Here are three big ways the new Republican bill might change health care in the United States. (Daron Taylor/The Washington Post)

The health-care plan House Republicans passed Thursday opens the door for states to upcharge people with preexisting conditions — including pregnancy, health policy analysts warned.

The risk of higher premiums for women of childbearing age arises from the so-called MacArthur amendment — crafted by Rep. Tom MacArthur (R-N.J.) — which allows states to propose their own “essential benefits” package. 

Under the GOP’s proposal, states are given the option of dumping an Obamacare rule that requires insurers to provide maternity coverage to all women and safeguards them from fee increases in the event of a pregnancy.

In other words, maternity coverage, as dictated by the federal government, would no longer have to be an “essential benefit.”

Critics of the Republican's American Health Care Act, which advances next to the Senate, fear a return to the days when women weren't guaranteed coverage for prenatal care and delivery room costs.

House Speaker Paul Ryan (R-Wis.) said in a statement Wednesday the MacArthur amendment won’t allow insurers to raise costs or deny coverage to anyone who keeps their insurance plan.


House Speaker Paul Ryan (R-Wis.) smiles after House Republicans passed their health-care bill. (Jim Lo Scalzo/European Pressphoto Agency)

“Under no circumstance can people be denied coverage because of a preexisting condition,” Ryan wrote. “Even if a state asks for and is granted a waiver, no person may be priced based on health status if they have maintained continuous coverage.”

But those protections might not apply to folks who face a coverage lapse, and that could potentially affect millions of women, said Alina Salganicoff, a health policy analyst at the Kaiser Foundation.

Under the GOP plan, a person who loses their employer-provided insurance could face a premium spike if they try to regain coverage in the state or private markets, Salganicoff said. For low and middle-income mothers, she added, it would be harder to shoulder rising costs.

“You could face a huge debt related to the cost of your delivery,” she said.

Janel George, director of federal reproductive rights and health at the National Women’s Law Center, said that before Obamacare took effect, insurers in most states could label pregnancy, both healthy and complicated, as a “preexisting condition” and increase premiums for mothers or soon-to-be mothers.

“We were penalizing women,” George said, “for conditions specific to women.”

The Republicans' plan, which heads now to the Senate, creates an opening for that to happen again, she argued. It's unclear what states, if any, would opt to return to that status.

“This brings us back to the days,” George said, “where a woman’s access to health coverage will depend on where she lives.”

Prior to 2010, 18 states required insurers to cover maternity care, while 32 states and the District of Columbia did not, according to data from the nonpartisan Henry J. Kaiser Family Foundation.

That posed huge potential costs for women. In the United States, the total cost of having a baby on average reaches $30,000 for a vaginal delivery, a 2013 study found, and about $50,000 for a C-section.

Republicans have set up a fund to help states manage preexisting condition costs, including maternity care. But Salganicoff said lawmakers have offered no clear guidelines as yet on who would be eligible for the aid and what costs it would help cover for expectant moms. 

The Center for American Progress, a left-leaning think tank, estimated that a woman seeking maternity care under the GOP’s current plan could face surcharges up to $17,000.

At least one House Republican has expressed interest in cutting pregnancy-related benefits. Rep. John Shimkus (R-Ill.) said he took issue with Obamacare’s prenatal coverage.

“What about men having to purchase prenatal care?” Shimkus said at a hearing in March. “Is that not correct? And should they?”

After the remarks sparked debate about men’s roles in procreation, Mick Mulvaney, President Trump’s budget director, said the GOP health-care plan would shift the decision of whether to cover maternity costs to states.

“States not only have the ability to require those services — many of them already do,” Mulvaney said two months ago on CBS's “This Morning.” “What we're doing is taking away the federal controls of the system.”