Tucked into the GOP bill to repeal the Affordable Care Act is a multi-pronged effort to limit women’s access to reproductive health services, including contraception, abortion, and maternity care. The bill bans women from using government tax credits to purchase any private insurance plan that covers abortion, discourages employers from offering insurance that covers abortion, and cuts more than $200 million dollars from Planned Parenthood over 10 years.
The result of that final provision, according to a new report from the Congressional Budget Office, would be “several thousand” more unwanted pregnancies, which would in turn cost the government $77 million more in Medicaid spending over the next decade.
Nowhere in the GOP bill do the words “Planned Parenthood” appear, but the bill is worded in such a way as to strip funding only from their network of clinics.
“CBO expects that, according to those criteria, only Planned Parenthood Federation of America and its affiliates and clinics would be affected,” the CBO report said, estimating that the reduction in funding to the clinics would be $178 million in 2017 alone, and $234 million over a 10 year period.
It should be noted that Planned Parenthood is already barred from using any federal dollars to fund abortion services. This new move would deny them federal funding altogether. Though Planned Parenthood provides a range of services, including cancer screenings and pre-natal check ups, to more than 2.5 million people each year, the CBO reports that the biggest impact of stripping away this funding would be the elimination of “services that help women avert pregnancies.” The organization provided more than 3 million contraception services in 2015 alone.
Those hit hardest by the potential cuts, the CBO found, are low-income women who live in areas with no other clinics available. Many of those women would then rely on Medicaid to cover the cost of their birth, and their children would then depend on the federal program as well, costing the government $77 million dollars over 10 years.
“The additional births stemming from the reduced access under the legislation would add to federal spending for Medicaid,” the CBO said, estimating that just in the first year of slashed funding, unwanted pregnancies would rise by “several thousand.”
As Republicans vow to cut government spending and get the government out of Americans’ personal health care decisions, these cuts and restrictions are making some lawmakers nervous.
“I believe Planned Parenthood should not be treated any differently than other Medicaid provider,” Sen. Susan Collins (R-ME) told TPM on Tuesday, reiterating that she has long opposed stripping government funding from the organization.
Though she refused to talk to reporters on Tuesday, yelling at them when questioned about the CBO report, Sen. Lisa Murkowski (R-AK) also opposes the Planned Parenthood cuts, and has said she will not vote for a bill that includes them.
Republicans’ narrow majority in the Senate means they cannot lose more than two Republican votes without putting the passage of the Obamacare repeal bill in jeopardy. They certainly will not be able to count on any Democrats to cross the aisle and bail them out, as Democratic senators stand in staunch opposition to the repeal in general and the Planned Parenthood cuts in particular.
“It’s crazy to change the policy and encourage more babies to be born when people are not ready for them,” Sen. Jean Shaheen (D-NH) told TPM on Tuesday, the day after the CBO report was released. “Over the last few years we’ve seen the lowest number of teen pregnancies in our history. That speaks to giving young women access to family planning services, and we should continue to do that.”
Sen. Patty Murray (D-WA) added that she’s “terrified” at the prospect of the cuts. “This Republican plan to throw literally millions of people off health insurance and take away funding from Planned Parenthood is going to hurt far too many people,” she said. “It needs to stop.”
Ironically, Republicans’ eagerness to include deep cuts to Planned Parenthood in their health care overhaul could be what dooms its passage in the Senate. GOP leaders are trying to pass the entire bill through a process called reconciliation, which would require a simple majority rather than 60 votes. But to qualify for that process, each piece of the bill has to significantly impact the federal budget. When Republicans tried to cut Planned Parenthood funding in 2015, experts ruled that it did not pass that test.
Sen. Susan Collins (R-ME) shared concerns about the Planned Parenthood cuts in the GOP health care bill.
The GOP repeal bill’s other provisions could also make life more difficult and expensive for women, whether they are trying to have children or trying not to.
“They’re trying to drive abortion coverage out of the individual insurance market entirely,” said Adam Sonfield, the senior policy manager of the Guttmacher Institute. “They’re also taking steps to drive abortion coverage out of employer-sponsored insurance as well.”
Currently, more than a dozen states ban anyone getting a federal or state subsidy from using it to buy a health insurance plan that includes abortion coverage. And even in the states that don’t explicitly ban it, many insurers do not offer abortion coverage.
The GOP repeal bill would take this policy national, banning anyone who gets a tax credit to purchase private insurance from buying a private plan that covers abortion. The provision would make almost every single plan in states like California and New York, and many in Massachusetts, ineligible for the tax credits.
The bill has additional provisions to ban small businesses that get tax incentives to give their employees insurance from offering abortion coverage, and to ban people from using tax credits to pay for any COBRA plan that includes abortion coverage.
“They’re saying no plan can include abortion if the person is getting even a single dime of federal support,” Sonfield said. “They have a provision saying that women can buy a separate policy rider just for abortion, but that’s a fig leaf. It’s not a realistic option. They’re essentially saying you should pre-pay for your abortion. But the whole point of insurance is to prepare for the unexpected. Abortion is almost always unexpected, whether it’s an unintended pregnancy or a wanted pregnancy that goes wrong.”
Meanwhile, the same GOP bill the CBO estimates would lead to more unwanted pregnancies also phases out regulations in the Affordable Care Act that ensure private insurance plans offer adequate and affordable maternity care. If the bill passes, states will be able to offer insurance plans that charge sky-high out-of-pocket charges for maternity care.