What Does “Rape as a Pre-Existing Condition” Mean and What Can You Do About It?

On May 4th, the House passed the American Health Care Act (AHCA) and many activists are concerned about how this potential legislation could affect sexual violence survivors if it becomes a law.

Back to Basics

Before we get into the nitty-gritty of the AHCA, let’s make sure we’re on the same page. Here is a quick information break-down:

  • What does AHCA stand for?
    American Health Care Act (the proposed replacement for Obamacare).
  • What does ACA stand for?
    Affordable Care Act (also known as Obamacare).
  • What is a pre-existing condition?
    A pre-existing condition is a health problem a person had before the date that new health coverage starts.  These conditions can include things like depression, cancer, asthma, diabetes, or other health issues.

American Health Care Act Eliminates Protections For Pre-existing Conditions

Under the ACA (which is currently the law), health insurers cannot charge more or deny coverage because of a pre-existing condition.  They also cannot limit benefits for that condition.[1]  This means that a person cannot be denied coverage or have higher premiums because they had a pre-cancerous mole removed, had a baby, are in counseling or therapy, are HIV+, or have other health issues.

Under the AHCA, these protections are under threat.  States can get waivers that allow health insurance companies to set premium costs based on an individual’s “health status” – including the existence of pre-existing conditions.  There is no central list of pre-existing conditions, and health insurance companies would be able to classify a wide range of screenings, diagnoses, and treatments as pre-existing conditions that impact one’s “health status.”

The people who have to buy health insurance on their own – those who do not have Medicaid, Medicare, or employer-provided health insurance – are on the “individual market.”  Before the ACA, many were unable to get health insurance or faced astronomical premiums.  If the AHCA becomes law, people with pre-existing conditions who are on the individual market will again be subject to high premiums or restrictions on coverage.  Additionally, those who are on employer-provided insurance plans are not immune from layoffs or termination of employment, or they may transfer to another job with different insurance coverage.  A lapse in insurance can be devastating for an individual’s health and future eligibility for coverage.

How This Will Affect Sexual Violence Survivors

Sexual assault survivors face higher rates of chronic disease (including heart disease), injuries, sexually-transmitted infections, and mental health issues than other individuals.  Restrictions on insurance coverage based on pre-existing conditions will hurt survivors, whether or not sexual assault is singled out as a pre-existing condition.  Health insurance companies may classify medical care like screening for sexually-transmitted infection, treatment for PTSD, medications for hypertension, or a forensic examination as pre-existing conditions.

Some states have laws prohibiting discrimination in insurance coverage for certain violent crime survivors, generally including domestic violence[2].  However, this still leaves many survivors of sexual assault who are not in these relationships (such as those assaulted by friends, acquaintances, strangers, authority figures, dating partners, and others) unprotected.  Additionally, less than 30% of sexual violence survivors choose to report their assault. Survivors should not have to disclose their rape to their insurance company in order to receive protection from discrimination.  The lack of transparency at many insurance companies regarding pre-existing conditions and coverage also creates a risk for discrimination based on victimization.

Sexual violence survivors – regardless of their current insurance plans – may opt out of medical treatment and mental health care because it would affect their ability to get health insurance on the individual market in the future.

What Can You Do?

  • The AHCA’s next step is a Senate vote. Contact Senators Bill Cassidy and John Kennedy and let them know that sexual assault survivors will be negatively affected by the AHCA, and any restrictions on coverage for pre-existing conditions.

Script: I am your constituent, and I am calling to encourage you to protect health coverage for all Americans, including people with pre-existing conditions.  I am particularly upset that the effects of sexual assault could be labeled “pre-existing conditions”, which could increase costs for the 1 in 5 women who are survivors of sexual assault. This policy not only hurts survivors, but may also keep survivors from coming forward for fear of losing coverage, which will keep rapists free in our community.

  • The AHCA has passed the House by two votes. Five Louisiana Representatives voted for it; one voted against it.  If you live in the district of Representatives Abraham, Graves, Higgins, Johnson, or Scalise, contact them and let them know you are disappointed in their vote.  If you live in Representative Richmond’s district, contact him and thank him for standing with survivors.  It is important for constituents to hold their elected officials accountable, as well as express support for their positive votes.  Louisiana representatives’ contact information can be found here.

More Information

If you or a loved one are a survivor of sexual violence, visit lafasa.org to find helpful resources, information, and your nearest sexual assault center.


[1] https://www.hhs.gov/healthcare/about-the-aca/pre-existing-conditions/index.html

[2] https://www.acf.hhs.gov/sites/default/files/fysb/state_compendium.pdf

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