Since their poorly received proposed replacement for Obamacare landed with a thud, the Republican effort to repeal and replace the Affordable Care Act has devolved into little more than a quest for cosmetic victory. Ironically, in their pursuit of optics, they’ve created an entirely new set of even worse ones. They’re throwing the baby out with the bathwater, in an almost literal sense.
Both involved rooms full of male politicians who have strong opinions on women’s health—save Kellyanne Conway, the Official Female Friend of rooms full of male politicians with strong opinions on women’s health. In one, men stood up and applauded President Donald Trump as he conceded that perhaps maternity benefits did not need to be included in insurance plans. The second photo included Vice President Mike Pence explaining to a room full of men why maternity benefits should not count as essential care. The men in both photos were going bananas over this very bad idea.
The American Health Care Act (or Trumpcare, or Ryancare, or, perhaps more aptly, TheyDontCare) already included a provision that required women who were interested in receiving insurance coverage for abortion to purchase an additional rider. It already defunded Planned Parenthood, an organization that serves as an entry point to healthcare for millions of women. It already gutted Medicaid, a program that helps low-income women and children access care. But that old bill didn’t go far enough to please the most conservative of the conservative party. This new, shinier version of the bill also eliminated other types of health care, including maternity care.
Which left me, a woman, with some pressing questions.
First, how many types of insurance must women purchase? One type for being a human being (like a man, sort of), one type for perhaps one day wanting to have children (maternity care), another for one day perhaps not wanting to remain pregnant (abortion). That’s three. Women who need mental health care would need a fourth kind of insurance, unless they’ve got deep pockets or generous shrinks. Women with pre-existing medical conditions may need to purchase additional coverage or invent a very popular app, and then use the money they make by cashing out on that app to pay for their own medical care.
Second, who is going to pay for childbirth under the Republican plan? If women can’t afford maternity insurance or abortion insurance and wind up pregnant anyway, will they have to pay for prenatal care out-of-pocket until they drain their personal savings? What then? Will they be outfitted with a government time machine they can use to go back and make sure their birth control un-fails? Will they go on Medicaid? Isn’t that being gutted? What about the women’s husbands, who ostensibly don’t personally need maternity care but probably would appreciate it if their wives had it? Will they chip in or what?
Third, have Republicans thought any of this through? Any of it at all? I thought Paul Ryan was a policy wonk. His whole brand is smartest-dude-at-the-keg-party patiently explaining to his bros why Jesus would have wanted poor people to have the freedom to buy whatever insurance they want. This bill and its witless tune-up make it seem as though nobody has thought any of this through past the photo op.
To seek answers to my burning questions, I reached out to a Democratic Senate staffer. “These are questions I don’t have answers to,” the staffer said, laughing.
“I think Republicans, including Paul Ryan, have been making this promise for seven years that they’re going to repeal it and now that they have the opportunity they do not know what to do. They were not expecting to be in this position.”
But what about women?
“I just don’t think they care,” the staffer added. “All they care about is saying they repealed Obamacare.”
Unfortunately for Paul Ryan and company, it doesn’t seem like Trumpcare has much chance of advancing past the democratic peristalsis of the House, if it even makes it that far. The more establishment Republicans bend to the whims of the conservative Freedom Caucus, the less palatable it is to the more-moderate Senate. Plus, a hot-off-the-presses Congressional Budget Office report says that actually, this new version of the AHCA stinks slightly more than the old version.
It is difficult for me to imagine any of the political men in either of the tacky aforementioned photos being able to label all of the parts of the female reproductive anatomy on a chart. I can’t picture any of them walking past a drug store tampon aisle without averting their eyes in embarrassment. And yet, today, they spent hours casually tossing around ideas that would change American women’s lives indelibly. In ways that would change the character of the women’s families, their communities.
The AHCA tune-up is not a good bill. If it doesn’t die, it will be an unmitigated disaster for American women and their families, apart from the ultra-wealthy who will enjoy a nice tax credit they can spend on things like top-of-the-line noise-canceling headphones to block the screams of the poor. If it does die, the ACHA will do more damage to the image of Republicans supporting it than it could possibly be worth.