Navigating Women's Health

Under the ACA:

Proposed under the AHCA:

  • Require all plans offered in the individual and small group markets to cover ten categories of essential health benefits including maternity care and preventive care, such as contraception and cancer screenings.
  • Prohibit preexisting conditions exclusions which historically have included pregnancy, prior C-section, and history of domestic violence.
  • Prohibit discriminatory premium pricing based on gender (gender rating).
  • Prohibit abortion coverage from being required. Federal premium and costsharing subsidies cannot pay for abortion beyond saving the life of the woman or in cases of rape or incest (Hyde amendment). If a subsidy-eligible individual enrolls in a plan that chooses to cover abortion services federal subsidy funds must be segregated from private premium payments or state funds.
  • Prohibit plans from discriminating against any provider because of an unwillingness to provide, pay for, provide coverage of, or refer for abortions


  • ACA essential health benefit requirement for individual and small group health insurance policies is not changed, including requirement to cover maternity care as an essential health benefit; however, EHB can be changed under state waiver authority.
  • Requirement for individual and group plans to cover preventive benefits, such as contraception and cancer screenings, with no cost sharing is not changed. Summary of the American Health Care Act 4
  • Prohibition on gender rating is not changed
  • Prohibition on pre-existing conditions exclusions, including for pregnancy, prior Csection, and history of domestic violence, is not changed.
  • Prohibit federal Medicaid funding for Planned Parenthood clinics for one year, effective upon date of enactment. Specifies that federal funds to states including those used by managed care organizations under state contract are prohibited from going to such entity.
  • In states electing Medicaid block grant, family planning would no longer be a mandatory covered service.
  • Redefine qualified health plan to exclude any plan that covers abortion services, beyond those for saving the life of the woman or in cases of rape or incest (Hyde amendment), effective in 2018
  • Prohibit federal premium tax credits from being applied to plans that cover abortion services, beyond Hyde limitations. Disqualify small employers from receiving tax credits if their plans include abortion coverage beyond Hyde limitations, effective in 2018. Does not prevent an insurer from offering or an individual from buying separate policies to cover abortion as long as no tax credits are applied.
  • would achieve at least one of the following goals: reduce average health insurance premiums, increase health coverage enrollment, stabilize the health insurance market, stabilize premiums for people with pre-existing conditions, or increase choice of health plans.