with paying other household and student loan bills.

She also expressed a concern for the future of her daughters’ reproductive health. “Looking to the future, I hope my 2 daughters have the ability to make their own reproductive choices for themselves with the input of their doctors and future partners, not the government,” she said.

Many women from different backgrounds, of different races and geographic locations, are fearful about their reproductive rights going forward, and whether the federal government will take away these services that have proven to be beneficial.

If these key provisions for women are not kept, it is likely that women across the country will be faced with tough decisions about their healthcare that they may not be prepared to make.