Ten Ways That the House American Health Care Act Could Affect Women

Appendix 1: Comparison of Women’s Health Provisions in the ACA and House AHCA
Affordable Care Act (ACA) House American Health Care Act (AHCA)
Medicaid Policy
Allow states to expand Medicaid eligibility to all adults up to 138% FPL. Repeal enhanced federal match for Medicaid expansion except for those enrolled as of December 31, 2019 who do not have a break in eligibility of more than 1 month;

Convert federal Medicaid funding to a per capita allotment or block grant and limit growth beginning in 2020 using 2016 as a base year.

Planned Parenthood
Planned Parenthood may receive federal reimbursements under Medicaid’s “any willing provider” provision. Prohibit federal Medicaid funding for Planned Parenthood clinics for one year.
Prohibit abortion coverage from being required.

Federal premium and cost-sharing subsidies cannot pay for abortion beyond Hyde limitations.
Allows qualified health plans to cover abortion, but plan must segregate federal subsidy funds from private premium payments or state funds.

Prohibit plans from discriminating against a provider because of unwillingness to provide, pay for, cover, or refer for abortions.

Prohibit all qualified health plans from covering abortion beyond Hyde limitations.

Prohibit federal premium tax credits from being applied to premiums of non-Marketplace plans that cover abortion services beyond Hyde limitations.

Ban small employers from receiving tax credits if their plans include abortion coverage beyond Hyde limitations.

Premium tax credits based on age, income and location to eligible individuals with incomes between 100-400% FPL on a sliding scale.

Provide cost-sharing subsidies to eligible individuals with household income between 100%-250% FPL.

Replace ACA income-based tax credits with flat tax credit adjusted for age only.

Repeals cost-sharing subsides as of January 1, 2020.

Preexisting conditions
Prohibit pre-existing conditions exclusions, which historically have included pregnancy, prior C-section, and mental illnesses, and rate surcharges based on health status. Retain ban on pre-existing conditions exclusions. Those with coverage gaps could be charged 30% more for premiums for the first year of resuming coverage or state could request a waiver to permit insurers to medically underwrite for one year, charging sicker individuals higher rates for that year.
Gender Rating
Ban discriminatory premium pricing based on gender in all group and individual insurance plans. Ban on gender rating is not changed.
Essential Health Benefits (EHB)
Require all private insurance plans to cover 10 EHB categories, including maternity care and mental health services. EHB standards are repealed for the Medicaid expansion population.

States could apply for a waiver to re-define EHBs for the individual and small group health insurance markets.

Preventive Care
Require almost all private plans to cover preventive care without cost-sharing, including contraception and breast cancer screenings. Requirement for individual and group plans to cover preventive benefits, without cost sharing is not changed.
Issue Brief

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