Just as it nearly was for Democrats seven years ago, abortion appears ready to scuttle any tentative deal to repeal-and-replace the Affordable Care Act between Republicans in Congress.
While President Donald Trump balances making direct threats on Capitol Hill with schmoozing at the White House bowling alley in an effort to sell a rushed bill to an increasingly reluctant conservative House caucus, at least two Republican women in the Senate are threatening to vote against Trumpcare because it restricts women’s access to reproductive health care.
The American Health Care Act, as the bill is formerly known, "restores pro-life principles to the health care system," House Speaker Paul Ryan said on Tuesday. On Monday night, House Republican leadership published 21 pages of revisions to the bill, a so-called “Manager’s Amendment” designed to gain the support of reluctant House conservatives ahead of Thursday’s crucial floor vote.
In addition to being courted with changes, conservatives in the House are also being pressured to support the White House-backed bill by targeted campaigns from anti-abortion groups.
“The final version of the American Healthcare Act must include language to prohibit direct subsidies or tax-preferential treatment for elective abortion services or coverage, whether in health care tax credits, subsidies or any other health care programs,” the president of the conservative Family Research Council, Tony Perkins, wrote in a recent op-ed in The Hill.
Trumpcare swaps out subsidies for limited tax credits and forbids women from using those tax credits to purchase any abortion-providing insurance plans on the Affordable Care Act marketplaces. The legislation only allows women to purchase a separate insurance plan, without subsidies, just for the specific purpose of abortion coverage. In effect, the Republican plan ensures that insurance companies no longer offer plans in the individual market that include abortion coverage.
Twenty-five states already bar abortion coverage, with limited exceptions, in Obamacare's insurance marketplaces. As Adam Sonfield, a senior policy manager of the Guttmacher Institute, explained to Salon, after Michigan enacted such a policy in 2013, not one insurance company in the state offered such coverage on the individual market.
Still, conservative groups are pressuring conservative House members worried about the bill's cost to support it on the merits of its anti-abortion merits.
“Doing nothing to overturn the multiple abortion-expanding and rationing provisions of Obamacare is not an acceptable option,” Carol Tobias, president of the National Right to Life Committee, wrote in a statement. His group announced last week that it would include the vote in its annual “scorecard” for members of Congress — applying significant pressure for conservative members eager to maintain their strict pro-life voting record.
Since Obamacare was passed in 2010, there has been an 18 percent decline in unintended pregnancies nationwide. Furthermore, according to the Guttmacher Institute, the U.S. has seen a 14 percent decline in the abortion rate between 2011 and 2014.
Trumpcare includes no less than four abortion coverage restrictions. And while the House races to sacrifice women’s reproductive health in order to repeal Obamacare, more than enough senators have already declared that they won't vote for the House GOP’s plan to render the legislation virtually dead on arrival in the upper chamber.
Bloomberg News reported Tuesday that Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska oppose the House bill’s other provision attacking women’s health — its defunding of Planned Parenthood.
The House GOP bill blocks about $500 million in federal funding for Planned Parenthood, the nation’s largest single abortion provider. The women's health organization receives federal funds through Title X and Medicaid reimbursements, which the House Republican plan would gut.
“I think that Medicaid funding that goes to Planned Parenthood is important not only for women and men in Alaska and around the country and I will maintain that," Murkowski told reporters Tuesday. Along with three other Republican Senators, Murkowski threatened to vote against any bill that severely guts Medicaid even before the release of the House GOP plan. Her additional explicit support for Planned Parenthood is notable because it appears in line with the majority of American voters, including Trump supporters.
Earlier this month, the Congressional Budget Office estimated that defunding Planned Parenthood would not only result in thousands of unintended pregnancies, but would increase Medicaid spending by $21 million in the first year alone. Republicans even want to bar Americans covered by Medicaid from receiving any care at Planned Parenthood, including cancer screenings and STD testing.
Both Murkowski and Collins opposed the GOP’s Obamcare repeal effort in 2015 over similar language defunding Planned Parenthood. In 2011 and in 2015, Republicans nearly shut down the government over Planned Parenthood.
“I have said continuously and repeatedly that I support the work of Planned Parenthood. I support the continuation of Medicaid funding going to them,” Murkowski told The Atlantic earlier this month.
Sensing the demise of the president’s first major legislative push, the White House signaled to Planned Parenthood earlier this month that the organization could keep its federal funding if it stopped performing abortions. But Planned Parenthood didn’t bite.
“It would be easier to light the Capitol on fire,” Rep. Trent Franks, R-Ariz., said of any chance of compromise on defunding Planned Parenthood inan recent interview with The Atlantic. "One of the main concerns I have is to make sure we don’t lose the pro-life provisions in the senate,” Franks told Politico this week after Vice President Mike Pence met with conservative House members to sell Trumpcare's “pro-life” provisions.
So, Trumpcare appears trapped between abortion politics and a hard place, much like Obamacare before it.
When anti-choice Democratic members of the House initially insisted on including a provision that would bar any of the Affordable Care Act’s insurance subsidies from going to any plan that includes coverage of abortion in 2010, the delicately negotiated bill appeared doomed. Then-President Barack Obama eventually signed an executive order making that commitment in a last-minute compromise known as the Stupak Amendment.
But anti-abortion groups have already stated they will accept no such compromise on Trumpcare.
“Recall the 11th hour agreement in March 2010 between Rep. Bart Stupak and former President Obama, which got hold-out pro-life Democrats to vote for ObamaCare in exchange,” FRC’s Tony Perkins wrote in his op-ed to conservatives. “Until that point, former Rep. Stupak had a 100 percent pro-life record. That one vote changed everything. He is no longer in office and he has not spoken again at the March for Life.”