All of a sudden, a last-ditch attempt by Republicans to repeal Obamacare, the Cassidy-Graham bill, is back on the table. With just over two weeks to go before the September 30 deadline, when the reconciliation budget procedure, allowing Republicans to pass their bill with just 50 votes instead of the usual 60, expires, Republicans are moving extra fast to see if they can muster those 50 votes and pass it, without even having a chance to get its impact fully assessed by the Congressional Budget Office. While the full effects of Cassidy-Graham remain unclear, we know that Cassidy-Graham would have huge effects on Planned Parenthood.
Like the previous iterations of Republican health care efforts, Cassidy-Graham defunds Planned Parenthood and similar women's health care facilities, by forbidding federal funds (such as Medicaid money for non-abortion medical procedures) from going to women's health clinics that perform abortions. Republicans have tried this in numerous states, arguing that other health providers could pick up the slack, although the Guttmacher Institute, a think tank that focuses on reproductive health policy, disputes that claim heavily.
Dawn Lugens, executive vice president at Planned Parenthood Federation of America, said in a statement: "Policy on women’s health care should not be written by a small group of male politicians behind closed doors. Enough is enough. With this latest version of Trumpcare, Americans will pay more and get less, but women will pay the biggest price of all.”
But defunding Planned Parenthood wouldn't be the only way that Cassidy-Graham would limit access to abortion. The bill forbids federal funds from going to any health insurance plan that includes abortion coverage, starting this year. So people who get their health insurance on the individual health care market that covers abortion will either have their plans dissolved, lose subsidies, or have the abortion coverage pulled from their insurance. In California, it is illegal to sell health insurance that doesn't cover abortion, so it looks like hundreds of thousands of Californians could lose insurance starting this year. Since the bill dismantles all federal subsidies for insurance in 2020 to replace them with block grants, this could lead to a change farther down the line, but in the mean time, it will cause chaos for the country's largest state, and block abortion access for millions around the country.
In addition to blocking plans from covering abortion, Cassidy-Graham also limits what portions of women's health care insurance plans do have to cover. Under the Affordable Care Act, all health insurance must cover a set of Essential Health Benefits, such as mental health care and prescription drug coverage. Notably for women's health, the Affordable Care Act requires every health insurance plan to cover pregnancy and child care. But Cassidy-Graham would allow states to waive the Essential Health Benefits requirements for insurance plans. Similarly, it would allow states to end the rule that all customers have to be charged the same for their insurance regardless of health status, meaning that people with pre-existing conditions could be charged more.
There's a real issue for women's health in these changes. Covering pregnancy, as well as long-term health issues that affect women, costs real money, and if not all health plans have to cover women's health issues, it would likely lead to insurance companies offering cheaper plans that don't and more expensive plans that do. In effect, it would mean that women trying to deal with their health needs would have to pay more for insurance plans than men.
Beyond the parts of Cassidy-Graham that specifically affect women, the bill cuts Medicaid spending after it was expanded under Obamacare. Since Medicaid is the biggest single insurer of women in America, a shrinking version of the program (or one that covers less, as some states may choose) will cut the health care for millions of women. And since the program changes how health care spending is allocated among states, it could lead to massive cuts for states like New York, California, and Massachusetts, which have enrolled millions of women.
On the other hand, some states will get more money under the Cassidy-Graham funding formula. But since the one that stands to gain the most, Texas, seems to really have a problem with women's health, it's hard to look at this bill and say that it will likely have a positive effect on women's health care.