The nonpartisan Congressional Budget Office’s new assessment of the GOP health plan to repeal and replace Obamacare projects 22 million fewer people will have insurance by 2026 if the bill is passed.
It’ll also result in thousands of unintended pregnancies, since the plan restricts funding for Planned Parenthood, which offers women family planning and abortion services.
Margot Sanger-Katz at the New York Times noticed the key passage today:
CBO: Planned Parenthood defunding will result in more births and around 15% of current patients losing care. pic.twitter.com/kvhHYh1SPz— Margot Sanger-Katz (@sangerkatz) June 26, 2017
If you search the latest draft of the bill and its amendments for precise language about Planned Parenthood, you won’t find it. But the bill’s provisions about “prohibited entities” are basically attempts to defund Planned Parenthood.
In essence, these sections of the bill say groups that are primarily engaged in family planning services, reproductive health, and providing abortions (other than abortions that are medically necessary or responses to cases of incest or rape) — and whose Medicaid receipts exceeded $350 million in fiscal year 2014 — are barred from receiving federal dollars through several health programs, most importantly Medicaid, for one year. And the one group that meets that description is Planned Parenthood, the CBO said.
If passed, the provision would mean that if a woman has Medicaid, the health insurance program for low-income Americans, as her health insurance plan, she can’t go to Planned Parenthood and get those services covered because Planned Parenthood would no longer be able to be reimbursed.
The impact here would be huge. Three-quarters of the public dollars spent on family planning in this country are Medicaid dollars. And right now about 2.5 million people rely on Planned Parenthood for a range of health care services, like birth control and cancer screenings.
Defunding Planned Parenthood will leave thousands of people, particularly low-income people, without access to these health care services — and would also result in more unintended pregnancies, CBO said (emphasis added):
To the extent that access to care would be reduced under this legislation, services that help women avoid becoming pregnant would be affected. The people most likely to experience reduced access to care would probably reside in areas without other health care clinics or medical practitioners who serve low-income populations. CBO projects that about 15 percent of those people would lose access to care.
The Better Care Reconciliation Act also guts Medicaid, which pays for about half of all births in this country, including two-thirds of unplanned births.
The core idea behind the BCRA is cutting spending on health care for the poor to finance tax cuts for the rich, as Vox’s Andrew Prokop explained. In practice, this means phasing out Medicaid expansion (which made more people eligible for the program) by 2021.
If fewer people can access Medicaid, that means fewer people can get the women’s health and reproductive services that do things like cover cancer screenings, improve access to birth control, and make sure moms and babies have health care throughout a pregnancy and in the months after a baby is born.
Here’s the CBO again, on the impact that’ll have:
Because the Medicaid program pays the costs of about 45 percent of all births, CBO estimates that the additional births stemming from the reduced access under this legislation would add to federal spending for the program. In addition, some of those children would themselves qualify for Medicaid and possibly for other federal programs. By CBO’s estimates, during the one-year period in which the funding prohibition would apply, the number of births in the Medicaid program would increase by several thousand, increasing direct spending for the program by $79 million over the 2017-2026 period. Overall, with those costs netted against the savings estimated above, implementing the provision would reduce direct spending by $146 million over the 2017-2026 period, CBO estimates.
Some of these provisions may not pass the Senate
The Senate chose to try to pass their health reform bill through budget reconciliation, a process that allows bills to pass with only 50 votes, as Vox's Dylan Scott explained.
The reconciliation process was designed for dealing with bills related to the federal budget, and specifically budget deficit reductions. Under Senate rules (the Byrd Rule in particular), bills passed this way are supposed to be focused on the budget.
Anything in the bill designed for other purposes is suspect and may be stripped out — and the defunding of Planned Parenthood is something that may violate these Senate rules. If the bill is allowed to stand as is, though, it would have a major impact on women and, eventually, their children.