Tuesday, June 27, 2017
By Risa E. Kaufman, Director of US Human Rights at the Center for Reproductive Rights, and lecturer-in-law at Columbia Law School
Leaving an estimated 22 million people uninsured, the Senate bill to repeal the Affordable Care Act targets low-income women and exacerbates persistent and deep racial disparities in maternal health. The bill would erase critical gains made in women’s access to healthcare. And it would undermine women’s human rights.
Human rights principles require health care that is available, accessible, acceptable, and of good quality. The bill threatens each of these principles, with particular impact on women. In addition to making severe cuts to Medicaid (which covers half of all births), the Senate Bill prohibits people who receive Medicaid coverage from accessing preventative and other healthcare services at Planned Parenthood. It allows states to waive the provision of essential health benefits, eliminating the guarantee of maternity care. The Bill allows states to impose a work requirement for Medicaid recipients, meaning that states may require new mothers receiving Medicaid to find work within two months of giving birth. It prohibits some immigrants from purchasing insurance on state exchanges and eliminates related financial assistance. And it limits women’s ability to purchase private insurance coverage for abortion care (women receiving Medicaid are already denied this coverage for most abortions).
The Senate’s healthcare repeal bill violates other core principles of human rights, as well.
Human rights requires transparency, participation, and inclusion. Yet, the Senate bill was cloaked in secrecy and drafted behind closed doors. The bill’s drafting committee, comprised of 13 men, held no public hearings on the bill, thus excluding critical perspectives and input.
Human rights requires universality and non-discrimination. Contrary to these principals, the Senate bill targets women’s access to reproductive and maternal health care, further restricts immigrants’ access to health care coverage, and disproportionately impacts people of color.
Women’s access to health care in the United States is of dire concern. The United States is the only wealthy country with a rising maternal mortality rate. The number of women in the U.S. experiencing life-threatening complications during pregnancy and child birth is rising, as well.
Black women are at the highest risk. In the United States, Black women are between three and four times more likely to die in child birth than white women, and twice as likely to suffer life-threatening pregnancy complications. These racial disparities in poor maternal outcomes are inextricable from structural discrimination and the inequalities that shape underlying determinants of health, including access to housing, education, employment, and safety.
Immigrant women in the United States face life threatening challenges in accessing health care, as well. As a stark illustration, Latina immigrants in the Rio Grande Valley in Texas have documented the barriers they face in accessing basic reproductive healthcare services, and the resulting severe health risks.
Indeed, over the past several years, women’s access to health care has raised alarm among human rights experts. The UN Committee on the Elimination of Racial Discrimination recently expressed concern over the difficulties immigrants face in accessing adequate health care, and the persistent high rates of maternal mortality among Black women in the United States. The Committee called on the U.S. to ensure access to adequate and affordable health care for all and improve monitoring and accountability for preventable maternal mortality. The UN Working Group on discrimination against women in law and practice recommended that the U.S. address racial disparities in maternal health. Similarly, the UN Working Group on People of African Descent recommended that the U.S. prioritize policies and programs to reduce maternal mortality for Black women.
Contrary to these recommendations, the Senate bill paves the way for eliminating essential benefits such as maternal health care, reduces subsidies for Medicaid, further restricts women’s access to abortion care, and defunds Planned Parenthood. The bill would deprive millions of women of critical health care benefits and deepen persistent and wide-spread racial disparities in maternal health. It is yet another reminder that the fight for human rights begins at home.