Fact check: Does the AHCA make being a woman a pre-existing condition?
Cecile Richards, president of Planned Parenthood
At a speaking event following the passage of the American Health Care Act (AHCA) in the U.S. House of Representatives, Planned Parenthood President Cecile Richards said of the bill, “Being a woman is going to be now a pre-existing condition in this country.”[1]
Does the AHCA make being a woman a pre-existing condition?
In support of Richards’ claim, Planned Parenthood cites a provision in the bill that would permit insurers, under limited circumstances, to factor in health status (i.e. pre-existing conditions) when setting premium rates. But such circumstances would not be limited to women, nor would the pre-existing conditions that could be considered only affect women. Therefore, Richards’ claim is false.[2][3]
Moreover, as currently written, the legislation states that insurers cannot charge applicants higher premiums based on gender.[2]
Background
The AHCA, if enacted, would repeal some provisions of the Affordable Care Act (ACA), including the individual mandate; income-based tax credits; and cost-sharing mechanisms. It would implement age-based tax credits and restructure Medicaid funding, among other changes.[4] The bill passed the House on May 4 by a four-vote margin (217 “yes” votes from Republicans and 213 “no” votes from 193 Democrats and 20 Republicans).[5]
Is being a woman a pre-existing condition?
Under the Affordable Care Act, health insurers are prohibited from charging different premiums within a given community based on age, gender, health status or other factors. That precludes insurers from pricing coverage based on pre-existing conditions.[6][7]
The House bill contains an exception to this “community rating” rule. New Jersey Republican Rep. Tom MacArthur introduced an amendment to the legislation, which was adopted, to permit states to seek a waiver from the secretary of Health and Human Services to factor health status into premiums for individual coverage under limited circumstances. [8][9][10] The waiver would not apply to employer-based insurance, Medicaid, or Medicare.[11]
Under the waiver, insurers would be permitted to consider health status when setting a premium only if the applicant had a lapse in insurance coverage of 63 continuous days or more during the 12 months prior to applying for a policy.[12] However, insurers would have to recalculate the premium after one year without considering health status if there was no lapse in the individual’s coverage (of 63 continuous days).[13][2]
The waiver provision is intended to limit the number of individuals who would only obtain health insurance after becoming ill and requiring costly treatment.[14]
In order to qualify for a waiver, states would be required to design a program to reduce average premiums; increase insurance enrollment and expand health plan choices; improve access to preventive care; and/or provide assistance for out-of-pocket medical costs.[2]
According to Planned Parenthood, the MacArthur amendment “disproportionately affects women—insurers can claim having given birth, having had a C-section, or having been a survivor of domestic violence is a so-called pre-existing condition.”[2][3][15]
However, the circumstances in which a pre-existing condition could affect insurance rates would not be limited to women, nor would the pool of pre-existing conditions be limited to those impacting women.
Moreover, the MacArthur amendment states that insurers would be prohibited from considering gender in setting rates, nor could they deny coverage because of a pre-existing condition. As the bill states: "Nothing in this Act shall be construed as permitting health insurance issuers to discriminate in rates for health insurance coverage by gender. … Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions."[2]
Whether states would apply for or receive waivers and what impact that might have on women (or any other demographic group) are matters of speculation.
Conclusion
At a speaking event following the passage of the American Health Care Act (AHCA) in the U.S. House of Representatives, Planned Parenthood President Cecile Richards said of the bill, "Being a woman is going to be now a pre-existing condition in this country."[1]
Richards’ claim is inaccurate. The House bill, as currently written, states that insurers would be prohibited from considering gender in calculating premiums. The health conditions that insurers could consider in rate-setting would not only affect women or affect all women.[2]
See also
- American Health Care Act of 2017
- History of healthcare policy in the United States
- Fact check/Did 14.5 million gain health insurance through Medicaid expansion?
Sources and Notes
- ↑ 1.0 1.1 The Guardian, “Planned Parenthood Head: ‘Being a Woman is Now a Pre-existing Condition,’” May 5, 2017
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 House of Representatives Committee on Rules, “Amendment Offered by Mr. MacArthur of New Jersey,” accessed May 17, 2017
- ↑ 3.0 3.1 Planned Parenthood, “Planned Parenthood Slams U.S. House for 'Defunding' in the Worst Bill for Women’s Health in a Generation,” May 4, 2017
- ↑ Government Publishing Office, “H.R. 1628,” March 20, 2017
- ↑ Office of the Clerk, U.S. House of Representatives, “Final Vote Results for Roll Call 256,” May 4, 2017
- ↑ Healthcare.gov, “Community rating,” accessed May 18, 2017
- ↑ Investopedia, “Pre-Existing Condition,” accessed May 19, 2017
- ↑ The amendment would also allow states to apply for waivers from the age rating ratio cap of 5:1 (meaning premiums for older individuals cannot be more than five times higher than for younger individuals) set by the AHCA and from the list of essential health benefits specified by the ACA. Government Publishing Office, “The Patient Protection and Affordable Care Act, Sec. 1302,” March 23, 2010
- ↑ In addition to the MacArthur amendment, the Upton amendment calls for the appropriation of an additional $8 billion between 2018 and 2023 to be allocated to states that obtain waivers under the MacArthur amendment and specifies that states must use the funds to reduce premiums or out-of-pocket expenses for individuals whose costs would increase due to the waiver(s). U.S. House of Representatives Document Repository, “Amendment to H.R. 1628, Offered by Mr. Upton of Michigan,” May 3, 2017
- ↑ Government Publishing Office, “H.R. 1628, Sec. 2202,” March 20, 2017
- ↑ According to the Census Bureau’s 2015 Current Population Survey (most recent data available), 16.3 percent of the population had insurance through the individual market at some point that year. United States Census Bureau, “Health Insurance Coverage in the United States: 2015,” September 2016
- ↑ The waiver would apply to plans beginning in 2019 or during the 2018 special enrollment period.
- ↑ See definitions for “applicable policyholder” and “enforcement period” in the AHCA: Government Publishing Office, “H.R. 1628, Sec. 2710A(b),” March 20, 2017
- ↑ Speaker Paul Ryan, "VERIFIED: MacArthur and Upton Amendments Strengthen AHCA, Protect People with Pre-Existing Conditions," May 2, 2017
- ↑ The Washington Post fact-checked the claim that the AHCA would make domestic violence a pre-existing condition and found it to be false. The Washington Post, “Despite critics’ claims, the GOP health bill doesn’t classify rape or sexual assault as a preexisting condition,” May 6, 2017
Launched in October 2015 and active through October 2018, Fact Check by Ballotpedia examined claims made by elected officials, political appointees, and political candidates at the federal, state, and local levels. We evaluated claims made by politicians of all backgrounds and affiliations, subjecting them to the same objective and neutral examination process. As of 2025, Ballotpedia staff periodically review these articles to revaluate and reaffirm our conclusions. Please email us with questions, comments, or concerns about these articles. To learn more about fact-checking, click here.
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