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Obamacare also says insurers can only use four basic factors, such asage and geographical location, to determine rates for premiums and deductibles. AHCA specifically addresses states abilities to get a waiver so that health status is no longer protected from underwriting, according to a House Energy and Commerce aide. But other protections remain in place including for mental conditions and conditions relating to acts of domestic violence and are still protected from being incorporated into insurance underwriting, according to the aide. States and the Secretary of Health and Human Services woulddecide how to interpret health status. State waivers must be approved by the federal government. Opponents of AHCA say that because health status is up for interpretation, there is no control in the bill to prevent rising costs for survivors of rape and sexual assault. But there is another wrinkle which makes this scenario highly unlikely: Virtually every state already has a law prohibiting insurance discrimination based on sexual assault and/or domestic violence. At least 45 states have laws prohibiting health insurance companies from using a womans status as a domestic violence survivor to deny coverage, according to the National Womens Law Center. Domestic violence is not always interchangeable with sexual assault, including rape. All but two states (Idaho and Vermont) enacted key provisions of a 1999 model legislation by the National Association of Insurance Commissioners to ban insurers from discriminating against sexual abuse survivors, according to Americas Health Insurance Plans, a trade association for1,300 health insurance companies.The organization, which said AHCA needs important improvements, said: Our perspective is that of course survivors of domestic abuse and rape should be covered. Bottom line: Almost all states (at least 45 to48) have their own laws protecting survivors of domestic violence and sexual abuse.

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