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The GOP's Obamacare plan targets Planned Parenthood — and private abortion insurance coverage

A leaked draft of House Republicans’ plan to repeal the Affordable Care Act has major repercussions for women’s health.

Mark Wilson / Getty Images Staff; Jennifer Graylock / WireImages Contributor

A leaked draft copy of House Republicans’ plan to repeal and replace the Affordable Care Act was published Friday by Politico. While the language isn’t final, it’s a sweeping plan that would dismantle many foundational parts of Obamacare, including Medicaid expansion and many of the taxes that currently fund the health care law.

And as promised by House Speaker Paul Ryan, the ACA repeal bill also defunds Planned Parenthood. It would strip the organization of hundreds of millions of dollars of Medicaid reimbursements, which make up the majority of the organization’s federal funding.

But the draft bill goes even further than that. It threatens to dismantle the entire private insurance market for abortion coverage, not just public funding.

The bill could effectively eliminate private insurance coverage of abortion

Under the new Republican plan, any insurance plans that cover abortion won’t be eligible for tax credits. The tax credits would help make insurance more affordable for some consumers. That means insurance coverage for abortion, specifically, will be more expensive.

To be clear, the proposed plan doesn’t ban abortion coverage directly. Nor does it prohibit anyone from buying abortion coverage, or a separate insurance “rider” for that coverage. It just doesn’t allow that coverage to be subsidized by the government.

That means many consumers would have to go out of their way to find a plan that covers abortion — and once they did, it would be more expensive. And if abortion insurance coverage is both expensive and a logistical hassle, many consumers simply won’t buy it.

That wouldn’t leave insurance companies much incentive to offer abortion coverage at all, even if it’s technically not prohibited by law. Indeed, it gives insurers almost no other choice but to stop covering abortion in many, or even most, of their plans.

Similar language on subsidies for private insurance coverage of abortion on the ACA exchanges could be found in another bill the House recently passed, HR7. That bill was a sweeping abortion funding ban that would also permanently codify the Hyde Amendment, which bans federal funds from covering abortion except in very rare circumstances (rape, incest, and to save the life of the woman — but not for nonfatal health issues or for fetal anomalies).

“It’s clear the goal is to try to eliminate private coverage of abortion entirely,” Megan Donovan, senior policy manager at the Guttmacher Institute, told Vox in an earlier interview.

Lumping in Planned Parenthood with Obamacare repeal could threaten the success of the entire bill

While targeting Planned Parenthood’s funding is popular among Republicans, most Americans don’t consider it a priority. In fact, most Americans, including nearly half of Trump voters, oppose defunding Planned Parenthood, the nation’s largest family planning provider. One in five US women have visited a Planned Parenthood clinic for services like birth control, cancer screenings, STD tests, or pregnancy termination.

Republicans have threatened a government shutdown over Planned Parenthood funding before, in 2011 and 2015, but they were ultimately forced to back down — mostly because Democrats in the Senate and President Obama were a firewall.

That’s why many GOP members of Congress have expressed reservations about lumping Planned Parenthood defunding and ACA repeal together.

Republicans need at least 50 of their 52 senators to pass the ACA repeal through the budget reconciliation process — and two pro-choice Republican senators, Lisa Murkowski of Alaska and Susan Collins of Maine, have said they oppose linking ACA repeal to Planned Parenthood defunding. Murkowski took a harder line Thursday when she said she will not vote to “deny Alaskans access to the health services that Planned Parenthood provides.”

What does it actually mean to “defund Planned Parenthood” at the federal level?

Paul Ryan Holds Weekly Press Briefing At The Capitol
Paul Ryan wants to divert Planned Parenthood funding to “community health centers.” Trouble is, Planned Parenthood operates a lot of community health centers. And they can’t be easily replaced.
Photo by Mark Wilson/Getty Images

In practice, defunding Planned Parenthood takes funding away from its mostly low-income patients — who might be forced to seek care elsewhere if the government stopped subsidizing their visits to Planned Parenthood. Low-income women will be hit especially hard, but all Planned Parenthood patients may be affected.

The more than $500 million Planned Parenthood receives annually from the federal government — the funding that Republicans in Congress now want to take away — pays for specific health services, like birth control or cervical cancer screening, for people who couldn’t afford them otherwise.

Most of the funds (75 percent) are actually reimbursements from Medicaid, the US’s public health insurance program for the poor. Just like with any other insurance, Medicaid patients go to their health care appointment first and then have Medicaid pay all or most of the bill later.

Planned Parenthood of Michigan

The rest of Planned Parenthood’s federal funds come in the form of grants from Title X, the nation’s only federal program for family planning. Title X grants are awarded on a competitive basis to clinics that meet the program’s standards for family planning coverage and services.

Title X subsidizes free or low-cost contraception and other preventive services, and it’s especially helpful for low-income or uninsured people who make too much to qualify for Medicaid.

The ACA repeal bill targets Medicaid. Another proposal that just passed the House targets Title X, by making it easier for states to block Planned Parenthood from receiving federal Title X grants.

Again, Title X grants are competitive. When Planned Parenthood affiliates and clinics earn Title X grants, it’s because they have proven they can administer better care than other local providers.

If the government stopped paying for Planned Parenthood to accept Medicaid patients or Title X grants, it would be a huge financial blow to the organization.

Federal funding makes up about 40 percent of Planned Parenthood’s budget. Most of its patients are low-income and rely on Medicaid coverage or Title X subsidies for health care.

In 2015, a whopping 78 percent of Planned Parenthood’s patients had incomes of 150 percent or less of the federal poverty level. Losing even a significant fraction of these low-income patients would be devastating to Planned Parenthood; it would probably have to close clinics or reduce capacity, which would affect all of its patients, regardless of income.

But Planned Parenthood wouldn’t stop performing abortions. It just wouldn’t. No matter how you count it (abortion makes up 3 percent of Planned Parenthood’s services provided, but probably a higher percentage of its revenue), abortion is nowhere close to the majority of Planned Parenthood’s business.

So giving up abortion services wouldn’t solve the organization’s financial woes if it’s defunded — and, more importantly, it would go against everything Planned Parenthood stands for. Offering women the full spectrum of reproductive health care, including pregnancy termination, is just too central to its mission.

Correction: The repeal bill will affect tax credits for private insurance more broadly, not subsidies for plans offered on the Affordable Care Act exchanges, as this piece originally indicated.