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Rape Could Become a 'Pre-Existing Condition' Again Under Trumpcare

Before the ACA, insurance companies could refuse to pay for crucial medical services for rape survivors because sexual assault was considered a pre-existing condition. The GOP's new healthcare plan could reinstate that cruel reality.
Photo by Per Swantesson via Stocksy

In 2008, Kimberly Fallon was raped. During her medical exam, the 38-year-old New York woman told her nurse about being assaulted 17 years earlier in college. Months later, she told the Huffington Post, she received a bill from her doctor's office for the treatment. Apparently, her insurer, Blue Cross Blue Shield, had declined payment for the rape exam because she "had been raped before."

In recent years, survivors of sexual assault haven't had to endure the kind of heartlessness Fallon faced when she was forced to pay out of pocket for care associated with being attacked. Denying a person health care coverage because of their medical history—also known as having pre-existing conditions—was banned under the Affordable Care Act. But today, House Republicans are planning to vote on a new health care bill that would repeal the ACA, and, thanks to the inclusion of a new amendment, in effect roll those protections back.

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Read more: Rape Victims Who Go to the Emergency Room Forced to Pay About $1,000 in Bills

In short, rape could once again become a pre-existing condition that insurance companies could deny coverage for.

According to researchers from the Center on Budget and Policy Priorities, the new MacArthur-Meadows Amendment does nothing to fix the American Health Care Act's largest problems, which include offsetting costs and coverage loss. Instead, it "would largely restore pre-ACA rules for people with pre-existing conditions. Just like before the ACA, insurers could discriminate based on medical history, eliminate coverage for key health services, and impose annual and lifetime limits on benefits, except in states that chose to prohibit these practices."

Proponents argue that the amendment doesn't actually roll back those protections for people with pre-existing conditions; rather, it leaves that decision with states. This morning, Oklahoma Rep. Tom Cole told NPR that he thought it was "very unlikely that any states will remove the preexisting conditions clause." But data from the National Conference of State Legislatures reveals that, before the ACA was passed, most states did not require insurance companies to offer coverage despite claims history or health status.

And while the amendment's language doesn't outright say insurance providers can deny coverage, it does offer a waiver that would allow providers to charge people more based on their medical history. And, according to Linda Blumberg, a senior fellow in the Health Policy Center at the Urban Institute, "that's effectively denying people coverage."

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Individuals' health quality will decline and mortality rates will increase. It's unfortunate that in our society, we place focus on profits and not people.

A study published earlier this year found that rape is exorbitantly expensive for victims who choose to go to the hospital: According to its findings, the average cost of rape in 2013 was $6,737. Thanks to the ACA, insurance companies picked up about 86 percent of those costs. If the AHCA makes it through the House and Senate as is, though, individuals may go from incurring 14 percent of the costs to a full 100 percent of costs, says Ashley Tennessee, an assistant professor of health care studies at the Medical University of South Carolina in Charleston, "and that's egregious."

While a rape may seem like an isolated incident, it's actually a precursor to other chronic health conditions, Tennessee explains—such as PTSD, withdrawal, depression, and other mental illnesses. "If an individual has been raped, that insurance provider is [seeing the potential for an] extensive health care bill," with visits to the psychiatrist, and the possibility of the insured engaging in high-risk activities or even chronic drug use to deal with their attack.

Allowing states the option to waive the ban on denying coverage for pre-existing conditions, including sexual assault, creates a scenario for a potential public health crisis, Tennessee continues. By weeding out people with chronic health conditions from its coverage pool, an insurance provider sees its profit margins trend up, but the quality of individuals' health trend downward, she says. That means more people who don't have coverage will go to the emergency room for care, which taxes a hospital's charity care lines. As a result, she says, more hospitals will close their doors.

"We're going to have communities without even access to hospitals," Tennessee says. "And individuals' health quality will decline and mortality rates will increase. It's not rocket science. It's unfortunate that in our society, we place focus on profits and not people."

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Another possible outcome if the bill passes is that sexual assault reporting rates may go down. "If sexual assault becomes an exclusionary criterion, I'm thinking many people are not going to want to report these crimes to the proper authorities because they're not going to want it in black and white if it will impact their health insurance."

"So now we're going to have even more victims suffering alone in silence," she says.