Repealing the ACA: What it Could Mean for Maternal Mental Health


By Bridget Frese Hutchens, MSN, RN, CNM and Joy Burkhard MBA

President Trump’s promise to repeal the Patient Protection and Affordable Care Act (ACA), also known as Obamacare, is stirring up controversy around the country.  This week’s announcement that the repeal will occur in 2018 has provided a bit of breathing room, though the fear and uncertainty for many Americans who rely on ACA coverage still exists with the looming threat. Within hours of taking the oath of office, President Trump issued his first executive order instructing federal agencies, such as Health and Human Services and the Treasury, “to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market.”

At 2020 Mom, we are concerned about how repealing the ACA may impact Americans, particularly women at risk for or suffering from maternal mental health (MMH) disorders.

What the ACA Provides

Under the ACA, 20 million Americans gained private health insurance coverage which included 9.5 million women. The Act worked by mandating that everyone get health insurance in 2014 or pay a tax. It provides subsidies (or financial assistance) for middle-income families (who don’t qualify for Medicaid or Medicare) and small businesses by taxing some healthcare providers and high-income families.

In addition to the health insurance mandate, the ACA contains other measures that support women’s health such as funding for Maternal, Infant and Early Childhood Home Visiting (MIECHV) and women’s preventive health care. MIECHV provides home visiting services to vulnerable mothers and children, including the Nurse-Family Partnership and other similar programs. Women’s preventive services are outlined by the U.S. Preventive Services Task Force (USPSTF) and include insurance coverage for maternity care, breastfeeding support and supplies, and birth control. The USPSTF recommendations also include screening for depression during pregnancy and the postpartum period. It is estimated that 55 million women have benefitted from these preventive health provisions.

What a Repeal Could Mean

According to a report issued by the nonpartisan Congressional Budget Office, repealing the ACA without a replacement would result in a 20-25% increase in insurance premiums for individual policies purchased on the insurance exchange (also known as the marketplace). Also, the Office estimates 18 million people would lose their coverage. Both numbers would continue to rise, premium prices rising to 50% the following year and uninsured rates to 27 million as the full repeal were to take effect.

A bill introduced in late January by two Republican Senators, Bill Cassidy, R-LA., and Susan Collins, R-ME, would allow states like California who embraced the Affordable Care Act by developing their own state insurance exchanges to keep their federally funded insurance exchange with the same consumer protections noted in the current federal rules intact.   

This is how a repeal could impact women at risk for and suffering from MMH disorders:

·        In states that choose not to continue to offer coverage through their state exchanges, women who already have a diagnosis of depression (or another medical or behavioral health condition) will likely be faced with either higher rates for health insurance or could even be declined coverage, through what is referred to as the pre-existing condition limitation, which was prohibited under the ACA. Women who receive PPO type coverage through an employer, may also be negatively impacted by a reinstated pre-existing condition limitation. Women seeking new coverage through new employer plan could find that any pre-existing conditions would be excluded from their benefit plan for up to a year.

·        Women who cannot afford insurance coverage without the incentives provided under the ACA may face higher rates of financial distress, putting them at greater risk for MMH disorders.

·        The loss of coverage for some women’s preventive services, such as contraception, would put women at greater risk for unwanted pregnancies, which is a risk factor for MMH disorders

·        The loss of coverage for breast pumps could increase distress during the postpartum period as women understand the benefits of breastfeeding.

·        The loss of additional MIECHV funding gained under the ACA threatens maternal home visiting programs for low income women. These programs offer support to vulnerable women and aid women in finding the needed treatment for MMH disorders.

Desirée L. Israel, LGSW, who offers counselling to women suffering from MMH disorders in Maryland shares:

“The repeal of the ACA causing no health care coverage to the mothers of color I serve, would mean difficulty accessing treatment or no treatment at all; as they're not able to afford high self-pay fees or private insurance premiums.”

As the debate roars across the country, it is important that we don’t lose sight of the most vulnerable whose health and well-being are at stake. This includes vulnerable moms and babies susceptible to the negative consequences of MMH disorders. 2020 Mom, and the National Coalition for Maternal Mental Health will continue to follow the ACA repeal discussion and will continue to be a leader and a voice for all those impacted by MMH disorders on capitol hill and beyond.

Want to do more?  Consider contacting your federal house of representatives elected official and your two state senators.  You can also attend the National Coalition for Maternal Mental Health’s Lobby Day in Washington DC this May.  Learn more here: