Should I Still Be Worried About My Reproductive Health Even Though Congress Didn’t Repeal the ACA Yet?

The GOP's failure to pass its American Health Care Act last month was less a fixed victory for Obamacare than it was a deferment. I'm relieved the ACA wasn't overturned, and that tens of millions of Americans still have something standing between them and death or crippling debt. But we know this didn't kill the AHCA entirely, or prevent the GOP from proposing something even worse. Meanwhile, anyone with female reproductive organs still can't relax because we're on the lookout for how and when the GOP's spite will catch up with its ineptitude, even if just by accident.

In attempting to repeal the ACA, congressional Republicans tried to remove the lynchpin of the plan -- Title I -- or else leave it to the states. Title I requires insurers to cover 10 essential health benefits, which you've probably heard about either because of the outcry over their being targeted or because, you know, you use the services to be a functioning human. All 10 would disproportionately affect women if stripped, with more than half of them (hospitalizations; maternity and newborn care; prescription drugs; lab tests; preventative services; and pediatric services) hamstringing reproductive health explicitly. Essentially, a repeal here makes female anatomy a pre-existing condition, which is a bummer since protections for those fall under Title I, too.

And even though Obamacare survived it, the weeks since the AHCA's fizzle have felt their own creeping encroachments on reproductive rights around the world. On April 3, Donald Trump signed away protections for U.S. funding for the United Nations Population Fund Agency -- which facilitates international maternal and child care health programs, to which we've been a huge financial contributor -- and justified the move with fake news (claiming UNPFA enables forced abortions and sterilizations in China. It does not). One of his first acts as president was to force through a global gag rule that prevents the United States from funding international NGOs that provide abortion counseling. To be clear, this means they're cut off for even talking about abortion, even if none were performed and the funds were reserved for, say, HIV tests. This will hurt primarily poorer women in developing countries. But it's also worrisome to Americans directly, because it normalizes that kind of extremity to an already emboldened Congress.

With or without the ACA, the GOP is taking a scorched-earth approach to reproductive health, which is manifesting as an increasingly fanatical attack on abortion without concern for the maternity care or cancer screenings that will go down with it.

Planned Parenthood provides the most abortions of any one entity in the country -- around 3 percent of its total services. It's also the single largest provider of sex education, and provides hundreds of thousands of pap smears and breast exams -- and millions of STD tests -- each year. The organization performed 323,999 abortions in 2014, and prevented about six times as many unplanned pregnancies. Defunding it, which the GOP remains excited to do, restricts access to sex education, birth control, and pregnancy tests -- all of which could mean an increase in abortions. The biggest hit from its defunding would be to women of color and those in rural areas below the poverty line, for whom it's often the only resource available.

On April 7, Trump confirmed Supreme Court nominee Neil Gorsuch, a man who is fucking terrible for marginalized communities of any gender. If you believe, as I do, that death will never come for Ruth Bader Ginsburg, then Gorsuch's appointment is bad but not yet catastrophic. (A five-justice majority still upholds Roe v. Wade; if it fell, 22 states could outlaw abortion immediately.) He's yet to issue any rulings on abortion rights, but he's also referred to the widely debunked conspiracy theory that Planned Parenthood harvests and sells fetal tissue without denouncing it. And in the high-profile Hobby Lobby case, he wrote that religiously opposed employers shouldn't have to cover birth control as it could have "the effect of destroying a fertilized human egg," which on top of being logically unsound makes you slightly question his understanding of female anatomy.

On April 13, behind closed doors and out of reach of the press, Trump signed a bill allowing states to cut off Title X federal funding for abortion providers. The same caveats apply: Planned Parenthood is being subtweeted; birth control will go down; undetected cancers and STDs and potentially dangerous non-medical abortions will go up.

The AHCA impasse was largely a testament to the disfunction of the Republican party's current form. But Republican infighting aside, a big factor in how and why the the plan failed was pressure from grassroots organizations. Despite fears that the incredible momentum channeled through the Women's March would dissipate once it was over, there's been a sustained and widely documented surge of protests across the country. People are showing up at town halls, organizing, calling their representatives to explain again why the ACA has been an invaluable resource for millions, myself included.

The AHCA should have failed on the sole basis that it is ridiculous, but that doesn't really do it these days. More than being dangerous or inadequate, to fail now something has to be unpopular. This idea isn't entirely comforting considering how Trump was elected; it works best in a healthy democracy, which currently ours is not. But it's still true that representatives are not immune to visibly unhappy constituents, and will often shift, depending on the issue, in order to not alienate voters.

Protest won't make an anti-choice member of congress into a pro-choice one. But consistently applied pressure does drive a wedge into issues where the GOP is internally cracked, things that were already unpopular the way the AHCA was. The next version of Trumpcare, whenever it arrives, is likely to be unpopular too, and people better be ready to stand up and fight.

Learn more by heading to sites from orgs who oppose restrictions on abortion and are fighting to expand access to abortion. Planned Parenthood and NARAL Pro-Choice America are leading the charge.