A proxy vote on repealing the Affordable Care Act and defunding Planned Parenthood failed Wednesday, but as the health care debate continues in the Senate, reproductive rights advocates and abortion providers are still worried.
Republicans plan to vote on a “skinny repeal” bill that would get rid of the individual mandate, partially repeal the employer mandate to provide insurance, and defund Planned Parenthood. This bill has still not been made public, but based on what is known so far, the Congressional Budget Office (CBO) estimated that 16 million more people would be uninsured and insurance premiums would be 20 percent higher than under the current law.
All of this has concerned reproductive rights activists and abortion providers.
Regardless of what bill may pass the Senate, advocates worry about what will happen to abortion coverage and contraceptive coverage once the House and Senate are in conference. Any bill that passes the Senate would likely severely cut Medicaid and affect low-income women’s access to health care, said Andrea Flynn, a fellow at the Roosevelt Institute, who researches policy issues affecting women and families.
“The term Trojan horse has been used. Even if the Senate were to pass something that on its face seems not so harmful, we have no reason to believe they will change their tune now,” Flynn sad. “They will use the negotiation process to push through as many conservative pieces of legislation as they can. We should not be distracted by whatever piece of legislation they’re going to vote on either today or tomorrow.”
Flynn said she believes that many of the other provisions far-right Republicans favor, such as repealing the contraceptive mandate, ending Medicaid expansion, and stopping employers from including abortion coverage in plans will make their way into a bill.
“It’s a fair assumption that conservatives will use the House bill to layer on as many abortion restrictions as they can. The Senate wanted those too, so it doesn’t seem like a stretch to think they’ll use it to get into conference and then figure out how to re-appropriate those pieces they have been harping on for a really long time,” Flynn said.
Dr. Kristyn Brandi, an OB-GYN practicing in Los Angeles and a member of Physicians for Reproductive Health, said she is worried about how a repeal bill will affect her patients, especially her Medicaid patients.
“Today I feel even more so worried because we really don’t know what is on the table and what is being cut for this skinny bill and a lot of things are still up in the air,” Brandi said. “I also worry about things like having preexisting conditions no longer be covered, like before ACA was enacted so things like pregnancy, which is definitely an issue for my patients, is not covered.”
Even the birth control mandate has had a huge impact on the people Brandi serves as a health care provider. She said the bill could also change how she and other health care providers treat patients.
“It may change the way that we practice, if with contraception, another factor for how you choose would be cost. And that’s putting women at disadvantage to pick what is best for health,” Brandi said. “How do we manage services when we have to then factor in all of these new costs? How does it change our interactions with our patients?”
A higher cost would obviously force women to make tough decisions based on their finances, rather than the effectiveness of the birth control. IUDs, for example, are very effective at preventing pregnancy but are typically very expensive when paid for out of pocket.
“I know a lot of patients thought IUDs and implants were a great idea but just couldn’t do it because of the cost,” Brandi said. “But now that women have it covered, it’s amazing to have a conversation that’s focused on health and that is free from worry about coverage so women can just pick whats best for them and their health. That’s it.”
Flynn said that the repeal of Medicaid expansion would be particularly harmful to low-income women and women of color.
Women of color encounter significant disparities in the health care system, such as discrimination in the care they receive and lack of access to quality health care. The ACA has certainly not eliminated these disparities, but the proportion of black and Latino women of reproductive age who did not have health insurance fell by over 30 percent under the ACA.
Low-income women would encounter a number of barriers, depending on how far the “skinny repeal” bill and the conference may go in its consideration of reproductive health care restrictions. The 2011 unintended pregnancy rate along low-income with an income below the federal poverty level was five times higher than the rate for women with an income at or above 200 percent of poverty, according to the Guttmacher Institute. For this reason, access to affordable birth control and access to abortion services are vital to the financial health of low-income women.