Senate Republicans are taking one last stab at repealing Obamacare before September 30, when their ability to squeeze a filibuster-proof budget reconciliation bill through the legislature expires. The bill Sens. Lindsey Graham and Bill Cassidy have proposed is the most extreme version Congress has considered so far—it would slash essential parts of Obamacare that benefit low-income Americans and those in poor health without offering any meaningful replacement.
And, like the last health care bill the Senate rejected, this one would be disastrous for women’s health. It would cut off poor women’s access to Planned Parenthood, decimate the private insurance market for abortion coverage, allow states to let insurance companies cut essential health benefits for women, and—this is some new garbage—restrict how states can cover abortion care.
The Graham-Cassidy proposal would accomplish several major rollbacks of women’s health care that Republicans have been trying to push through for years. First, it would block the use of federal Medicaid dollars at Planned Parenthood health centers, a so-called “defunding” measure. Over half of Planned Parenthood’s client base—more than 1 million patients—currently gets its health care through Medicaid. These patients would have to turn elsewhere for care. For all these patients, Graham-Cassidy would cause a possibly dangerous disruption in care; for those who live in rural areas or health care deserts, where the majority of Planned Parenthood clinics sit, it could mean an end to accessible reproductive health care altogether. The average Planned Parenthood serves nine times the number of contraceptive clients as the average federally qualified health center, which Republicans have proposed as alternate sources of publicly funded reproductive health care. The Congressional Budget Office has estimated that the interruption in contraceptive services caused by a nationwide block of federal Medicaid dollars to Planned Parenthood would result in thousands of extra unplanned, unwanted births.
Women who don’t rely on Medicaid would also see their reproductive health care access curtailed by Graham-Cassidy. The bill would prohibit the use of health care tax credits for both individuals and small businesses on private insurance plans that cover abortion care. That means any woman who gets tax credits because she neither qualifies for Medicaid nor gets insurance through her employer would not be able to purchase abortion coverage with those credits on the individual market. People who work for small businesses that use tax credits to offer health insurance benefits would also be left without abortion coverage. Right now, most private insurance plans cover abortion—but if the federal government slashed the population of people and businesses that could buy those plans, insurance companies would be likely to stop offering them, limiting coverage access for those who don’t use tax credits, too.
Like the previous Obamacare repeal bill, Graham-Cassidy would let states end rules that require insurance companies to cover essential health benefits, such as maternal health coverage. Before the Affordable Care Act mandated it, about 88 percent of health insurance plans didn’t cover maternity care. Planned Parenthood estimates that up to 13 million women could lose such benefits if Graham-Cassidy goes through. The bill would also end the Medicaid expansion, causing disproportionate damage to the health of women, who make up the majority of Medicaid enrollees and 69 percent of the 9 million people who qualify for both Medicaid and Medicare. More than half of all U.S. births are currently covered by Medicaid. Substantial cuts to the health program would be devastating to children, mothers, and low-income families.
The most significant bit that sets Graham-Cassidy apart from its predecessors is its introduction of block grants to states. States could spend these grants however they wished, essentially inventing their own health care programs. (As Slate’s Jordan Weissman explains, the loose restrictions on the funds would allow states to put the money pretty much wherever they wanted, making the grants more of a slush fund than a health care program.) But Graham-Cassidy would forbid states from using any parts of those grants on insurance plans that covered abortion in any cases other than rape, incest, or a life-threatening medical emergency. States that currently allow insurance coverage of abortion—including states such as California, Massachusetts, and New York, which require all insurance providers that cover maternity care to also cover abortion care—would be hampered by the rules of the grants. If they wanted to use the block grants to subsidize parts of their health care programs, they would have to limit abortion coverage to those parts that didn’t include federal money.
The GOP’s past proposals for Obamacare repeal met their end in part because of their impact on women’s health. Sens. Lisa Murkowski and Susan Collins, both Republicans who cast crucial votes against former proposals, have reliably supported the continued federal funding of Planned Parenthood through Medicaid reimbursements. Collins gave an eloquent defense of the organization in her statement on why she voted against the “skinny” repeal proposed in July. “If Planned Parenthood were defunded, other family planning clinics in Maine, including community health centers, would see a 63 percent increase in their patient load. Some patients would need to drive greater distances to receive care, while others would have to wait longer for an appointment,” she wrote. “This is about interfering with the ability of a woman to choose the health care provider who is right for her. This harmful provision should have no place in legislation that purports to be about restoring patient choices and freedom.” So far, Collins seems like the Republican most likely to oppose Graham-Cassidy, and Rand Paul has already said he won’t vote for the bill. If one more Republican doesn’t turn against the bill, millions of women will pay an exorbitant price in both their dollars and health for the benefit of the wealthy, who’ll get a little treat come tax time.