On March 6, House Republicans finally unveiled their proposed health care bill. A week later, the Congressional Budget Office (CBO) and the Joint Committee on Taxation released an estimate that by next year, 14 million more Americans would be uninsured than under the present law. Following the implementation of changes brought about by the American Health Care Act (AHCA), CBO predicted the number of uninsured Americans would rise to 21 million by 2020 and 24 million by 2026.
According to this estimate as well as research by Century Foundation senior fellow Jeanne Lambrew and fellow Ellen Montz, we know that the Republican plan would bring about not just a dramatic increase in the number of uninsured Americans, but also specifically discourages rural, low- and moderate-income, and healthy individuals from signing up, which CBO projects will increase premiums by 10 to 15 percent next year.
But what would the future of reproductive health care look like under the American Health Care Act? Some critical provisions have been changed from that of the Affordable Care Act (ACA); others have been left intact—for now—by Republicans due to the rules of the budget reconciliation process, which the bill’s advocates plan to use to pass it through the Senate. This is a status report on what this “repeal and replace” strategy means for reproductive rights.
Barring Federal Funds from Planned Parenthood Health Services
As has gained much media attention, Speaker Paul Ryan (R-WI) kept his promise in largely “defunding” Planned Parenthood through the AHCA. To translate: 75 percent of the $500 million that Planned Parenthood currently receives annually from the federal government are actually reimbursements from Medicaid. For a year following enactment, this Republican plan bars Medicaid from paying for health services at essential community providers that also provide abortions—like Planned Parenthood clinics—thereby effectively defunding them. Indeed, CBO predicted that the GOP plan would block roughly $400 million in Medicaid reimbursements to Planned Parenthood each year—and decrease federal spending on reproductive care for women by $178 million in 2017 alone.
Because of the Hyde Amendment, Medicaid already can’t pay for abortions at these clinics, so it’s other services like HIV and STI testing, mammograms, and cervical cancer screenings that will be impacted.
Because of the Hyde Amendment, Medicaid already can’t pay for abortions at these clinics, so it’s other services like HIV and STI testing, mammograms, and cervical cancer screenings that will be impacted by this changed provision. Ultimately, it’s lower-income families and those who live in areas with less health care options—who depend on these clinics for all kinds of health care services—would take the hit and feel the brunt of this change. CBO estimated that approximately 15 percent of these populations would lose access to care as a result of this changed provision.
It’s also worth noting while on this topic that—as I have researched—due to stringent state regulations, just over half of Planned Parenthood centers actually offer abortion services, while 38.5 offer abortion referral services, and roughly 6 percent offer no abortion-related services (instead focusing solely on the organization’s other health services).
The Trump White House, perhaps weary of the overwhelming bipartisan support for federal funding of Planned Parenthood, informally stipulated that if Planned Parenthood stops providing abortion services, the organization could be eligible once more for federal funding. The organization answered with a resounding no. As Planned Parenthood Federation of America vice president Dawn Laguens responded, “Let’s be clear: Federal funds already do not pay for abortions. Offering money to Planned Parenthood to abandon our patients and our values is not a deal that we will ever accept. Providing critical health care services for millions of American women is nonnegotiable.”
Restricting Private Insurance by Placing Stipulations on Tax Credits
Under the ACA, health insurance plans are allowed to cover elective abortions, but they are required to collect separate premiums to pay for the procedures to ensure that, in accordance with the Hyde Amendment, no federal funds are used for abortions. But under the Republican plan, tax credits—which lower the cost of insurance—won’t be able to be used to pay for any insurance plan bought by a woman/her employer if it includes abortion coverage, therefore restricting private insurance with regard to abortion coverage as well.
This tax credit provision banks on companies potentially dropping the abortion coverage from their insurance plans rather than disqualifying the health plans in their entirety from tax credit eligibility. The stipulation is particularly detrimental for small businesses that rely on such credits to purchase health insurance for employees, and the bill phases out the allocation of tax credits to small businesses entirely beginning in 2020.
In 2014, 53 percent of women were already forced to pay for abortions out-of-pocket—an expense that averages around $500 at ten weeks of pregnancy. The tax credit provision would only push more women into this group—at a time when 63 percent of Americans don’t have enough savings to cover the cost of a $500 emergency.
Birth Control Remains Free, for the Time Being
The ACA mandated that insurance plans (either private or Medicaid expansion) are unable to charge cost-sharing or copays for women’s preventive services which includes birth control, as well as STI/HIV screenings, prenatal care, breastfeeding support/supplies, and screenings for domestic violence. The Republican plan keeps this provision, as it cannot be modified in a reconciliation bill—but also perhaps related to public opinion on the matter: the Kaiser Family Foundation has found that 71 percent of Americans (77 percent of women and 64 percent of men) support the free birth control requirement.
But U.S. Department of Health and Human Services secretary Tom Price opposes the requirement, and it could potentially be overturned by executive regulations.
Essential Benefits, Including Maternity Care, Left Intact for Now
The congressional committee meetings necessary for the bill’s advancement have included discussions surrounding what should be considered “essential benefits,” as were laid out by the ACA. In a March 9 House Energy and Commerce Committee meeting on the revision plan, when Representative Mike Doyle (D-PA) asked Representative John Shimkus (R-IL) what issue he found with the ACA, Shimkus responded, “What about men having to purchase prenatal care?” he continued, “I’m just… is that not correct?”; “And should they?”
Regardless, the ten essential health benefits laid out by the ACA that must be offered by major insurance plans, including maternity and newborn care, were left intact by the Republican plan, likely due to the same procedural reason that women’s preventive services remain. The maternity and newborn care provision encompasses prenatal care, care received throughout labor, delivery, and post-delivery, as well as care for newborn babies. That said, this care could be on the chopping block in the next phases of reform—phase two, which encompasses administrative actions, and phase three, which is a set of additional bills.
The final House vote on the American Health Care Act is expected to be this week.