The Republican replacement for Obamacare is bad for women in lots of ways

After Republicans unveiled their plan to replace Obamacare Monday night, House Democrats wasted no time in arguing that it’s a bad deal for women.

The plan “would take our nation back to the days when being a woman was a pre-existing condition,” Reps. Louise Slaughter and Diana DeGette, co-chairs of the House Pro-choice Caucus, said in a joint statement.

The Republican plan would significantly reduce the access low-income women have to healthcare, prevent insurance plans from covering abortions, and defund Planned Parenthood. (Under Obamacare, birth control is covered as an essential health benefit at no cost to women.) Republicans have not yet addressed the current requirement for private insurers to cover birth control.

On Tuesday, Health and Human Services Secretary Tom Price repeatedly declined to address the birth control question when asked. “We’re working through the rules and regulations,” he said at a press conference. In November, House Speaker Paul Ryan dismissed the fate of contraception coverage as “nitty-gritty details” when questioned by CNN’s Jake Tapper

The bill is a long way from law and faces significant opposition from some Republicans, but one thing seems certain: It won’t get any cheaper to be a woman under Trumpcare.

About 17 million women rely on Medicaid for their primary source of health care, making it the single largest provider of reproductive health care in the country. Public health programs, primarily Medicaid, pay for about half of all births in the U.S. and account for 75 percent of all publicly funded family planning services.

Obamacare expanded Medicaid coverage in 31 states, giving nearly 11 million low-income people health insurance. The uninsured rate of women aged 15-44 dropped by a third between 2013 and 2015, in large part due to this expansion.

Starting in 2020, the Republican replacement plan would roll back Medicaid funding, potentially leaving millions of low-income women with no coverage for services like cancer screenings, STI testing, maternity care, and basic family planning. Currently, 15 states use state-only Medicaid funds to pay for abortions, which would also likely be cut under the Republican plan.

“Medicaid is absolutely essential to reproductive health care,” said Adam Sonfield, senior policy manager at the Guttmacher Institute, a research organization that supports reproductive rights. “These large attacks on Medicaid are devastating attacks on reproductive health.”

The Republican plan would also put abortion procedures out of reach for many low-income women. The proposal seeks to ban government subsidies, which help people afford private insurance, from being used to buy insurance plans that include abortion coverage. That would mean insurance plans that cover abortion will effectively be much more expensive, probably prohibitively so, for anyone who uses government subsidies.

This will give insurance companies very little incentive to cover abortions at all.

The GOP proposal doesn’t prevent people from buying an additional plan that includes abortion coverage, called a rider, on top of an existing plan. But this would cost money and be a logistical nightmare. It’s also not how insurance is meant to work, Sonfield says.

“Abortion is a good example of why you generally need insurance, because it’s for the unexpected,” he said. Abortion is for when “either you have an unplanned pregnancy or a planned pregnancy that goes wrong. In either case it’s not something you’re counting on.”

Under the Republican proposal, people will have to pay for abortions entirely out of pocket. Costs vary from $500 to thousands of dollars, depending on the procedure, making it out of reach for many women who have to pay for it on their own. Slightly more than half of women who have an abortion say they pay for it themselves, according to the most recent data from Guttmacher — including about 60 percent of women who have private insurance.

The Republican health care proposal fulfills a longtime promise to cut federal funding to Planned Parenthood because it provides abortion services. But federal funds are already prohibited from being used to pay for abortions, so cutting off federal reimbursements (mostly in the form of Medicaid payments) hurts low-income women who rely on the organization for routine reproductive services.

Price was asked about the effects of defunding Planned Parenthood during a press conference Tuesday and repeated the answer Republicans have often given: There are plenty of other “community health centers” that can provide an array of services to women.

Multiple medical experts, including the American Congress of Obstetricians and Gynecologists and the National Partnership for Women and Families, have said that other family planning organizations would not be able to meet the demand if Planned Parenthood is forced to close clinics. As many as a quarter of Planned Parenthood’s 2.6 million patients would lose access to services if Medicaid was no longer allowed to go to the organization, according to the Congressional Budget Office.