Tomorrow, the House will vote on the Republican "replace and repeal" plan for the Affordable Care Act, which they call the American Health Care Act. The last time AHCA was brought to vote it was clear it was in no way an improvement on ACA, and a vote was postponed until more changes could be made that Republicans assumed would get them more votes (which they still don't have ).

Last time, AHCA would have been detrimental to many Americans, especially women . And AHCA 2.0 is no different.

The main change to the first iteration of AHCA comes from an amendment proposed by Rep. Tom MacArthur of New Jersey, which would allow states to opt out of "essential health benefit" requirements and offer their own requirements instead.

Under ACA, all plans must cover "essential benefits ," which include things any rational person would consider essential to health care—hospitalization, prescription drugs, and preventative services like vaccines. Many of these benefits, however, directly benefit women. Pregnancy, maternity, and newborn care are essential benefits, as are birth control and breastfeeding coverage. Under AHCA, states could apply to not include those benefits.

Back in 2010, it was legal in several states to deny somebody coverage because they were a domestic abuse survivor. That was considered a pre-existing condition.

"The MacArthur amendment just makes things kind of worse," Dr. Diane Horvath-Cosper, an Advocacy Fellow at Physicians for Reproductive Health, told ELLE.com. "The thIng to remember is that this bill is so bad that when the initially put this change through, members of congress wrote in an exception for themselves. If you can't even be subject to the bill's provisions yourself, how do you even put that out there?"

Dr. Horvath-Cosper says that, by letting states decide on their own essential benefits lists, women could be disproportionately targeted as having pre-existing conditions. "Back in 2010, it was legal in several states to deny somebody coverage because they were a domestic abuse survivor. That was considered a pre-existing condition," she said. So was having had a C-section. "Most of the people who have C-sections identify as women, so that's a shorthand for a gender discriminatory policy." Also, under this new plan, that "high-risk pool" of people who have a pre-existing health condition would not have enough funding from everyone else.

Those who support AHCA argue that, by opting out of these benefits, they could sell cheaper plans to people who will never need birth control, mental health care, or other essential benefits. But many fundamentally understand how insurance works. Rep. Mo Brooks of Alabama said in an interview on CNN that "people who lead good lives, they're healthy, they've done the things to keep their bodies healthy," will get to pay less, as if having a pre-existing condition is a matter of morality. Sorry if you were born with diabetes, or got hit by a car and now have to manage chronic pain. Also, does he think anyone deciding to get pregnant isn't living a good life?

The MacArthur Amendment states that "Nothing in this Act shall be construed as permitting health insurance issuers to discriminate in rates for health insurance coverage by gender," nor shall it be construed to "limit access to health coverage for individuals with pre-existing conditions." But that's exactly what the rest of the amendment would allow. If a state decides to not include maternity care as an essential benefit, "a majority of people who get pregnant identify as women, so that's gender discrimination, straight up," says Dr. Horvath-Cosper. Similarly, if premiums are higher for anyone with a pre-existing condition, and insurance companies decide that having had a C-section is one, women will be disproportionately affected.

Most of the people who have C-sections identify as women, so that's a shorthand for a gender discriminatory policy.

"I see the benefits of ACA every single day. I saw patients in my practice who had not been able to get health insurance for five, ten years finally come in and get care because they could finally afford the premiums, or get maternity coverage," said Dr. Horvath-Cosper. And, as town halls across the country show, Americans have been vocal about wanting to keep their existing protections.

Jaya Saxena I'm a writer and author from New York City who covers everything from sex to culture to witchcraft.

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