Asbury Park Press

Rape As A Pre-Existing Condition

Asbury Park Press — April 26, 2017

By Ann Vardeman

In a remarkable exchange with a 17-year-old constituent named Daisy at a town hall meeting in Willingboro last week, Rep. Tom MacArthur, R-N.J., the architect of the deal that allowed the American Health Care Act, the House GOP's Obamacare repeal bill, to pass, was asked for a straight "yes or no" answer as to whether sexual assault would be counted among the "preexisting conditions" that could make it more difficult to purchase health insurance.

MacArthur was hesitant to answer the question as it was posed, saying that he did not want to reduce rape by calling it a "preexisting condition." But he eventually answered that "this bill does not allow discrimination in health insurance based on that [rape]."

Fact checkers would probably rate MacArthur's claim mostly true or true. The American Health Care Act, including the MacArthur Amendment, maintains protections for preexisting conditions that currently exist under the Affordable Care Act. And most states already ban insurers from factoring in a history of abuse into premium costs. However, there is a massive caveat. Included in the MacArthur Amendment is the ability for states to obtain waivers to get out of the Affordable Care Act's community rating provisions.

Those community rating provisions are what keep sick people (and those with preexisting conditions) from being charged more for health insurance than healthy people, especially after a lapse in coverage. So while sexual assault may not be a "preexisting condition" according to MacArthur, the medical and mental therapies that often follow a sexual assault would almost certainly be a rating factor in a state that acquired a waiver. Victims of sexual assault, who often carry physical and mental scars, could also bear the additional burden of increased costs to their health insurance.

This question of sexual assault as a preexisting condition affects me directly. Ten years ago as I was heading home from a shift at my waitressing job, I was held at gunpoint by a stranger in my car, robbed and sexually assaulted. Physically, I was fine. Mentally and emotionally I struggled. After a few weeks of sometimes debilitating symptoms that included insomnia, terrifying episodes when I was unable to breathe, and uncontrollable fear, I was diagnosed with Post Traumatic Stress Disorder (PTSD). My treatment, which lasted through the eventual court proceedings and trial nearly 18 months later, was expensive. I required regular therapy, medication and doctors visits. Luckily, I had health insurance through my job, and an understanding employer who allowed me to take the time necessary to care for myself while keeping my health insurance. Many women are not so lucky.

More than 90 percent of women experience PTSD symptoms during the first two weeks after an assault, with 30 percent still showing symptoms nine months later. Living with PTSD can make continuous employment, which is how most people maintain their health insurance, difficult. One 1993 study showed that nearly 50 percent of sexual assault survivors lose or leave their jobs in the year after a sexual assault due to court dates, doctor's appointments, or the symptoms of PTSD — fear, anxiety and embarrassment. Gaps in health insurance coverage, which by its very nature PTSD can cause through spotty employment, used to allow insurers to charge more or even deny coverage for "preexisting conditions."

The Affordable Care Act closed the door on that practice by enacting community ratings provisions. The MacArthur Amendment would open that door back up in states that successfully applied for a waiver to community ratings provisions. And despite what Tom MacArthur told Daisy at his town hall in Willingboro, waiving community rating provisions could cause the victims of sexual assault to be charged more for health insurance due to the physical and mental scars of their attacks.

The MacArthur Amendment to the AHCA is not likely to survive in the Senate. Being viewed as endangering the most popular aspect of the Affordable Care Act (preexisting conditions protections) is not likely to be something on which many GOP Senators wish to stake their reelection campaigns. But in the House the votes have already been cast. Only two of New Jersey's 12 U.S. representatives, MacArthur and Rodney Frelinghuysen voted for the American Health Care Act.

As a sexual assault survivor who has been diagnosed and treated for PTSD resulting from that sexual assault I believe I deserve a straight "yes or no" answer from these men. Should insurance companies be allowed to use my diagnoses and treatment for PTSD as a rating factor for my insurance premium and possibly charge me more for my health insurance should I ever experience a lapse in coverage? I doubt I will get a direct answer to my question — but congressmen MacArthur and Frelinghuysen's constituents really already have their answer. They voted "yes."

Ann Vardeman is the program director at New Jersey Citizen Action.

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