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GOP Health Plan Dares Americans to Cast Off the Poor

Christine Grimaldi

Some House Republicans believe the ACA replacement legislation doesn’t do enough to make reproductive and other health-care services inaccessible to people with low incomes.

Congressional Republicans formally launched their assault on reproductive health-care access for people who already have few options with the release Monday evening of their Affordable Care Act (ACA) repeal legislation.

The 123-page American Health Care Act from the U.S. House of Representatives notably undermines the ACA’s family planning services and “essential health benefits,” specifically for Medicaid recipients. In doing so, advocates say Republicans are daring the rest of Americans to turn their backs on millions of the most marginalized people. Medicaid and the Children’s Health Insurance Program (CHIP), which covers kids through both Medicaid and other programs, served more than 74 million people by December 2016, according to nonpartisan Kaiser Family Foundation data.

Republicans go even further by ending the ACA’s Medicaid expansion in 2020, though states can enroll until that time. At least four rank-and-file Republicans in the U.S. Senate—Rob Portman (OH), Cory Gardner (CO), Shelley Moore Capito (WV), and Lisa Murkowski (AK)—oppose that plan. All represent states that expanded Medicaid under the ACA.

Murkowski also won’t vote for any ACA repeal bill that touches funding for Planned Parenthood. Sen. Susan Collins (R-ME), a fellow Planned Parenthood ally, could also defect.

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There’s growing opposition from House Republicans who believe the legislation doesn’t do enough to make health-care services inaccessible to people with low incomes. Members of the ultra-conservative House Freedom Caucus oppose the bill, as do influential outside groups such as the Heritage Foundation and the Club for Growth. The legislation even failed to pass muster with the Koch brothers.

Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association, slammed Republicans for stripping people of accessible, affordable health care.

“This ideology runs counter to the beliefs of the American public,” Coleman said in a statement.

The health-care policy-setting House Energy and Commerce Committee and the tax-writing House Ways and Means Committee are scheduled to hold simultaneous markups on Wednesday morning. Amending and approving the legislation in the committees at the same time will allow Republicans to expedite the bill to the floor for a final vote. Potentially behind the GOP’s rush: The nonpartisan Congressional Budget Office has yet to score or price the plan.

As they have long promised, Republicans plan to “defund” Planned Parenthood by stripping the health-care provider of Medicaid reimbursements for one year. Cutting off Planned Parenthood from Medicaid reimbursements really means cutting off Medicaid recipients from Planned Parenthood. And that means people with low incomes and nowhere else to go won’t have access to contraceptives, cancer screenings, and STI testing and treatment, among other covered services, all because Republicans want to punish Planned Parenthood for providing abortion care that isn’t covered by federal funds.

Some Republicans remained indifferent to the experiences of people who were not powerful, wealthy, and white.

Americans may need to choose between the “new iPhone that they just love” and having health care coverage, Rep. Jason Chaffetz (R-UT), chair of the powerful House Oversight Committee, said on CNN’s New Day.

Dawn Laguens, executive vice president of Planned Parenthood Federation of America, said that attitude isn’t acceptable.

“One in five women in America has relied on Planned Parenthood, and their health care shouldn’t get caught up in congressional Republicans’ extreme agenda,” Laguens said in a statement.

The community health centers that Republicans have falsely propped up as an alternative to Planned Parenthood are not prepared to fill the gap in care. Even so, the GOP legislation makes $422 million of federal money immediately available to community health centers for the current fiscal year. Under a prior draft that Rewire examined, community health centers would have received $285 million in fiscal year 2018, which doesn’t start until October 1, 2017.

Other differences would be no less harmful. Republicans initially sought to devolve the ACA’s “essential health benefits,” a set of ten categories of health services that health plans in the individual and small group markets must cover, to the states by the end of 2019. Doing so would effectively kill that federal requirement by letting states set their own standards, which could allow those led by GOP-majority legislatures to cut off birth control coverage in plans sold within their borders.

Republicans are only killing essential health benefits for Medicaid recipients—again, leaving people with low incomes without guaranteed access to pregnancy, maternity, and newborn care, as well as a wide range of preventive services, including contraceptives. The U.S. Department of Health and Human Services could still gut essential health benefits writ large and target the ACA’s popular birth control benefit providing no-copay contraceptives to consumers.

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