With the termination of the Trump administration just hours away, women’s health care is due for a hard reset in the new Biden-Harris era. Many healthcare experts are bracing for immediate reversals of Trump policies that directly impacted women, while the bigger question of how the “Bidencare” plan to build and expand on Obamacare with a new public option will affect women’s health still remains.
With Democratic control of the House of Representatives, the Senate and the White House, much of Biden’s healthcare agenda is likely to come to pass. We’ve laid out just a handful of the ways healthcare for women is likely to transform over the next few years as the U.S. undergoes a major ideological repositioning.
Plan to ‘protect and build on Obamacare’
The most explosive upcoming change to the overall healthcare landscape is within the Biden administration’s promise to “protect and build on” the Affordable Care Act (ACA), better known as Obamacare. The healthcare law which was the signature legislation signed by President Barack Obama in 2010, when President-elect Biden served as vice president. Biden’s latest healthcare plan includes a public option for healthcare insurance alongside the current private market.
The ACA brought about huge change for the American health insurance market by requiring a number of essential health benefits and no-cost preventive services including contraceptive care. It also included some of the most popular healthcare provisions to date, such as protections for those with pre-existing conditions and enabling young people to stay on their parent’s insurance plans until the age of 26. Since the healthcare law was implemented, an additional 20 million people gained insurance coverage. A public option signals another huge shift.
“It’s a significant change to the Affordable Care Act, while at the same time protecting a system that Americans have gotten used to, both in the years since the ACA has been implemented but through the history of private insurance in America,” Dania Palanker, JD, assistant research professor at the Center on Health Insurance Reforms at Georgetown University, told The Whipp.
The public option has been touted as being “like Medicare,” which is the federal healthcare program for seniors. Americans will have the choice to purchase a public option resembling Medicare or the same private health insurance offerings on the ACA exchanges. The public option is expected to be cheaper because the government will have the power to negotiate prices with healthcare providers like it does with Medicare.
Biden has also promised to make private healthcare coverage options more affordable by expanding the tax credits already in place under the ACA. While families can currently receive subsidiaries to pay for their health insurance up to 400% of the federal poverty level, Biden plans to eliminate the 400% cap and instead lower the limit of the cost of coverage from 9.86% of income to 8.5%.
“This means that no family buying insurance on the individual marketplace, regardless of income, will have to spend more than 8.5% of their income on health insurance,” Biden’s plan states.
Making healthcare coverage more affordable, while also ensuring that coverage is fully comprehensive, is one of the best ways to improve women’s health.
“That would have the dual effect of not just making health insurance more affordable, but because comprehensive health insurance is more affordable, fewer women will need to look to alternative coverage” that doesn’t cover most women’s health services, Palanker told The Whipp. “Making coverage more affordable and expanding the health insurance subsidies is really the biggest step that could be made to cover those women who are going without coverage because it’s unaffordable.”
Women’s health policies
Women’s health care is expected to see a number of rapid changes once the Trump administration is out the door, in part because some of the damage done in the Trump era is likely to be overturned.
One way Trump undermined Obamacare protections for women was by expanding religious exemptions for employer-sponsored health plans to cover contraceptive care at no cost. Some religious-affiliated organizations have been able to fight this ACA requirement successfully, most famously after Hobby Lobby won their Supreme Court case and was allowed to block their employees from accessing birth control on their health plans. The Trump administration pushed these exemptions even further.
“They went well beyond where the Supreme Court went in the Hobby Lobby case and expanded the religious exemption to many more employers and schools,” Palanker told The Whipp. “Effectively all employers and schools can claim religious exemption. In addition, they added a moral exemption, which means that the employer doesn’t necessarily have to be affiliated with a religion that is opposed to birth control, but can have some type of moral opposition to it, which is unprecedented in law.”
The Trump administration also altered a type of health insurance coverage called short-term health plans, which were intended to offer individuals basic coverage for a short period of time. For example, these plans could prove useful for a person transitioning between jobs or for students between insurance coverage. Short-term health plans specifically do not have to cover the essential health benefits mandated under the ACA and have been criticized as “junk plans” by some leaders. Instead of limiting these plans, which do not cover many necessary services, the Trump administration’s new rules allowed people to remain on them for up to three years.
“They were limited by the Obama administration and expanded by the Trump administration with encouragement that these plans are an option for long-term coverage instead of comprehensive health coverage,” Palanker said about short-term health plans. “And specifically to women, those plans do not cover maternity [care]. A lot of them explicitly exclude contraceptive coverage. ...These plans explicitly exclude women’s healthcare services. Many also exclude coverage for abortion services.”
Another critical women’s health policy area to watch under Biden is abortion access, which has been increasingly constrained at the state level and threatened at the federal level. And there are a few ways for the Biden administration to make immediate changes.
Namely, they could overturn, via executive order, the changes to the Title X family planning program made by the Trump administration, which took aim at the program by severing federal funding to organizations with comprehensive reproductive health care that included abortion access.
Title X supports roughly 4,000 service sites annually, with more than 4 million people relying on the program for essential services like contraceptive care, wellness exams, lifesaving cancer screenings and more, according to Planned Parenthood. The Trump-era regulations led to about 1,000 clinics leaving the program, an analysis from the Kaiser Family Foundation found. The regulation also deeply impacted Planned Parenthood.
The “domestic gag rule” implemented by the Trump administration imposed “sweeping and destructive changes to Title X,” by prohibiting abortion referrals, imposing coercive counseling for pregnant patients and imposing strict separation from Title X-funded activities and abortion-related services, according to the Guttmacher Institute.
It is likely the Biden administration will restore the previous standards of care under Title X soon after taking office, as Biden campaigned on restoring funding to Planned Parenthood, which has treated 1 in 5 women in the U.S.
"We have a ton of work to do to undo the harm over the last four years, but knowing we have champions there who understand what needs to happen in the first 100 days is tremendously exciting," Alexis McGill Johnson, president and CEO of Planned Parenthood, told NBC News.
Beyond Title X, President-elect Joe Biden also campaigned on overturning the Hyde Amendment, which has restricted federal money for abortion services in the Medicaid program since 1976. Hillary Clinton similarly advocated for a reversal of this law when she ran for president in 2016.
Transgender health protections
One of the most discriminatory policies enacted by the Trump administration was the removal of nondiscrimination protections for LGBTQ people. The rule meant that protections are not allowed based on gender identity or sexual orientation, applying only to discrimination against someone for being male or female, NPR reported in June 2020 when the rule was finalized.
Biden heavily criticized the rule last year, calling out the administration for its “cruelty” toward LGBTQ people.