Many of us are concerned about how the Trump administration’s efforts to repeal and replace the Affordable Care Act (ACA) will impact access to sexual and reproductive health care, especially for marginalized folks. With Republican leadership drafting their bills in secret, plus attempting to rush votes on them without hearings or much floor debate, it can be difficult to understand what is going on. The numerous moving parts only add to the confusion.
I’m here to break down four ways that any effort to repeal and replace the ACA would spell disaster for full spectrum sexual and reproductive health care access:
It would gut coverage of essential health benefits, many of which include aspects of sexual and reproductive health care
The ACA includes a list of essential health benefits that all insurance plans must cover—in many cases at no cost to the insured individual. This includes FDA-approved forms of birth control and a yearly gynecological visit plus screenings for breast cancer, cervical cancer, mental health, intimate partner violence, and STIs, as well as the Hepatitis B and HPV vaccines. The list also includes pregnancy care, childbirth, and breastfeeding support. Under the new legislation, insurance plans would no longer be required to cover some or all of these services. That means we could be forced to go back to the pre-ACA era where only 12% of individual market plans covered pregnancy care and the cost of needed services such as long-acting reversible contraceptives or early cancer detection were out of reach for many. People would instead be at the mercy of state laws regarding whether or not these services must be covered. For instance, only twenty-eight of the U.S. states have laws which mandate contraception coverage and not all of these laws provide the comprehensive protections under the ACA. Thus, a GOP health care bill threatens contraception coverage under public and private insurance plans alike.
It would defund Planned Parenthood, putting its clinics’ ability to stay open in jeopardy.
When our foes talk about “defunding Planned Parenthood,” they are referring to revoking its clinics’ ability to receive Medicaid reimbursements for the services they provide. Never mind that federal funding for abortion care is already prohibited under the Hyde Amendment (states in which Medicaid does cover the procedure utilize their own funds to so do)and Planned Parenthood also offers other critical components of sexual and reproductive health care. If Planned Parenthoods are unable to receive Medicaid reimbursements for these services, many would be forced to close. We’ve seen how defunding Planned Parenthood on the state level led to higher rates of unplanned pregnancies and already one unprecedented HIV outbreak. We also know that Planned Parenthood clinics are often the only full-service option for millions. This is especially the case for residents in states which did not expand Medicaid, as well as immigrants who are ineligible for coverage because of the clinics’ generous sliding fee scales. Don’t be fooled into believing other clinics would come even close to covering this gap. While the legislation would technically defund Planned Parenthood for one year at baseline, enough damage would be done by that year’s end.
It would leave even more people without abortion care coverage
Certainly, the ACA is a far cry from recognizing abortion as an important part of health care. If someone wants to purchase a plan covering the procedure, they must opt-in to tack the coverage on via a separate rider. Not only is this hardly transparent, but most people obtain abortions precisely because, well, they did not expect to become pregnant in the first place. Yet the new legislation is attempting to completely ban the use of tax credits towards purchasing plans which cover abortion beyond cases of rape, incest, and life endangerment. This strongly disincentivizes insurance companies from offering plans on the individual and small business employer marketplaces that provide comprehensive abortion care coverage. Not to mention that these efforts directly conflict with New York and California laws which mandate all insurance plans to provide such coverage, begging the question as to whether any residents of these states could utilize said tax credits meant to make plans more affordable. Additionally, the new plan would dismantle the ACA’s Medicaid expansion which is terrible in and of itself, though it’s also worth keeping in mind that all fifteen states where Medicaid covers abortion also opted to expand the program.
It would deeply cut Medicaid by introducing disastrous funding mechanisms
The subject of Medicaid funding is complex and occurs through several different avenues, though one important aspect is that states are guaranteed at least $1 in federal funds for each $1 of state spending. Trumpcare would replace this with a combination of funding via block grants and per capita caps. To break it down, block grants consist of a fixed amount that states may choose to allocate as they wish and per capita caps would limit spending to a fixed quantity per enrollee. Of course, neither could be altered in the face of rising health care costs and or unexpected needs like, say, another Hurricane Katrina or the HIV outbreak I mentioned above. It also doesn’t take into account how millions of people with disabilities reply on expensive, extensive, and life sustaining care which would likely be one of the first Medicaid services to be cut. This could force them into institutions, which states are required to cover in their Medicaid programs (unlike home and community-based care, which is optional). To add to the callousness, states which accept Medicaid block grants would no longer be required to cover family planning services and states could impose work requirements on enrollees, including people who have just given birth. Make no mistake, these measures would bring less flexibility to Medicaid, not more.
While efforts to stop such a cruel bill have been working so far, we are hardly out of the woods. Even if the Republicans in Congress don’t have the votes today or tomorrow or even for this go-around, they have made it clear they are dead set on dismantling the progress we have made under the ACA. As individuals who volunteer our time to fund abortions, we have plenty of stories to share — including our own — regarding how important comprehensive, affordable health care really is. Let’s keep up the pressure and keep telling our powerful stories! Have one to share? Email media(at)dcabortionfund.org.
By volunteer Meredith Nicholson