House Speaker Paul Ryan’s long-promised Republican replacement for the Affordable Care Act has hit the news cycle with a wonkish thud. Some aspects of the Artist Formerly Known as Obamacare remain, like coverage of pre-existing conditions and the provision that allows young adults up to age 26 to remain on their parents’ plans. Others, like funding for Planned Parenthood and private insurance coverage for abortion, do not.
First off, the American Health Care Act, or AHCA, defunds all providers that deal mainly in reproductive health for one year, which amounts to a sly backdoor Planned Parenthood repeal achieved without even namechecking the organization. Also prohibited from receiving federal funding: all organizations that provide abortions to women who were not victims of rape or incest, or whose pregnancy damages their health.
Second, the proposed bill prohibits lower-income women who qualify for subsidies from using those subsidies to purchase private insurance plans that cover abortion, except for plans that cover abortion in the aforementioned cases of rape, incest, or life-threatening complications. The proposed law makes sure to spell out that this theoretical low-income woman is free to use her own money to purchase special abortion insurance. It also may dictate what kind of insurance employers are allowed to offer their employees and still qualify for tax credits.
This isn’t going over particularly well with advocates for abortion access, says Erin Matson, cofounder and co-director of the pro-choice advocacy group Reproaction. “It’s incredibly hypocritical that given one week ago Trump stood in front of Congress and held previous statements by Obama up for ridicule. ‘If you like your health-care provider, you can keep it,’” she says. “For a lot of women in this country, Planned Parenthood is the only doctor they have. So, in Trump’s world, you can keep your doctor as long as your doctor isn’t Planned Parenthood.”
These two provisions—defunding Planned Parenthood and restricting private insurance purchases—could easily be a one-two punch for low-income women seeking reproductive health care, effectively choking out funding for their local Planned Parenthood clinic while dictating that if they might theoretically someday need to have an abortion, they’ll have to pay out-of-pocket or have the foresight to purchase a special abortion insurance rider.
But there are other troubling aspects of Obamacare’s replacement. There’s the fact that while there isn’t anything in bill that specifically strikes coverage of contraception, no-copay birth control may be on the chopping block without even being mentioned in the bill. That’s because Tom Price is the secretary of Health and Human Services, the agency that has the power to define what specifically qualifies as “preventative care.” In 2011, HHS, then helmed by Kathleen Sebelius, determined after reviewing a nonpartisan study by the Institute of Medicine that contraception qualified as the sort of care insurers ought to provide women at no cost. Now, the definition of what is and is not necessary preventative care may lie in the hands of a man who backed “personhood” bills, proposed laws that define human life as beginning at the moment of conception. It’s probably safe to assume that when Price gets to decide what counts as essential health care, he won’t include pharmaceuticals that he considers instruments of murder in that definition.
The “replace” part of the GOP’s “repeal and replace” promise is, of course, a work in progress that needs to snake its way through the House and Senate before landing on President Trump’s desk. It’s safe to assume that at least some of this bill will change between now and when (or if) it’s enacted. There’s also already chatter that this iteration of the bill is to the right enough to be a nonstarter for the few moderate Senate Republicans that remain which, in these days of division would doom the bill from jump. Still, it’s worthwhile to take a look at the anti-choice wish list House Republicans have assembled on this fine Monday evening.