The Better Care Reconciliation Act (BCRA), the Senate GOP version of the health care bill (also known as the bill written in secret by 13 men), has been released and — once again — the news is not good for women. The bill, like the House version (the American Health Care Act), whittles away at Medicaid, defunds Planned Parenthood for one year, prevents people from using tax credits for insurance plans which cover abortion, and plays strange games with the Essential Health Benefits that cover services like maternity care, birth control, and mental health benefits.
But the BCRA doesn’t just target reproductive health care. Rewire News calls it “a huge, unprecedented rollback of health coverage for poor and disabled people.”
Last week, news coverage zoomed in on the ways in which the Senate GOP health care bill will restrict access to necessary health care for all Americans, but especially for some of the most vulnerable: low and middle income women, women of color, disabled people, and other marginalized groups.
Ilyse Hogue, head of NARAL Pro-Choice America, calls the Senate bill “a direct attack on the health and well-being of hundreds of millions of Americans and a savage attack on women’s healthcare in particular.” She goes on to say:
By defunding women’s health centers, denying abortion coverage to Americans who get their insurance through the exchanges or who receive tax subsidies, and slashing healthcare for the families who need it most, it’s clear that the Trump administration and the GOP’s concern with being “pro-life” only reaches as far as the nearest tax cut for millionaires.
The BHCA targets Planned Parenthood (even though it’s never mentioned by name in the bill). Planned Parenthood is the largest provider of reproductive and sexual healthcare for millions of low-income people across the country. The bill puts a freeze on Medicaid spending to any organization that receives Medicaid reimbursements “that is primarily engaged in family planning services, reproductive health, and related medical care; and provides for abortions.” Yep, that’s Planned Parenthood.
According to Buzzfeed:
A federal law called the Hyde Amendment already prevents any federal funding from going toward abortions, so Planned Parenthood only receives reimbursements for providing non-abortion services like birth control coverage, pap smears, and pelvic exams to Medicaid patients.
About 60% of Planned Parenthood patients received Medicaid reimbursements for non-abortion services. According to its annual report, Planned Parenthood currently has around 650 clinics across the country and served about 2.4 million people from 2015–16.
In an interview with attn about the Senate bill this week, Planned Parenthood president Cecile Richards explains:
We serve about 2.5 million patients every single year. Most of our patients are young people — not only young women, but a lot of young men come to us. They come to us primarily for birth control — for affordable birth control, for affordable STI testing and treatment.
And we’ve seen the results of improved access to contraception, especially for young people. Not only are more young women using contraception for first-time sex, the number of teen pregnancies has reached its lowest level in 40 years.
By any measure, cutting Medicaid funds to Planned Parenthood is bad for women’s and young people’s health. But dismantling Medicaid over time will wreak havoc on the health and lives of millions of people — not just those who use Planned Parenthood’s services.
Medicaid serves nearly 75 million Americans, including low-income children and seniors. That’s one out of every five Americans. In fact, two-thirds of Medicaid recipients are elderly or people with disabilities. As you’ve no doubt heard by now, even President Trump called the House version of the health care bill “mean.” The Senate version of the bill is no less so. It would also phase out Medicaid, leaving pregnant women, poor children, disabled people, and seniors without coverage.
According to NBC News, almost every major medical group opposes the bill:
“Medicaid coverage for up to 6.5 million women of childbearing age will be rescinded, making it harder for them to get healthy before they get pregnant,” March of Dimes president Stacey Stewart said.
The President of the American Academy of Pediatrics explains,
“Medicaid is there for families struggling from the opioid epidemic, covering treatment for parents and services for their children. Medicaid covers a grandmother’s chemotherapy and a newborn baby’s emergency heart surgery and a six-year-old’s hearing screening and a teenager’s asthma inhaler.”
Speaking of newborns and childbirth, the Medicaid cuts cruelly ignore rising maternal mortality rates in the U.S. by making childbirth more dangerous for women and babies. These are conditions that the Affordable Care Act sought to address. Vox explains that, in addition to expanding contraception access, the Affordable Care Act required small-group insurance plans to cover maternity care and “broadened the number of people who could access Medicaid — which pays for half of all births in this country”:
These advances mattered to public health when you think about how poorly American women fare compared with women in other rich countries when it comes to several health outcomes. (We have some of the worst maternal health and mortality outcomes in the developed world, and life expectancy for women is going down.) They also gave women some relief from worrying about the cost of accessing very basic health services.
If fewer people can access Medicaid, and Medicaid is skimpier, that means fewer people can get the women’s health and reproductive services that do things like cover cancer screenings, improve access to birth control, and make sure moms and babies have health care throughout a pregnancy and in the months after a baby is born.
In “If Republicans are Pro-Life, Why Don’t They Care About My Child?” writer Jessica Valenti makes a heart-breaking plea, rooted in her own daughter’s premature birth, for coverage that doesn’t punish parents for doing everything possible to keep their babies alive:
Care for a premature baby can cost literally millions of dollars, and before the ACA, it wasn’t uncommon for families with preemies to end up financially devastated. In the new bill, the text of which was just released today, that lifetime cap comes back. I’ve always wondered how it is that Republicans who call themselves pro-life could support financial ruin for parents who simply want to keep their babies alive.
Finally, if you’re seeking a way to pay for your abortion — even with your own funds — through insurance coverage, the GOP bill will prevent that as well. The bill bans individuals and small employers from using tax credits to purchase plans that cover abortion services (except in cases of rape, incest, or when the mother’s life is in danger). It’s hard to understand how that looks in practice. Does a woman need to already be in one of those situations to purchase the plan or “prove” that she experienced one of those scenarios? Adam Sonfield, senior policy manager at the Guttmacher Institute, says in Vox that this mandate — along with several others embedded in the bill — will devastate private insurance coverage of abortion:
All together, these changes will likely eliminate abortion coverage in the individual health insurance marketplace for individual health insurance nationwide, and have a chilling effect on employer-sponsored coverage of abortion too.
The Senate version of the GOP health care bill is a stunning series of barriers set-up to make sure women have little to no control over our bodies and health. As Destiny Lopez, head of the reproductive justice group All* Above All is quoted as saying on Rewire News:
Not only is this bill going to make it harder to prevent unintended pregnancy and nearly impossible to get an abortion covered by insurance, they’ve also added provisions that would penalize folks for having children. So, you’re kind of damned if you do, damned if you don’t.