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Some blogs this week circulated a bombastic claim about the House Republican health care plan: that it would make sexual assault a pre-existing condition that might result in denied coverage.
"Under Trumpcare plan, rape would be considered a pre-existing condition," said the Resistance Report May 3.
"In Trump’s America, rape is a pre-existing condition," read a headline by the Cut, a New York Magazine blog.
We should say right off the bat that the Cut has since changed its headline and issued a correction, as did Mic. The updated headlines say sexual assault "could" be a pre-existing condition, which is more accurate because it is not so definitive.
Here’s what’s wrong about the viral narrative.
Under the Affordable Care Act, insurance companies cannot deny coverage or charge higher premiums because a person has a pre-existing medical condition.
Republicans’ Affordable Care Act replacement — the American Health Care Act, which the House passed May 4 — weakens those protections.
These blog posts get at a real problem with the Republican bill if it were to become law. Victims of sexual assault could, conceivably, find themselves in a situation where they can’t afford insurance because of medical issues that stem from their assault.
But the headlines that say the GOP bill makes sexual assault a pre-existing condition are hyperbolic based on the what the bill actually says.
They stoke fears that the bill singles out victims of sexual assault, limiting their access to health care specifically.
But the Republican bill doesn’t pinpoint any specific medical event or diagnosis as a pre-existing condition; that’s something the insurance companies or individual states would decide. As it stands, anyone with a pre-existing condition could face problems.
Problems prior to the Affordable Care Act
The blogs discuss anecdotal stories of women who, prior to the Affordable Care Act, were sexually assaulted and then sought treatment stemming from that assault. Later, when these women tried to purchase health insurance, they were denied coverage.
These women weren’t necessarily denied coverage because of the sexual assault; rather, it was because of residual treatment they sought afterward, such as taking HIV-preventative medication or seeing a therapist.
None of the several health insurance experts we consulted were aware of insurance companies with policies that specify "sexual assault" or "rape" as a condition to consider when evaluating someone’s eligibility. But insurance resources did regularly list mental health issues or sexually-transmitted illnesses as pre-existing conditions.
For example, if a person were pricked with a used needle or had consensual sex with someone they later discovered had HIV, that person might also take HIV preventatives. And because they took that medication, they, like some sexual assault victims, might have trouble buying health insurance on the open market.
If a sexual assault victim chose not to seek medical treatment, he or she wouldn’t necessarily face the same challenge in getting insurance.
"This is not something specific about sexual assault," said Urban Institute senior fellow Linda Blumberg. "But to the extent victims of sexual assault are needing to take this (HIV) medication, they’re very vulnerable in terms of getting insurance coverage in the future."
What repealing the Affordable Care Act could mean
The Kaiser Family Foundation, an independent authority on health policy, recently wrote policy papers about pre-existing conditions prior to the Affordable Care Act and how repealing the law would affect women. Neither of those two articles say sexual assault victims would face a particular challenge.
The Republicans’ bill doesn’t change what is or is not a pre-existing condition.
What it does is allow more consideration of pre-existing conditions than is permitted under the Affordable Care Act.
"The bill just leaves it to the imagination at this point," Blumberg said, referring to what insurance companies might consider as a pre-existing condition.
To be clear, the bill doesn’t allow insurance providers to deny coverage to someone based on pre-existing conditions outright. But with a waiver, states can allow providers to set premium costs based on an individual’s "health status." Even though the bill puts in some protections, health economists say this could make insurance unaffordable for those with pre-existing conditions.
Before the Affordable Care Act, health insurance companies were not transparent about what counts as a pre-existing condition, and the House Republican replacement doesn’t change that, said Kathryn Votava, president of health care consulting company Goodcare.
This allows for the real possibility that sexual assault victims who seek medical treatment could face challenges in getting health insurance if the Republican bill becomes law, she said.
"Could" is the key word.
What ultimately happens depends on whether the bill is changed in the Senate and how states and insurance companies respond.
The lack of transparency, as well as the potential for different policies from state to state, would put a significant burden on consumers trying to figure out whether they can obtain insurance given their health status, said Claire Brindis, director of the Institute for Health Policy Studies at the University of California San Francisco.
For victims of sexual assault in particular, the bill could have a chilling effect, she added. Women might choose not to seek medical treatment after an assault because they are concerned it might affect their ability to get health insurance down the line.
Sexual assault "is the tip of the iceberg," Brindis said. "There are many many other examples of unexpected events that occur in day to day life, that you can’t plan for, can’t avoid."
Various bloggers wrote that under the House Republican health plan, sexual assault is a pre-existing condition.
Several websites have since softened their headlines to be more careful, going from "would" to "could."
The bill does not change what is or is not a pre-existing condition; the health insurance companies write those definitions for themselves. The House bill also does not single out sexual assault or any other medical issue as a pre-existing condition.
Prior to the Affordable Care Act, some victims of sexual assault said they had trouble getting health insurance because they sought medical services that the insurance companies viewed as evidence of a pre-existing condition, such as for sexually transmitted illness or mental health.
The Republican bill might make it harder for people who have pre-existing conditions to get affordable health care coverage. Victims of sexual assault would face the same challenge as others with pre-existing conditions. But we don’t know for sure given the bill’s current form.
We rate this claim Mostly False.
Congress, Affordable Care Act, passed Jan. 5, 2010
Congress, American Health Care Act, passed House May 5, 2017
Kaiser, "Summary of the American Health Care Act," May 4, 2017
Kaiser, "Ten Ways That Repealing and Replacing the Affordable Care Act Could Affect Women," March 22, 2017
Huffington Post, "Rape Victim’s Choice: Risk AIDS or Health Insurance?" March 18, 2010
PolitiFact, "Does the GOP's new health care bill still cover pre-existing conditions, as Trump claims?" May 1, 2017
Phone interview, Goodcare President Kathryn Votava, May 4, 2017
Phone interview, UCSF Institute for Health Policy Studies Director Claire Brindis, May 4, 2017
Phone interview, Urban Institute senior fellow Linda Blumberg, May 4, 2017
Email interview, Georgetown professor Sabrina Corlette, May 4, 2017
Email interview, Kaiser spokesman Craig Palosky, May 4, 2017
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