Photo: AP

After a wave of public outcry, yesterday, the GOP’s controversial American Health Care Act narrowly passed in the House of Representatives. While a horde of Republicans were toasting in the Rose Garden afterward, millions of Americans struggled to make sense of the calamity they had just witnessed. For many women and non-binary people, seeing the bill move onto the Senate means the state of their health—and lives—rests in the hands of people who seem to have forgotten their humanity. It’s more than a disappointment—the deeply misogynistic implications of the bill feel like a punishment for existing as anything other than a man.

The second iteration of the American Healthcare Act is similar to the first version in that it’s terrible, especially for people who are poor and/or identify as female or non-binary. After the first version of the AHCA failed to pass, the GOP had to get crafty in order to attract more far right voters. Their answer came in the form of an amendment from Rep. Tom MacArthur of New Jersey, which would allow states to opt out of “essential health benefit” requirements, which, under Obama’s Affordable Care Act, all plans had to cover. The MacArthur amendment would allow states to offer their own requirements, which is far more insidious than it sounds. By giving states the power to make their own rules for who receives certain forms of care, women—who are the primary beneficiaries of basic services like maternity care, birth control, and more—have the most to lose.

Under the Affordable Care Act, it was also illegal to discriminate against people with pre-existing conditions. But the MacArthur Amendment would allow states to repeal this restriction among others, giving them the power to choose who has to pay more for healthcare.

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“This new bill would be disastrous for women’s health in general, and would have a disproportionate impact on women and families with low income, as well as women of color, in part because of how it allows discrimination based on pre-existing conditions,” Dr. Raegan McDonald-Mosley, Planned Parenthood’s Chief Medical Officer, told Gizmodo. “For example, if a woman has a C-section, that would be considered a pre-existing condition, and she could be charged much higher premiums for healthcare coverage.”

Women are more likely to be survivors of domestic violence, sexual assault, and/or have mental health conditions, which insurance companies are also allowed to consider pre-existing conditions under the AHCA.

It’s hard to read the rest of the list and not feel like according to Republicans, being a woman is a pre-existing condition. For people who identify as such, there’s a palpable feeling of being punished.

Photo: AP

“I have had ovarian cysts that may recur,” Talia L., 27, told Gizmodo. “I’m scared that may count as a preexisting condition. It’s already an example of sexist bias in our medical system that so much gynecological care is considered specialized, that women are so much more vulnerable to ‘preexisting conditions.’ The AHCA is a punishment, in some ways, for existing in a female body.”

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Cisgender women aren’t the only ones with a lot to lose. Under the AHCA, being transgender could be considered a pre-existing condition, as there are no stipulations in the bill that protect trans people from insurance companies discriminating against them—under Obamacare, trans people were explicitly protected under Section 1557 of the Affordable Care Act. For many transgender and gender nonbinary folks, getting healthcare is already a humiliating experience—under the AHCA, it’d be a nightmare.

“I’m 19 and have little to no contact with my parents and thus am not a part of their healthcare,” Vin Tanner, who identifies as nonbinary, told Gizmodo. “I’m concerned because not only does my transness make me uninsurable, but it also means even [if] this bill doesn’t pass, people can still deny me service on religious freedom grounds. The [AHCA] targets people with uteruses too, and that affects me—I can get pregnant just like [cis women] and I face all the same risks in life. It sucks because you end up fucked over in even more ways.”

One of the most disturbing aspects of the AHCA is that, depending on which state a person lives in, her insurance could consider her to have a “pre-existing condition” if she’s a sexual assault survivor. While not all sexual assault survivors are women, according to the Rape, Abuse & Incest National Network (RAINN), women are disproportionately victims of sexual violence. “Females ages 16-19 are 4 times more likely than the general population to be victims of rape, attempted rape, or sexual assault,” the organization reports.

“I’m a woman, and I’ve been raped,” Cindy* (name changed), 32, told Gizmodo. “I get insurance through my employer, but now I am scared that I will have to disclose my rape, pay more, or lose coverage. I’m devastated by the GOP voting yes on the AHCA...it is monstrous to see them gleefully celebrating while millions are terrified for their very lives.”

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Alex, an astronomer, echoed some of Cindy’s fears.

“I am afraid about my healthcare. Crohn’s, ulcerative colitis, depression, PTSD from sexual assault,” she told Gizmodo. “I’ve been able in the last eight years to get treatment and insurance without worrying about being uninsurable or lifetime limits. And now, I worry I’m going to have to choose between medical debt and a slow, agonizing death.”

Allowing insurers to drop essential women’s health services and discriminate against a litany of pre-existing conditions isn’t all the AHCA would do. The legislation would ban medicaid funding from going to Planned Parenthood for a year, which would be a heavy blow to the organization that is a primary health care provider for many women. The latest version of the bill also prevents the use of federal tax credits to pay for any health plan offering abortion services. To throw even more salt on the wound, on Thursday, president Trump delivered an executive order on religious liberty, which includes “religious objections to the Obama administration’s mandate in the Affordable Care Act,” according to The New York Times. While it isn’t clear yet how the order will be implemented, it opens the door for employers to deny their employees birth control coverage on the grounds of religious beliefs.

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And now, the wait begins. While there hasn’t been a date announced for the senate vote on the AHCA, it’s expected that sometime in the next few weeks, we’ll know more. While it’s understandable to feel hopeless, McDonald-Mosley said there’s still time to put the pressure on congress.

“It’s really important that people let their senators know that they’re going to be held accountable if they pass this bill,” she said. “It clearly shows the values of the Republicans in the House, that they have prioritized tax cuts for the wealthy over protecting coverage for the citizens of this nation.”