Repealing and replacing the Affordable Care Act has been a rallying cry of the GOP for eight years. Now that they’re finally getting their chance, Republican leaders are struggling to find a politically acceptable replacement for the Affordable Care Act. Obamacare greatly expanded women’s access to healthcare, so Republican attempts at repeal pose a direct threat to millions of women. Here’s what could change.
Republican Replacement for the Affordable Care Act: Changes Now, Changes Later, and an Uncertain Future
The Republican replacement for the Affordable Care Act is a fiscal reconciliation bill. It’s also, they say, just the first in a series of legislation. So we don’t yet know how extensive the changes will be, or when they will come. So far, Republican changes include only defunding Planned Parenthood, draconian abortion regulations, and a massive scale back of Medicaid.
Planned Parenthood Funding
Republicans have been at war with Planned Parenthood, a major provider of women’s healthcare, for years. Unsurprisingly, their new plan completely defunds the organization. This could leave millions of women without access to birth control, reproductive health counseling, and other vital services.
The Hyde amendment already prohibits any public funding of abortion. The new Republican replacement for the Affordable Care Act would go further. Tax credits for healthcare coverage are a signature feature of the new legislation. But Republicans want to prohibit tax credits for any plan that covers abortion—even if the plan recipient never has an abortion. This could reduce the number of plans eligible for tax cuts, while encouraging insurers to refuse to cover abortion care.
The Republican replacement for the Affordable Care Act would scale back Medicaid coverage. Funding for Medicaid would be given to the states. However, funding would be capped, and coverage would be limited, reducing the total number of people eligible for care. This could have disastrous effects on preventative care, including for women’s health.
Birth Control Coverage
For now, birth control coverage is safe. As one of the most popular features of the ACA, coverage for birth control has saved countless women thousands of dollars. To anti-choice Republicans, birth control access should be a no-brainer. Research shows that birth control access can prevent abortions. Yet Republican opposition to abortion seemingly has little to do with protecting life. Republicans have steadfastly opposed the ACA’s birth control mandate. It’s likely that as soon as they get the chance, they’ll remove birth control coverage, throwing millions of women’s reproductive futures into uncertainty.
Republicans apparently aren’t sufficiently pro-life to want to fund the costs of carrying a baby to term. For years, Republican men have insisted they shouldn’t have to cover pregnancy and childbirth, even as they insist that women cover male-specific treatments such as prostate cancer screening and Viagra.
The Affordable Care Act requires all insurance plans to cover maternity care. Prior to the law, most employer-backed policies offered maternity coverage, but other plans rarely did. Moreover, even employer-supported plans often featured significant coverage gaps. While Republicans have not yet moved to eliminate the maternity care mandate, their long-time opposition to this piece of the legislation suggests they may soon attack it.
With average birth costs ranging from $10,000-$40,000 without insurance, this could put many women into bankruptcy solely because they chose to have a baby.
Choice advocates interested in abortion access for all woman now often talk about reproductive justice as opposed to reproductive choice. The reproductive justice movement, which originated with feminist organizations such as SisterSong led by women of color, focuses on access issues, not just legal rights. Reproductive justice advocates argue that abortion can’t just be legal; it must also be available to the women who need it most.
Here are five ways abortion rights are constrained even when abortion is fully legal.
In December, when the election of Donald Trump still felt like a nightmare, we offered five strategies to fight anti-choice laws and rhetoric. Now that President Trump is a frightening reality, it’s more important than ever to defend choice. The battle might seem like a losing one, but Trump and his administration specialize in demoralization. By making things seem hopeless, they hope to subvert the progressive will to keep fighting.
Don’t let them win. Here are five things you can do right now to fight for reproductive freedom. Fight back against anti-choice!
As states across the nation move to constrain women’s abortion rights, U.S. maternal mortality continues to rise. The trend stands in contrast to other nations, which has seen sharp drops in deaths during and after pregnancy.
Republican’s haven’t made a peep about the upswing in maternal mortality. They have, however, moved to increase it by working to slash social safety net programs, remove maternity coverage mandated in the Affordable Care Act, limit access to birth control, and force women to carry to term even pregnancies resulting from rape. Republicans’ stark opposition to any policy that could lower abortion rates or reduce maternal mortality suggests their anti-choice politics have nothing to do with protecting life.
