The XX Factor

To Trump and the GOP, Being a Woman Is a Pre-Existing Condition

Speaker of the House Paul Ryan and Donald Trump see womanhood as an unpredictable state of perennial sickness.

Win McNamee/Getty Images

House Republicans will attempt on Thursday to pass their latest health-care bill, a piece of legislation that threatens to kick millions of Americans off their health insurance and interrupt critical care for people who need it to survive. (Update, 2:30 p.m.: The bill passed on a 217–213 vote.) Read closely, the American Health Care Act, or Trumpcare, also reveals the basic theory that underlies the GOP’s entire legislative wishlist on health care: the idea that being a woman is a chronic medical condition and a liability.

Before the Affordable Care Act, the U.S. was a patchwork of state policy and insurer discretion that made living as a woman more or less expensive depending on where a given woman lived. Eight states allowed insurance companies to deny coverage to women or charge them sky-high premiums if they’d sought treatment for physical or mental health issues caused by domestic abuse, because having experienced domestic violence, insurers claimed, was a “pre-existing condition.” Pregnancy, too, was a pre-existing condition that could cause an insurer to turn a woman away or price her out at a time when she urgently needed health care for her and her fetus. And if a woman wasn’t pregnant, if she’d previously had fertility treatments or a Cesarean section—a procedure used in one-third of all U.S. births—that could be considered a pre-existing condition. Insurers even turned their backs on survivors of rape who’d gotten medical care after their assaults, refusing them coverage or exploiting their trauma for thousands of dollars in higher premiums. Enduring a brutal sexual assault made a woman too risky to insure.

Where once states had to individually prohibit insurers from discriminating against women who’d experienced sexual assault, domestic abuse, pregnancy, infertility issues, or birth—and many did not—the ACA explicitly forbade this practice. The legislation Republicans are rallying behind on Thursday would re-grant states permission to waive that prohibition, letting insurers charge women who’ve given birth, for example, premiums four or more times higher—about $17,000 more—than men.

The amendment that includes this policy change was ushered in by the ultraconservative Freedom Caucus, a collection of white men who throw a fit if any health care bill offers too much health care. They look exactly like you’d expect them to. Remember that photo that made the rounds in March, depicting a conference room filled with only men, sitting around a table to hash out what exactly was up with women’s bodies? That was the Freedom Caucus!

To justify a bill that allows states to let companies treat what may be the majority of women as inherently sick, Trump and the men of the GOP have convinced themselves that manhood is the norm and womanhood is an aberration. They have complained every time health care has come up for a vote that men shouldn’t have to pay higher premiums so that women can get their mammograms, contraception, and prenatal care covered at affordable rates. Of course, there are conditions specific to the male sex, too, but no Republican legislators have protested that women shouldn’t have to subsidize treatment for those, because prostate cancer and erectile dysfunction happen to regular people, not women-people.

The authors of what’s being called the MacArthur-Meadows amendment (the one that would destabilize protections for people with pre-existing conditions) anticipated this criticism. There’s a provision within the amendment that states “nothing in this Act shall be construed as permitting health insurance issuers to discriminate in rates for health insurance coverage by gender.” That’s funny—the amendment’s entire purpose is to let states go back to doing what they were doing before the ACA: allowing insurers to price women out of health care plans for gender-specific health concerns.

There are no surprises here: The legislators who will vote for Trumpcare are almost all men. These are the minds that, with the support of the Trump administration and the mainstream Republican Party, endorse an idea of womanhood as a disease. Women have a set of reproductive organs that ebb and flow in rhythms indecipherable by human logic. They—women and their organs, both—are governed by hormonal surges that cause psychic distress and physical weakness. Their bodies invite sexual and physical brutality that causes permanent damage, seen and unseen. At literally any moment, any woman might spring forth with child, bulging at her midsection like a sea creature incubating its eggs. Her body is a “host,” as one Republican legislator elegantly put it, for man’s seed and offspring, requiring additional upkeep. All these things make the chronic condition of womanhood very unpredictable, very expensive, and a very bad gamble for insurance companies that deserve to make an honest buck.