On Monday, House Republicans revealed the plan they want to replace the Affordable Care Act. There are a few things to celebrate: The GOP decided to drop a segment of an earlier draft that would have allowed insurers to sell policies that didn’t cover prescription drugs and maternity care, which the ACA mandates. But overall, the proposed plan represents a sweeping rollback of coverage for women’s health care, including abortion, for people on both public and private insurance.
The bill would “defund” Planned Parenthood and any other provider of abortions in cases other than those of rape, incest, or a condition that threatens the life of the pregnant person. The “defunding” comes in the form of barring people on Medicaid from using their public insurance at these health-care providers for non-abortion services like pap smears, cancer screenings, contraception, and STI tests. (Pursuant to the Hyde Amendment, Medicaid already does not cover abortion care.) Planned Parenthood currently gets about 75 percent of its federal funding—more than $500 million—from reimbursements for care provided to Medicaid-covered patients.
This will inevitably harm Planned Parenthood and other abortion providers, who will lose a good chunk of their clientele and may have to consider closing their doors. But it will also erect a huge barrier to health-care access for the low-income and rural women who rely most on these clinics for their basic health needs. If patients on Medicaid can’t get care at clinics that provide abortions, which are some of the most accessible places for reproductive health care, they’ll have to travel further from their communities for care, and they’ll likely overburden many other health clinics with an influx of patients usually served at other venues.
The GOP’s plan for reproductive health care extends beyond public insurance options by incentivizing private insurers to drop abortion coverage from their plans. The bill would ban use of tax credits on insurance policies that cover abortion care in any case that doesn’t involve rape, incest, or a threat to the patient’s life. Tax credits lower the costs of insurance policies for people who qualify for them and for small businesses who use them to buy health care plans for their employees. (Under the GOP plan, small businesses will no longer get these credits starting in 2020.) If the bill passes, policies that cover abortion care will be a lot more expensive, because people and businesses who use tax credits for their insurance plans won’t be able to buy them. An individual would have to buy an unsubsidized, far more expensive plan or a separate rider to get abortion coverage.
This would put people on the market for an insurance plan in a tough position, wherein getting abortion coverage would take a lot more initiative and research, plus a lot more money. Most would likely opt for the cheaper plans that don’t include abortion coverage, which means insurers would be far better off offering subsidized, abortion-free plans than plans that a large number of potential consumers could not or would not buy. By penalizing women who want to purchase abortion coverage, businesses that want to offer it, and insurers that include it in their plans, the GOP bill could effectively eliminate abortion coverage from most of the insurance market.
In January, the House of Representatives passed a bill that would do essentially the same thing to abortion coverage under the existing system of the Affordable Care Act. At the time, Destiny Lopez, co-director of anti-Hyde Amendment campaign All* Above All, told me this strategy is a way for Republicans, who haven’t succeeded in outlawing abortion, to at least make it so expensive that few women can afford it. “At best, we’re looking at a burdensome and confusing system that disincentivizes insurers from covering abortion and stigmatizes women who seek this coverage,” Lopez said. At worst, depending on how the bill is enforced, “we may be looking at a total ban on abortion coverage, including for women in the private insurance market.”
As Emily Crockett at Vox points out, a lack of abortion coverage will harm pregnant women in all kinds of distressing situations. A woman who wants an abortion after she learns that her fetus won’t be able to survive outside the womb; a woman who has a mental-health condition that makes pregnancy and birth traumatic; a woman whose physical health is harmed, but not to a life-threatening degree, by pregnancy or birth—all of these women will have to pay out of pocket for abortion care if they can’t afford a plan that covers it because the GOP bill restricted the choices they could make with tax credits.
If there’s one bright spot to be found in this effort by Republicans to dismantle the infrastructure of women’s health care, it’s the smiles to be gleaned from the thoughtful olive branch Donald Trump tried to extend to Planned Parenthood. According to the New York Times, the White House was worried about losing support from women over the GOP’s attempts to take funding away from the organization, so it told Planned Parenthood it could keep the federal funds it gets if its clinics stop providing abortions. Planned Parenthood, however, has declined Trump’s generous offer and will continue providing the reliable abortion care that has, in part, made it the subject of so much fervent activism in recent months.
“Planned Parenthood has always stood strong against these attacks on our patients and their ability to access the full range of reproductive health care,” Planned Parenthood President Cecile Richards said in a statement. “We are glad that the White House understands that taking away the preventive care Planned Parenthood provides is deeply unpopular and would be a disaster for women’s health care.”