Thirteen male Republican senators finally unveiled their long-awaited secret health care bill on Thursday, and it contains big plans to shake up women’s reproductive health care by taking federal funding away from Planned Parenthood and making it harder to get abortions, contraception, breast cancer screenings, and HIV tests.
But it’s not just reproductive health: Nearly four out of 10 women rely on family planning centers like Planned Parenthood as their only source of health care, according to the Guttmacher Institute. So the fate of those clinics has a broad impact on women’s health care.
We broke down some typical scenarios to show how women fare under the GOP Better Care Act vs. Obamacare:
If you’re a low-income woman of reproductive age who is sexually active but does not want children right now…
Booking an appointment at a reproductive health care provider such as Planned Parenthood, to review contraceptive options, would be the logical next step. Following a consultation, you could decide that a contraceptive method such as an IUD or the pill would work best for you. Without insurance, an IUD can cost as much as $1,000. Under the Affordable Care Act, approved contraceptive methods such as IUDs and birth control pills are covered by Medicaid, making them free or low-cost.
Maybe not for much longer. The Senate bill labels any clinics or reproductive health care providers that also offer abortion services as “prohibited entities.” This means that Planned Parenthood and other safety-net clinics that perform abortions are no longer eligible to receive Medicaid reimbursements for at least a year, or as long as it continues to provide abortion services outside of cases involving rape, incest, or physical injury or illness that puts a woman’s life at risk.
Planned Parenthood, which provides abortions among its wide range of services, stands to lose about $400 million in Medicaid reimbursements each year, according to Jacqueline Ayers, the director of legislative affairs for the organization.
You could book an appointment with another “safety net” reproductive health care provider that accepts Medicaid and does not provide abortion services, but those are few and far-between. According to a study by the Guttmacher Institute, in 2010, 36 percent of the 6.7 million women receiving contraceptive care from such providers were served at a Planned Parenthood Clinic.
If you’re pregnant, and don’t want to be…
Federal Medicaid funds didn’t cover abortions under Obamacare, and that won’t change with this bill. Currently, 17 states use their own funds to cover abortion for women insured under Medicaid. But stripping federal funding from Planned Parenthood and other safety net abortion providers, as well as removing their eligibility from Medicaid, has the potential to put remaining clinics out of business.
As of this month, seven states have just one remaining abortion clinic left, which for some women means traveling a long distance for the procedure. One study by the Texas Policy Evaluation Project two years ago found that as many as 240,000 women between 18 and 49 in Texas had tried to end a pregnancy on their own. Researchers correlated the apparent return of DIY abortions to the recent passage of Texas bills curbing abortion rights, which led to half the abortion clinics in the state closing down.
If you’re pregnant…
The Senate bill revokes the Essential Health Benefits provision of the Affordable Care Act, which covers all the medical costs of being pregnant, giving birth, and caring for a newborn.
For example, Medicaid providers would cover diagnostic imaging, lab tests, and other services, including sonograms when medically necessary. The Truven Report put the uninsured overall cost of having a baby, from pregnancy to two months after giving birth, at around $30,000 for a vaginal birth and $50,000 for a C-section.
The elimination of that provision leaves it up to the states to decide what is or isn’t an Essential Health Benefit. Currently, an estimated 15 million rely on that provision to help pay for their pregnancies and births, and about half of all babies born in the United States are born under Medicaid.
If you’re in labor…
Ambulance rides were also considered an Essential Health Benefit, but now states can decide whether their Medicaid policies cover them. If you’re uninsured, they don’t come cheap; just a 15-minute trip in an ambulance while you’re going into labor can end up costing you nearly $2,000.
If you’re a new mom…
The Senate bill also includes a “work requirement provision,” which gives states the authority to require that non-disabled, non-elderly and non-pregnant individuals enrolled in Medicaid engage in some amount of “work activities.” Moms have to return to work or find work within 60 days of giving birth, or risk losing Medicaid eligibility.
Cover: Madison Tolchin visits Paula Glass, an advanced registered nurse practitioner, for a health checkup at a Planned Parenthood clinic on April 14, 2017, in Wellington, Florida. (Photo by Joe Raedle/Getty Images)