A study that’s gotten little press attention quietly argues that increased access to abortion could save women’s lives. In the midst of a maternity care crisis, the research argues, fewer—not more—abortion regulations could mean the difference between life and death. Republicans continue to attempt to regulate the practice, in spite of data suggesting regulations harm women.
Saving Women’s Lives With Abortion
The study—a doctoral thesis that looked at maternal mortality across the globe—emphasizes that unsafe abortion kills tens of thousands each year. In 2015, more than 300,000 women worldwide died from complications of pregnancy and childbirth.
The dissertation’s recommendations include:
Increasing access to knowledge about abortion. When providers understand abortion and the reasons women seek it, they are more likely to offer quality care.
Allowing midwives, not just doctors, to perform abortions. Research suggests that increasing the number of abortion providers can improve outcomes and lower the number of unsafe abortions.
Increasing access to contraceptives.
Improving women’s access to chemical abortions, including the so-called abortion pill.
Educating medical students about abortion laws. Doing so reduces stigma and increases empathy toward women who seek abortions.
Republican Anti-Abortion Measures Can Kill Women
Pro-life sentiments seem only to extend to the fetus—not the woman who carries it, and certainly not the baby after he or she is born. Their anti-abortion maneuvers read like an exact mirror image of recommendations to save women’s lives.
State legislatures have enacted measures to:
Require doctors to provide women with medically inaccurate abortion information.
Limit which providers can perform abortions, and in which contexts.
Decrease access to the abortion pill.
Force women to carry pregnancies to term, even if those pregnancies threaten their lives.
Under a Trump administration, these laws are likely headed to the Supreme Court, where abortion rights face an uncertain future. As men fight over what women can do with their bodies, women’s lives hang in the balance.
An Indiana House committee has narrowly approved legislation requiring providers to tell women about so-called “abortion reversal.” Women seeking to reverse a chemical abortion may seek injections of progesterone, a hormone that supports a number of chemical changes during the first trimester of pregnancy. The approval of the bill moves it one step closer to becoming law.
The procedure, which has no scientific support and which may be dangerous, is based on the faulty premise that many women regret their abortions. Abortion is inherently irreversible, so the bill marks a strange turn in an increasingly aggressive push to undermine reproductive choice.
Bizarre Indiana ‘Abortion Reversal’ Bill
The bill, which stoked heated debates in an House committee meeting, requires medical providers to tell women about medications that could reverse drug-induced abortions. The idea is that women may immediately regret their abortions and want a way out.
The American Congress of Obstetricians and Gynecologists says there’s no science supporting abortion reversal. There have been less than 10 cases of claimed abortion reversal, and each case raises more questions than it answers. It may be that women seeking abortion reversal simply had failed abortions—not successfully reversed terminations.
The medications used to “reverse” such an abortion may cause serious side effects. Because abortion reversal is not an approved medical treatment, women may go to unethical clinics or buy progesterone injections online.
Even Republican lawmakers admit that the science they lean on is dicey at best. Two Republicans joined Democrats in opposing the bill, citing health and ethical concerns.
Women, Abortion, and Regret
In recent years, anti-choice activists have taken a new tack: rather than shaming women, they claim they’re trying to help them. Of course, those offers of help end as soon as the fetus becomes a baby, since anti-choice activists are generally the same people who oppose welfare, food stamps, a minimum wage hike, paid maternity leave, and other measures that could reduce the abortion rate. But when women are still pregnant with the babies Republican lawmakers will one day care nothing for, anti-choice zealots say they’re trying to help women avoid a lifetime of regret.
There’s no denying that a small number of women regret their abortions. However, research shows that the mental health effects of abortion are almost universally positive. Post-abortion syndrome—a type of PTSD that supposedly affects large numbers of women who have abortions—is a myth of the anti-choice movement.
We do know one way that abortion affects women’s mental health: women who receive abortions tend to report improvements in mental health. That makes sense, since having an unwanted child can lead to poverty, thwarted careers, and a wide range of health issues.
One ongoing study of women denied abortions has found that denying abortions can spur long-lasting psychological harm. Women who seek, but are denied, abortions are more likely to experience depression anxiety, to live in poverty, to remain in abusive relationships, and to suffer poor pregnancy outcomes.
Republican leaders seem fine with this. Their concern has never been about women seeking abortions. Their only interest appears to be punishing women with pregnancies—never mind the consequences those pregnancies yield for the woman or her child.
