A version of this piece was originally published in the Hill on May 3, 2017.
So far, we know that about 24 million Americans stand to lose their health insurance coverage if the Affordable Care Act (ACA) is replaced with the American Health Care Act (AHCA). We know that most of those 24 million people will be low-income. We also know that groups of people who experience significant health-care disparities, such as lesbian, gay, bisexual and transgender (LGBT) people, and Black and Latino people, will be among those who risk losing the most if the ACA is repealed. To that list, we must add all survivors of sexual violence—women, men, people who are transgender, and children and teens.
Before passage of the ACA in 2010, sexual assault survivors who had sought medical care for their injuries could be denied health insurance coverage at a later date. The reason? Health insurers often categorized rape-related treatment as a preexisting health condition. In one widely reported case, a 45-year-old woman met two men who bought her a drink at a bar in Florida. Hours later, she found herself lying by the side of the road with injuries indicating that she had been raped and that the men had spiked her drink. Her doctor prescribed a treatment of antiviral, post-HIV exposure drugs to protect against HIV transmission. When the woman lost her health insurance several months after the attack, she was unable to obtain new insurance due to the health-care treatment she had received for the assault. She went without health insurance for three years.
Stories like these prompted the National Women’s Law Center to launch a campaign called “Being a Woman Is Not a Pre-Existing Condition.” It was so popular that then-House Speaker Nancy Pelosi adopted the phrase in her pro-health reform talking points with media, and the New York Times ran an explainer on the ways in which health insurers treated women as if they were just one giant pre-existing condition.
The AHCA initially retained the ACA’s ban on discrimination against people with preexisting conditions. But an amendment to the AHCA bill offered last week would make it easier for health insurers to deny coverage to people with preexisting conditions. Perhaps more alarming, though, is the new amendment’s provision allowing states to get out of having to ensure that health insurance plans cover Essential Health Benefits. Essential Health Benefits include preventive health care services that most of us assume exist in our health plans. These include tests for blood pressure and cholesterol, mammograms, and vaccinations. Essential Health Benefits also include coverage for mental health care and substance abuse treatment, which are truly essential for survivors of sexual violence.
After an assault, survivors can face acute treatment needs such as care for genital injuries and other physical trauma, as well as the risk of sexually transmitted diseases and pregnancy. But sexual violence takes many forms: incest, ongoing child sexual abuse outside of the family, sexual assault, sexual harassment or exploitation, and rape. Each of these types of assault puts the survivor at long-term risk for various potential negative physical health and mental health outcomes. For example, an adult survivor of childhood sexual abuse is at a higher risk for psychiatric disorders. People of all genders who have survived rape as adults are at higher risk of post-traumatic stress disorder, depression, anxiety, and substance abuse—any of which can significantly interfere with daily living. No one can deny that there is a direct line between having survived sexual violence and an increased risk of physical and mental health problems.
The mental health impacts of sexual violence are deep and often longstanding. Survivors need long-term access to nonjudgmental health and mental health services to reduce their suffering and mitigate as much as possible the stress that recovery from sexual violence puts on intimate family relationships and obligations related to school and work. Access to this care will be much more difficult if the ACA is repealed and replaced with the new bill currently being considered by Congress.
It is hard to see that this Obamacare replacement, should it pass, would do anything other than bring additional grief and hardship to survivors of sexual violence.