Moving Backward
Efforts to Strike Down the Affordable Care Act Put Millions
of Women and Girls at Risk

By Jamille Fields Allsbrook and Sarah Coombs
This column was published in Center for American Progress,
Getty/AFP/Dominick Reuter--A mother and her daughter visit a
pediatrician at a medical center in Philadelphia, March 2017.
This piece is an update to a column published last year by the Center for American
Progress and the National Partnership for Women & Families.

The Affordable Care Act (ACA) guarantees women critically important consumer
protections, including by prohibiting discriminatory insurance practices in pricing and
coverage in the individual market. Before the law was enacted, women routinely were
denied or charged more for coverage if insurers determined that they had a preexisting
condition and, due to discriminatory gender rating practices, were often charged more
solely on the basis of their gender. For example, in the individual insurance market, a
woman could be denied coverage or charged a higher premium if she had a diagnosis of
HIV or AIDS, lupus, or an eating disorder, among other conditions, or even if she had
previously been pregnant or had a cesarean birth. Making matters worse, due to systemic
racism and entrenched health disparities, women of color experience higher rates of certain chronic conditions—such as diabetes, cervical cancer, and
asthma—that can lead to higher rates of coverage denial and higher premiums.

Thanks to the ACA, all women with preexisting conditions in the individual market are assured fair access to comprehensive and affordable health coverage.
Unfortunately, recent efforts to repeal and undermine the law would put millions of women and girls once again at risk of being charged more or denied

Efforts to repeal the ACA threaten the health and economic security of millions of women

The fate of the ACA is once again at stake, pending a decision from the 5th U.S. Circuit Court of Appeals in the health care repeal lawsuit known as Texas v.
United States. Texas and 17 other states—with support from the Trump administration—are challenging the ACA’s constitutionality, including its guaranteed
issue provisions and community rating system. Without guaranteed issue protections, women could be denied coverage based on their medical history, their
age, and their occupation, among other factors. Without community rating, they could be charged more, or priced out of the insurance market altogether, based
on their health status or other factors. Moreover, if the entire ACA is repealed, insurance companies could try to reinstate gender rating, a common pre-ACA
practice in which insurance companies charged higher premiums for women than they did for men.

If the court rules to strike down the entire ACA, there will be devastating consequences for everyone; but these negative outcomes will be most pronounced
for the millions of women with preexisting conditions and, in particular, for women of color and women with low incomes, whose health and economic
security would be most at risk.

More than half of all women and girls have preexisting conditions

The authors of this column estimate that more than half of nonelderly women and girls nationwide—nearly 68 million—have preexisting conditions. There are
also approximately 6 million pregnancies each year, a commonly cited reason for denying women coverage on the individual market before the ACA. The table
below provides state-level detail for the number of women and girls with preexisting conditions and the number of pregnancies.

A large share of women have insurance through an employer or Medicaid, and therefore, their coverage would protect them from discriminatory practices
such as medical underwriting or denials based on health conditions. But the data make clear that allowing insurers to return to pre-ACA practices could lead
to millions of women and girls being denied coverage or charged more based on their health status if they sought coverage in the individual market.

Jamille Fields Allsbrook is the director of women’s health and rights for the Women’s Initiative at the Center for American Progress. Sarah Coombs is the
senior health policy analyst at the National Partnership for Women & Families—a nonprofit, nonpartisan advocacy group dedicated to improving the lives of
women and families by achieving equality for all women and focusing on issues that increase equity, health, reproductive rights, and economic justice. More
information is available at