The Better Care Reconciliation Act, introduced Thursday by Senate Republicans to replace the Affordable Care Act, would both increase pregnancy costs for women, and increase the cost of not getting pregnant.
How does the bill manage such a feat? It defunds Planned Parenthood—which provides family planning and birth control for millions of low income women for one year. It also prohibits federal tax subsidies from paying for individual market plans that cover abortion. That means fewer women will have access to birth control.
Additionally, the bill allows states to redefine what counts as an Essential Health Benefit for Medicaid plans. Currently, all plans must cover 10 categories of care, including prescription drug coverage, maternity care, preventive services like birth control, and mental health care.
But those Essential Health Benefits aren’t just on the line for Medicaid enrollees; it’s possible that all women in the individual market could lose those protections. The bill allows states broad waiver authority in what services are covered by insurance plans, which experts told MONEY will allow them to redefine the Essential Health Benefits.
If states are able to redefine these, it is most likely maternity coverage that’s on the line, the nonprofit Kaiser Health reports. Just 12% of non-group plans covered maternity care prior to the passage of the ACA.
“It’s going to make it much harder to avoid a pregnancy that you don’t want, it’s going to make it harder to [end] an unwanted pregnancy, and it’s going to make it harder to take care of that baby when you do have it,” says Andrea Flynn, a health policy fellow at the Roosevelt Institute, a left-leaning think tank. “We can’t expect that women will be able to be economically secure if they can’t access health care and take care of themselves and their families.”
According to the nonpartisan Congressional Budget Office, which scored the House’s American Health Care Act (which included similar EHB provisions to the BCRA) women could end up paying as much as $1,000 a month for an additional rider that covers maternity care and pregnancy, on top of their premiums and other health care costs.
According to Stephanie Glover, a senior health policy analyst at the National Partnership for Women & Families, waiving Essential Health Benefits is an “attack” on the guaranteed coverage of maternity care in the individual market. “Women need access to maternity coverage, it’s an essential part of their health care,” Glover says. “It shouldn’t matter what kind of insurance you have.”
The BCRA is even worse for low income women: not only may they lose some Essential Health Benefits, but the BCRA phases out the ACA’s Medicaid expansion and cuts funding overall.
Medicaid currently covers at least 25 million low income women, according to Kaiser, and about half of all children in the U.S., including 60% of disabled children. As MONEY reported Thursday, “starting in 2025, Medicaid spending would only be allowed to rise at the rate of general inflation, a rate much lower than needed to keep pace with rising health care costs, experts say.” All of this means fewer people overall will be covered.
“This bill is really, really harmful for low income individuals,” says Janel George, director of federal reproductive rights and health at the National Women’s Law Center.
The BCRA also requires new mothers, starting October 2017, to return to work 60 days after giving birth or risk losing their Medicaid coverage. “It’s hard to articulate how unhelpful that is,” Flynn says. “It really just feels like a way to punish low income Americans and make it even harder for them to take care of their families.”
Taken all together, the Senate bill will make women’s health care more expensive and limit access to it.