The Republican Party has introduced its new replacement plan for Obamacare—they're calling it the American Health Care Act (AHCA), and it's as bad as we feared it would be. This Unaffordable Care Act will start eliminating Medicaid expansion in 2020, possibly even sooner if they can find enough votes to allow it, likely throwing hundreds of thousands of newly insured off their plans and making it too expensive for many others to purchase. Subsidies will be based primarily on age, not income, again making the premiums too spendy for those who had theirs highly subsidized under the current health-care system. And a lack of individual or employer insurance mandate will likely move many people to go uninsured and risk a 30 percent premium hike if they need insurance later. The end result will be a pool of insurees with a higher ratio of less healthy customers—driving up the cost of insurance for everyone.
While Republicans are divided in their support of the AHCA, Speaker of the House Paul Ryan has been getting some pretty loud accolades from anti-abortion groups for crafting a bill that at the very least incorporates nearly everything they want from a replacement plan. The AHCA will remove any Medicaid reimbursement funding that could go to Planned Parenthood when it comes to their contraception or sexual health programs. It also discourages any insurance company that will offer plans on the state or federal exchanges from offering abortion coverage by forbidding any customer who receives a tax credit for their insurance from buying a policy that includes coverage for an elective termination.
Removing abortion from the health-care exchanges was a quest for the anti-abortion movement from the moment someone first whispered “Stupak-Pitts.” Terrified that somehow they were allegedly paying for another person’s terminated pregnancy, anti-abortion activists pushed to kill Obamacare from its very inception, and refused to allow any sort of compromise like separate policies in each state that didn’t include any abortion coverage at all, or a separate fund for paying for abortion coverage. As they’ve grown in political power, they have expanded what falls under the Hyde Amendment’s rule that no taxpayer funds can be used to pay for elective abortions, passing local insurance coverage bans in red states and arguing that public universities can’t allow abortion training on campus for their medical students.
Now, their definition is even looser than ever. While massively shrinking the subsidy that the government will be providing to help afford insurance, the social conservatives are also demanding to decide what exactly you can spend that money on, even in states where abortion coverage on the insurance exchange isn’t just allowed, it may even be mandated. In California, for example, that means almost every single insurance plan on their state exchange would be ineligible for a tax credit.
Dave Jones, the California state insurance commissioner, told the Los Angeles Times that the House GOP proposal “is directly at odds with California law and California’s constitutional protection of an individual’s right to have access to abortions.” Because the California constitution mandates that the state must treat abortion and maternal care exactly the same, any insurance plan offered in the state that provides pregnancy coverage must also cover abortion, too.
You would think potentially forcing all insurers on the exchanges to stop providing any elective abortion coverage would be good enough. But apparently, even that is not enough for abortion opponents, who want to make it even more difficult for patients to pay for their non-covered out of pocket abortion costs, too.
“The American Health Care Act contains important provisions which prevent these health care credits and state block grants from paying for plans that cover abortion on demand,” wrote Tony Perkins of the conservative Family Research Council. “However, there is still a pro-life concern in the bill because it could allow funds from the refundable credits to pay for abortions in health savings accounts. We discussed with congressional leaders who agree with the importance of making sure this bill has rock solid pro-life protections.” Perkins added, “That said, we are encouraged that House Republicans have taken the first step to apply pro-life principles to the GOP health care replace package and must ensure all the abortion loopholes are fixed.”
What Perkins and his supporters are arguing is not just that a person cannot have a tax subsidy if their insurance plan covers elective abortions – claiming that is using their taxes to pay for your abortion – but that any credit provided to help afford your health care expenses also cannot be used to pay for an abortion, either. In a real world application, a single 28-year-old woman with two kids who earns $60,000 a year would receive $6,000 in tax credits to go to her Health Savings Account (HSA) to allow her to purchase insurance and cover premiums and deductibles. If she got pregnant and wanted to terminate, not only would she not have insurance to cover the procedure, she would need to pay the roughly $700 medical bill with money outside of that HSA account, once again going out of pocket despite having money set aside to pay for her medical care.
Should social conservatives get the final say on what is or isn’t healthcare, based on their own personal religious convictions? While at this moment they want to refuse to allow abortion expenses to be covered by HSA funds, it can be assumed it is only the beginning. The GOP health-care bill at this moment has an option for allowing prenatal care, birth control and other essential health-care benefits to sunset on the same calendar as Medicaid expansion. Will IUDs be the next healthcare item the far right refuses to pay for? Prenatal care for unmarried women or teen mothers? Hormone therapy for trans patients?
At this point there is very little indication that this Trumpcare nightmare bill will make it through the House, much less get a majority at the Senate. What it has done, both in its own words and from the reaction of those who tepidly support it, is reiterate what we’ve already suspected. The GOP really dislikes big government getting involved in anyone’s personal lives. However, they are more than willing to use government overreach as a cudgel to reinforce their own belief system the second they get into power.