Under the new Republican health care bill, being a woman is essentially a pre-existing condition

Perhaps the most widely beloved element of Obama’s Affordable Care Act was the protection it gave Americans with pre-existing conditions from being denied health insurance coverage. House speaker Paul Ryan and his party—as well as president Donald Trump—insist their new bill will preserve those protections.

The AHCA as it was voted on today includes the MacArthur amendment (pdf), which allows states to waive certain Obamacare requirements “to encourage fair health insurance premiums.” The amendment states that “nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with pre-existing conditions.” However, it also doesn’t do anything to actually guarantee that won’t happen.

Many believe the AHCA as written would leave millions of Americans potentially facing much higher premiums or even denial of coverage. Individual states would have the power to allow insurance providers to make their own decisions on what to do with patients with pre-existing conditions—and how to define what, in fact, is considered a “pre-existing condition.”

In the past—before Obamacare came into effect—that has included, in certain cases:

• C-sections, since they can lead to future health complications, for instance leading to the development of conditions such as placenta accreta in future pregnancies, or making future deliveries through C-sections far more likely, exposing the mother to higher risks of hemorrhage and post-surgery complications.
• Sexual assault, as it can put people at a higher risk for mental-health issues and substance abuse. (In some instances in the past—like the case of Christina Turner, in Texas, before Obamacare was implemented—getting prescribed medication like HIV retroviral drugs after a rape has compromised women’s ability to secure coverage.)
• Domestic violence, since it can lead to a higher need for mental and physical health care.

In short: Historically, being a woman in the US has basically been a pre-existing condition, considering 33% of American mothers have had a C-section, 20% of American women will experience sexual assault in their lifetimes, and 25% of women experience violent domestic abuse (compared to one in seven men).