Indiana has passed a number of controversial abortion regulations in recent years. Many were spearheaded by then-Governor and Now-Vice President Mike Pence. A 2016 law requiring women to bury the remains of aborted and miscarried fetuses sparked national outrage. The Periods for Pence Campaign responded to the legislation by encouraging women to call Governor Pence to report details of their periods and reproductive efforts.
President Trump is a direct threat to abortion rights, particularly if he gets more than one Supreme Court nominee. An end to Roe vs. Wade would send abortion back to the states. Women’s access to abortions would then depend on geography. So will abortion make it to the Supreme Court? And will the wrong case end abortion as a Constitutional right?
For that to happen, only two things must occur:
- A lawsuit about an abortion regulations under Roe must wind its way to the Supreme Court
- A majority of the Court must vote against abortion rights. This probably wouldn’t happen unless Trump nominated a second Supreme Court justice.
A number of state level abortion restrictions may soon give rise to lawsuits. In 2016 alone, 19 states enacted 60 new abortion restrictions. Here are some of the most disturbing.
A new law in Arkansas permits husbands to sue their wives to stop abortion. With no exception for rape, the law fundamentally undermines the right to privacy that underpins Roe vs. Wade.
Second Trimester Abortion Bans
Roe vs. Wade preserves the right to abortion up to the point of viability. Lawmakers in numerous states want to prohibit the procedure well before viability. Ohio recently enacted legislation banning abortion after 20 weeks. A number of states have recently banned dilation and evacuation (D&E), the safest and most popular second trimester abortion option. The Pennsylvania Senate just passed legislation banning the procedure. If the measure meets the approval of the House and governor, it could become law.
So-called personhood amendments define fetuses—and occasionally even fertilized eggs—as human beings. This enshrines for them the same rights that living, breathing women posses. And in the case of a woman seeking an abortion, a fertilized egg has the right to remain in the woman’s body, no matter how she feels about it, and no matter how it got there.
Personhood amendments almost never contain exceptions for rape or the life of the mother. In Wisconsin, anti-choice activists argued that the life of the mother is a “loophole” used to unfairly seek abortions.
A related group of laws, fetal heartbeat laws, prohibit abortion as soon as a fetus has a heartbeat—usually around six weeks’ gestation. One such law passed the Ohio legislature last year, but Governor John Kasich vetoed it.
Burying Fetal Remains
In their quest to penalize women, a number of states now require them to bury all fetal remains, including those from miscarriages. These laws are largely nonsensical, since abortion rarely produces a “body,” and miscarriages are often indistinguishable from menstrual periods.
Indiana’s fetal burial law sparked a national backlash in the form of “Periods for Pence.” Now Texas has a similar rule. Women’s groups already plan to sue—a decision that could launch the law on a journey toward the Supreme Court.
What Happens Now?
These laws present choice advocates with an impossible conundrum. They can let the law stand, thereby depriving women of abortion rights but preventing the case from going to the Supreme Court. Or they can fight back, risking nationwide abortion rights in the process.
Trump’s Supreme Court nominee, Neil Gorsuch, has never ruled on abortion. So what does the nominee believe about choice? He ruled in favor of Hobby Lobby in the landmark decision about access to contraceptives. His other rulings point to a staunchly conservative judge. Learn more with our Daily Kos post.
President Trump, apparently unmoved by millions of women protesting for reproductive rights, reinstated the global gag rule. The so-called Mexico City Policy bans organizations that receive US funding from discussing abortion. Research suggests the policy increases the abortion rate. This makes it just one in a series of ineffective and harmful Trump policies. Learn more about the rule change with our Daily Kos article.
Under President Trump, Republicans will likely get at least two Supreme Court nominees. States across the country have reacted with more abortion restrictions. From incarcerated women denied abortions to laws completely banning the procedure, restrictive legislation is increasing. If the right case goes before the Supreme Court, abortion rights could end. Even if Roe vs. Wade survives, fewer abortion rights under President Trump are nearly inevitable. To learn more, read our Daily Kos blog for more details.
Doctors cannot be compelled to perform abortions. But a federal judge has ruled that this religious protection is insufficient. A Texas district judge has ruled that doctors can refuse to treat women who have had abortions and people who identify as transgender. Read our Daily Kos post on the ruling here.