SWOP USA would like to keep our community informed on major pieces that would have an impact on their lives. Currently, there are many pieces of information floating around regarding the Republicans’ newly proposed healthcare law, the American Health Care Act. We hope that the following resource is a useful snapshot of some critical information in a digestible format.


Summary – Why Sex Workers Should Care:

  • Individuals on Medicaid and who privately purchase insurance will be most affected: Sex workers are almost universally self-employed or work as independent contractors. This means they (almost universally) either rely on either Medicaid (which has been expanded under Obamacare) or on individually purchased health insurance.
  • The ACHA will allow insurance companies to penalize individuals who have gaps in coverage: Due to discrimination by healthcare services, isolation, mobility and criminalization, sex workers are especially likely to experience gaps in healthcare coverage which could now cost them a hefty penalty fee upon gaining insurance.
  • As of 2020, Medicaid eligibility would be cut, and Medicaid would no longer be required to cover services that many sex workers rely on: the Republican healthcare bill would cap funding for Medicaid in 2020, forcing states to cut eligibility and benefits,  including HIV and HEP C treatment, basic mental health services and more.  The requirement for Medicaid to cover basic mental health and substance dependency services, services that many low-income and street-based sex workers, depend on, would end in 2020 according to the current draft of the American Health Care Act.
  • Insurance premiums are expected to rise, and cost-sharing benefits for lower-income sex workers will disappear by 2020: For the many self-employed and independent-contractor sex workers who have to buy their own insurance, premiums are expected to increase by 15-20 percent. Further, the government currently helps foot private insurance bills for the many sex workers with household income below $40-50,000. This cost-sharing will disappear as of 2020.


Below, board member Matthew Rose gives us an in-depth, easy-to-digest overview of how the Republican Healthcare Bill will impact costs and coverage:


The new proposed law is gonna cost you: Just like an iPhone, the price of the phone itself is not the only cost you have when selecting a cell phone plan. Similarly, there are more factors to consider with the new bill. The bill removes the individual mandate or penalty for not having insurance. As a result, the budget experts at Congressional Budget Office say the bill could raise premiums by 15 to 20 percent next year.Think of what you pay over three months for insurance and having to do that again in a single year to cover your health insurance.

Fewer healthy low- and moderate-income enrollees

Historically, the greatest barrier to health insurance coverage was cost: lower-income people were much less likely to be covered. This is why the ACA included income-base tax credits tied to the cost of local market costs for care. Under the House bill, premium tax credits would not vary with income. The lose of such tax credits would “price many poor and vulnerable people out of the health insurance market.”

Subsidies for insurance do not go to the poor

Though the proposed plan does offer some cost offsets, or subsidies, for individuals, they continue to stack the deck against those that are most vulnerable in our country. Cynthia Cox, a health expert from the Kaiser, estimates that a 40-year-old making 160 percent of the poverty line would get $4,143 in subsidies under the current system (the Affordable Care Act or “Obamacare”), but only $3,000 under the ACHA. By contrast, currently a 40-year-old making $75,000 would get no subsidies, but $3,000 under the ACHA.

Charges people higher premiums

In 2016, HealthCare.gov recorded that 65 percent of enrollees had income below $50,000 for a family of four. Virtually all of those enrollees would pay more under this proposal and would receive less, since the ACHA includes no cost-sharing reductions for low-income people (starting in 2020).  Those low-income families are not the only ones who would face higher premiums. By 2026, premiums  for low-income seniors will increase by more than 750% in America.

What the tax credit changes look like

The experts at the Kaiser Family Foundation have put together this helpful tool to understand the changes in tax credits or how much many is available from the government to purchase health insurance.

Tax Credits under the Affordable Care Act vs. the American Health Care Act: An Interactive Map

These maps compare county-level estimates of premium tax credits consumers would receive under the Affordable Care Act (ACA) in 2020 with what they’d receive under the American Health Care Act. This tool is a way to see what you would get under the new system and what that could buy for you in terms of coverage.


Less people getting covered: As premiums rise under the AHCA, the Congressional Budget Office and the Joint Commission on Tax estimate that by 2018, 14 million more Americans will be uninsured than under current law. Further projections show that under the current proposal the number that could lose insurance could rise to as high as 26 million.

Reducing options for women’s health and access points for rural communities

The proposed AHCA also limits where you can go to receive healthcare. Women, LGBT, and those living in rural communities are especially impacted by these provisions, as the new bill bans future funding for Planned Parenthood.

Continuous Coverage Requirement

The new bill would adds a continuous coverage requirement for all individuals. Any person who has a lapse in coverage of more than 63 days will be charged 30% more for their health insurance for one year regardless of their health status. This requirement erects a large barrier on low-income individuals that try to re-enter the insurance market. The system itself can make this more challenging by having issues with verify and re-enroll people on Medicaid.

Changes to the Medicaid system

The House plan would end the Medicaid expansion funding for new and returning enrollees, starting in 2020. Medicaid is not a static population, with people moving in and out of the program all the time, in many cases because they find a job with benefits and then lose that job. Those people would no longer be eligible for federal funding.  In order to maintain expansion under the new law, states would have to find an additional$250 billion in their own budgets over the next 10 years. In seven states, federal funding cuts would trigger automatic wind-down of expansion. The remaining 25 states (including DC) would likely have to end expansion as well, because maintaining it would become impossibly expenses.


It’s time to take action

You can find out who your Member of Congress is here.

Call your congress members and tell them to:

Hello my name is _______ and I live in [city & state]. I am calling to demand that you vote against the American Health Care Act. The American Health Care Act will hurt vulnerable people and those in need by making it harder and more expensive to get the care they need. All Americans deserve better. I urge you to support vulnerable people and oppose the American Health Care Act. 

Find a local event near you to take action at here:


Spread the word through social media and community events using #ProtectOurCare #NoCuts #Resist

Things to tell your governor: this bill shifts the costs of healthcare on to your state in a massive way!

New analysis from CBPP: House GOP Medicaid Provisions Would Shift $370 Billion in Costs to States Over Decade


The battle for our healthcare is a critical social justice issue of our time that will have impacts across generations.