Last week, the Senate revealed the Better Care Reconciliation Act, its bill to repeal the Affordable Care Act. The proposed changes to our health care system would compromise the long-term safety and stability of survivors of sexual and intimate partner violence.

What do survivors need from our health care system?

— Coverage for their pre-existing conditions. Survivors of sexual and intimate partner violence have worse overall physical and mental health than those who have not been abused or assaulted. They experience elevated levels of post-traumatic stress disorder, anxiety, substance abuse, and mood and other psychiatric disorders, compared with the general population. Survivors also suffer from greater rates of asthma, irritable bowel syndrome, chronic pain, frequent headaches, difficulty sleeping and many other physical and mental health issues.

— Insurance that won’t penalize them for gaps in coverage. Survivors often go without continuous coverage because of the violence that someone has used against them. For example, a person has insurance through their partner and their partner cancels that policy and never tells them, resulting in a long gap. We need to ensure survivors won’t be blocked from getting coverage down the line because of the conditions caused by perpetrators.

— Comprehensive coverage. This includes support for mental health and substance abuse conditions, which are linked clearly with experiences of trauma. It also includes reproductive health care, which is a key part of safety planning with survivors experiencing reproductive coercion and sexual violence.

— Access to primary care providers who will screen for and respond to domestic and sexual violence. The Maine Domestic Abuse Homicide Review Panel recognizes the unique and essential role that health care providers play in connecting survivors to help. Access to care is part of the long-term solution to ending violence.

The current health care system has provided many important protections for survivors. Those with pre-existing conditions have much-needed coverage after years of potential — and active — rejection from care, and they cannot be charged more because of their health care needs. It also provides options for survivors to access health insurance on their own — rather than through an employer or a partner — and makes contraception affordable.

We now risk undoing that progress.

We are deeply concerned the Better Care Reconciliation Act weakens these key protections. Under this bill, states would be allowed to let insurers decide whether to cover essential health benefits, which they currently are required to cover. Today, those benefits include things like mental health and substance use disorder treatment, prescription drugs and rehabilitative services — all key to the health and resilience of survivors of violence. Should those be changed, the people who need those benefits in their plans will likely experience significantly increased health care costs for services that are today considered to be the bare minimum. More people will opt for pared down plans, which will not provide the comprehensive coverage that survivors need in the aftermath of violence. The bill also severely cuts Medicaid, which will affect some of Maine’s most vulnerable survivors.

A survivor’s health care needs changes the moment someone commits violence against them. The proposed policy changes are deeply unjust, and compromise survivors’ chances of finding long-term safety and stability.

Sexual and intimate partner violence are significantly underreported crimes that impact all Americans, and greatly impact Mainers. One in five Mainers will experience sexual assault in their lifetime, and 14,000 Mainers experience sexual violence every year. A domestic violence assault is reported to police every 1 hour and 47 minutes in Maine — and only about half such assaults are ever reported.

The Better Care Reconciliation Act continues to weaken protections for pre-existing conditions and lessen people’s access to care. If this bill becomes law, the health of thousands of Mainers who have experienced trauma will be further jeopardized.

If we truly support survivors of sexual and intimate partner violence, we must advocate to maintain protections for their health and well-being. We hope that lawmakers support survivors — and their right to quality and affordable health care.

Cara Courchesne is the communications director for the Maine Coalition Against Sexual Assault. She may be reached at Regina Rooney is the education and communications director for the Maine Coalition to End Domestic Violence. She may be reached at