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The Uncertain Future of Reproductive Health Care

What's safe (for now) and what's not

By Megan Yoder | 5/1/17 10:51am | Updated 5/1/17 10:51am
Jaclyn Merica / American Word Magazine

It was supposed to be the bill that cashed in on a major campaign promise for President Donald Trump: to repeal and replace Obamacare. But instead of ousting the legislation so despised by Republicans, House Speaker Paul Ryan’s American Health Care Act (AHCA) never made it to a vote in the House of Representatives in March.

Advocates for reproductive health care are breathing sighs of relief after the bill’s flop. But how close did the bill come to cutting health care options like abortion and birth control? What might the administration still be able to roll back?

Just days after the GOP setback, Republicans said they have started negotiating a new health care bill. It is not clear what the new bill might look like, but there is no question where the administration stands when it comes to controversial health care measures like abortion. 

President Trump has limited abortion access internationally and has the power to roll back access to other women’s health care options in the U.S.

Prioritizing the issue just three days after his inauguration, Trump reinstated the “Mexico City Policy,” a rule originally put in place by the Reagan administration that has been revoked and reinstated on and off by presidents since its inception. Critics call it the “Global Gag Rule.”

The policy bars U.S. aid money from supporting international organizations that provide or promote abortions-- though the 1977 Hyde Amendment has long made it illegal for federal funds to be used specifically for providing abortions, except in cases of rape, incest or danger to the mother’s life.

Opponents of abortion supported the move, the first in Trump’s potential arsenal of rollbacks to reproductive health care options.

“We think things are going to move more pro-life under this administration,” said Jim Sedlak, Executive Director at the American Life League, a pro-life education organization based in Virginia. “We’re very excited about it.”

But for AU students like junior Hannah Walsh, Trump’s pro-life platform triggered concerns about her access to birth control in the future. Walsh said many of her friends grew anxious after the election, worrying that changes in health care policy might cause costs for their birth control to spike. 

“I think there was kind of this panic among my friends and people I know about how this [administration] is going to affect us, and I’m privileged in a lot of ways… but I was specifically worried about how this could affect me as a woman,” Walsh said.

Walsh went home to Chicago and got an Intrauterine Device (IUD). IUDs, small “T” shaped devices inserted into the uterus by a medical professional, last for three to ten years and are over 99 percent effective at preventing pregnancies. 

But how far could the Trump administration actually go in cutting access to reproductive health care like birth control? Pretty far, at least for low-income individuals, according to AU Assistant Professor of Government, Elizabeth Sherman. 

“Donald Trump and the Republican members of Congress have a very powerful voting bloc in the Evangelical Christians and this is their number one issue—Planned Parenthood, birth control and abortion,” Sherman said. 

We break down what almost happened to other reproductive health care options under the AHCA, and what could still be done to roll them back. 

Could abortions be banned? 

Is there a possibility that Roe v. Wade (1973), the defining court case in the abortion debate, could be overturned, eliminating the constitutional right to an abortion? 

That’s probably not the most likely option, according to Sherman. 

“Would they (the Supreme Court Justices) completely overturn Roe and say it is no longer a constitutional right and from now on say ‘the states are going to decide whether it’s legal or not’ and go back to the days before Roe? I don’t think so,” Sherman said. A decision like that would be a serious stray from legal precedent. 

What would be more probable, according to Sherman, is that more states would increase regulations that make it harder to get an abortion, such as implementing mandatory waiting periods or requiring clinics that provide abortions to meet surgical standards – instead of banning the procedure outright.

However, pro-life organizations have prioritized the Supreme Court as an important arena for anti-abortion campaigns. “Roe v. Wade was forced on the American people by the Supreme Court, and so the changes that are going to happen are most likely going to happen in the Supreme Court, because no one voted for abortion in the first place,” Sedlak said. 

Outside of Roe v. Wade, major changes to abortion access would have come from Republicans’ efforts to repeal and replace the Affordable Care Act. Trump’s AHCA would have decreased access to Medicaid and defunded Planned Parenthood, making it difficult for low-income individuals to find affordable abortion providers. It also would have changed abortion regulations for private insurance companies, likely increasing costs for the procedure

In summary: It would be a difficult process to make abortion illegal outright, but it may become tougher or more expensive to have the procedure, especially for low-income women. 

Will birth control become more expensive? 

Before the Affordable Care Act (ACA) was introduced by President Obama, insurers could charge hefty fees for contraceptives. The ACA prohibits private insurance providers from charging additional fees for birth control outside of regular insurance premiums.

This birth control mandate has been controversial in the past, because it requires employers who may be religiously opposed to contraceptives to cover birth control for their employees. While the AHCA did not propose changing that benefit, the Trump administration could still decide to alter or remove it in the future. 

In summary: It is very unlikely birth control would become unavailable entirely, but there is a possibility it may become more expensive. 

What will happen to Planned Parenthood?

Republicans came close to taking some serious, long-awaited hits at the controversial organization through the AHCA. 

It is important to note that the majority of funding for Planned Parenthood – over 60 percent, according to the organization’s website – comes from Medicaid reimbursements. That means the government refunds costs for care provided to Medicaid users at clinics. So what would have changed? 

Most notably, the AHCA would have defunded Planned Parenthood for a year by blocking Medicaid insurance from being used at clinics that provide abortions, even for non-abortion procedures like cancer screenings or STI testing. Remember, there is already a law that says federal funds cannot be used to cover abortions, except in the case of rape, incest or danger to the mother’s health.

Because reimbursements from Medicaid are an important part of how Planned Parenthood operates financially, this would have taken a serious toll on clinics and low-income patients who rely on Medicaid to pay for various services at the clinics nationwide. 

Could Planned Parenthood plausibly make up the difference in funding in other ways if it faced serious cuts again?

‘There’s no way,” Sherman said, adding that it would be very difficult for clinics to continue doing business as usual without federal money. 

The White House has suggested that Planned Parenthood can continue to receive funding if it stops performing abortions. Planned Parenthood has rejected that proposal.

“We’ve made tremendous gains in this country thanks to expanded access to reproductive health care and birth control,” Dana Singiser, Vice President for Public Policy and Government Relations at Planned Parenthood said in a statement on March 13.

“We are at a 30 year low in unintended pregnancies, and a historic low in teen pregnancies. Now is not the time to roll that progress back,” Singiser said in the statement.  

In summary: Planned Parenthood dodged funding cuts from the AHCA, but defunding the organization remains a major priority for Republicans. If that happens, it would be very difficult for the organization to continue operating in its current capacity.