A baker’s dozen of white male Republicans will have successfully placed abortion care out of reach for the majority of American women if the Senate passes the latest version of Trumpcare. The 13 men labored in unprecedented secrecy on a bill that would cut off poor women’s access to preventive care, prevent women who care for aging parents from keeping their jobs, and effectively dismantle a longstanding system for insurance coverage of abortion.
On a call with reporters on Friday, Sen. Patty Murray surmised that the all-male Senate committee kept their plan secret for so long because “they were just ashamed of their bill, and it’s easy to see why. … Senate Republicans’ Trumpcare bill is nothing less than an attack on women’s health and rights.”
Advocates had hoped that the Senate, with a much slimmer Republican majority than the House and procedural rules that could prevent targeted attacks on abortion care, would end up with a more moderate stab at Obamacare repeal. But the Senate’s Better Care Reconciliation Act—a response to the House’s American Health Care Act—contains the same attacks on women’s health that the GOP celebrated with the passage of the AHCA.
• It would block Planned Parenthood from accepting patients on Medicaid—more than half of Planned Parenthood’s client base—for one year, though Republicans would almost certainly seek to renew that provision every year they’re in power.
• It would make it possible for states to allow insurers to price people out of health care with sky-high premiums if they have a “pre-existing condition” in their medical histories, such as a previous Cesarean section or sexual assault.
• It would slash Medicaid, the majority of whose enrollees are women.
• It would let states decide whether or not to make insurance companies cover maternity care, which 88 percent of plans did not cover before the Affordable Care Act mandated it. Where the House bill included state subsidies for maternity and infant care, the Senate bill does not; Planned Parenthood estimates that up to 13 million women could lose access to coverage for maternal care if this bill becomes law.
Republicans have also taken the occasion of this bill to make it harder for women to afford abortion care. Conservative lawmakers have always used poor women as bargaining chips in abortion politics—see, for instance, the Hyde Amendment, which prohibits anyone on Medicaid from using her federally-funded health insurance for an abortion not needed for reasons of rape, incest, or a potentially deadly complication.
With their Trumpcare proposals, Republicans are trying to keep women on private insurance plans from getting abortion coverage, too. The Senate’s bill, like the House’s, would block any plan sold on a state insurance marketplace from covering abortion care. Any woman who gets tax credits to help her pay for health insurance—because she neither qualifies for Medicaid nor has insurance through her employer—would be unable to use those credits to purchase a plan that covers abortion. Both the Senate and the House’s versions of Trumpcare would also prevent small businesses from using their tax credits to offer insurance that covers abortion to their employees.
“For many folks, coverage for abortion care means the difference between getting the health care they need and being denied that care,” said Destiny Lopez, co-director of All* Above All, an abortion access advocacy group. “We know through research that the impact of denial can really have long-term devastating effects on a woman and her family’s economic future. … Frankly, it feels like it’s an attempt by antiabortion policymakers who can’t make abortion illegal to just interfere with our personal decision-making.”
Currently, states get to decide what services marketplace plans must or may not cover. Since 1981, California has required all insurance providers in the state to cover abortion care if they cover maternity care—and since the ACA mandated maternity care coverage, all insurance plans in California cover abortion. If Trumpcare becomes law, no person in California who uses federal tax credits for health insurance— about 1.2 million Californians in 2016—will be able to purchase any insurance plan at all, because they will all include abortion coverage. Neither will tax credit–using residents of New York and Massachusetts, where similar abortion-coverage mandates are in place. The immediate conflicts between these state regulations and the restrictions of Trumpcare would almost certainly result in litigation. California’s insurance commissioner told the Los Angeles Times that the GOP’s proposed restriction on private abortion coverage is “directly at odds with California law and California’s constitutional protection of an individual’s right to have access to abortions.”
If Trumpcare becomes law, its blows to the private insurance market for abortion coverage would disincentivize any insurer from covering the service. (Why offer plans that a large segment of employers and individuals can’t buy?) Abortion coverage is currently an industry standard in insurance plans; Trumpcare would attack it from two sides. “You’re going to see women being impacted directly if they rely on the subsidies, but also this chilling effect on insurers, because they’re not going to have that supply and demand in the market,” Lopez said.
“For us, it feels a little bit like a triple or quadruple whammy,” she continued. “Because it not only bans insurance coverage for abortion—it [also] bars reimbursement for Planned Parenthood; it decimates Medicaid; and it is going to make it harder for women who have babies to actually support their families and get insurance coverage for their families.”
Vox noted in a piece on Monday that post-natal care is already lacking in the U.S., and letting states allow insurers to stop covering maternity care will further damage what flimsy infrastructure exists. It is a remarkable feat of hypocrisy for the Republican Party to position its unparalleled crackdown on private abortion coverage as a pro-birth, pro-family policy while dismantling lifesaving health care for new mothers, who are more likely to die in the U.S. than any other country in the developed world. About half of the country’s new births each year are covered by Medicaid, from which the GOP hopes to cut $834 billion over the next decade. Anti-abortion policymakers love to talk about all the fetuses they “save” through draconian restrictions on women’s lives. After all that moralizing, they must have no empathy to spare for the babies and mothers who will suffer for the sin of being too poor to afford health care.