Here's How Graham-Cassidy Would Crush Abortion Access

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Last week, Republicans introduced another bill to repeal and replace Obamacare. The Graham-Cassidy bill, as it's known, has been widely criticized for a variety of reasons, including the potential to cause millions of Americans to lose health insurance. Two particular provisions of Graham-Cassidy makes insurance plans that cover abortions ineligible for tax credits.

The abortion coverage and tax credit-related provisions of Graham-Cassidy fall within sections 102 and 103 of the bill. They were pointed out in an article on the website ACA Signups, a site dedicated to comprehensively tracking Obamacare enrollments and updates on proposed changes to health care legislation.

Graham-Cassidy proposes completely eliminating federal premium tax credits and small business health insurance tax credits by January 2020. However, as the article on ACA Signups pointed out, it also almost immediately rescinds tax credits for health plans that offer abortion coverage, saying that this provision would be implemented in tax year 2018. Indeed, both in the case of individual premium tax credits and small business tax credits, a plan that covers abortion would not be considered a Qualifying Health Plan (QHP) that is eligible for such tax credits under Graham-Cassidy.

As ACA Signups described:

Starting in 2018 ... the term "qualified health plan" does not include any health plan that includes coverage for abortions, except abortions necessary to save the life of a mother or abortions for pregnancies that are a result of rape or incest.

While in 2020 this provision would essentially be moot (since Graham-Cassidy eliminates federal premium and small business tax credits for health insurance plans anyway), the fact that it singles out plans covering abortion for near-immediate rescinding of tax credits is particularly jarring — as is, of course, the fact that it, in addition to other Graham-Cassidy provisions, makes it even more difficult for American women to access and afford abortions.

These provisions essentially mean that if Graham-Cassidy were to pass, beginning in 2018, no plan sold on the ACA health care marketplace can cover abortions, since all plans on the exchange must be "Qualifying Health Plans." People can only receive individual tax credits for plans on the exchange and, thus, the prospect of having any type of tax credit for a health insurance plan that covers abortion is completely eliminated.

Under Graham-Cassidy, insurers could still sell plans that cover abortion off of the ACA exchange, but these plans would not be eligible for tax credits, making them largely unaffordable for many. As Vox pointed out, since fewer people would buy insurance plans that cover abortion over time (because they would be less affordable), fewer insurers would offer insurance coverage for abortion.

In addition to the restrictions these provisions would place on women's health and rights, they also present several policy quandaries, ACA Signups noted. For example, the deadline for the federal government to sign 2018 individual market participation contracts is in eight days, likely before the Graham-Cassidy could be passed. Thus, if the bill did actually become law, it would likely legally invalidate hundreds of insurance plans that were previously approved to be on the marketplace — because they provide abortion coverage.

This would then place the federal government and the American people in a massive quandary, as ACA enrollment begins on Nov. 1. Thus, Graham-Cassidy could mean that a number of plans would be eliminated from the marketplace just as Americans are beginning to sign up for new policies.

Furthermore, California state law actually requires all policies on the exchange to provide abortion coverage, meaning that if Graham-Cassidy were to pass, California law and federal law would clash — and federal law would render all of California's insurance plans ineligible for the health care marketplace. This would, again, present a highly complicated legal and logistical problem.

Graham-Cassidy is highly detrimental to women's health as it would make abortion incredibly inaccessible and unaffordable for the majority of American women. Moreover, if passed, it appears that the bill would almost immediately present a myriad of legal concerns relating to abortion and insurance coverage, causing even further uncertainty and injustice for women seeking to exercise their basic right to quality, affordable health care.