Don’t Give Up on the Affordable Care Act: Planned Parenthood and Don’t #MakeAmericaSickAgain

In a move that devastated many and shocked virtually no one, Paul Ryan announced on January 5th that repealing the Affordable Care Act would include defunding Planned Parenthood. This isn’t new. Republicans did the same thing last year in their repeal efforts then. Refusing federal funds to Planned Parenthood would prove a crushing blow to women across the country, since many — particularly low-income women and women who live in outlying communities without much access to medical facilities — visit Planned Parenthood clinics for preventive care, cancer screenings, family planning counseling, birth control, and more. Key to note, however, is that federal tax money doesn’t pay for abortions. What defunding Planned Parenthood actually means is that the government would no longer provide reimbursements through public health programs like Medicaid for preventive and family planning care only offered at Planned Parenthood. So if you’re a woman on Medicaid, you couldn’t get your treatment at Planned Parenthood, which would mean that a lot of women couldn’t get necessary medical treatment for things other than abortion, period. To be abundantly clear, we are not talking abortion here. We’re talking cancer screenings, prevention of unwanted and dangerous pregnancies (which actually savesthe federal government money), gynecological exams, and so forth. This move would specifically target women who can’t afford private healthcare.

Ironically enough, Ryan’s move to stop federal reimbursement to Planned Parenthood via public health programs might provide an opportunity for ACA supporters to seize the day. The Republicans want to repeal the ACA through what’s known as the reconciliation process, because that way they can pass it with a simple-majority vote (51 out of 100 senators). They have 52 seats in the Senate and VPEOTUS Mike Pence as a tie-breaker. However! Rand Paul is already opposed to the measure, because — surprise, surprise — it would increase the federal deficit. And some moderate Republicans, Susan Collins of Maine and Lisa Murkowski of Alaska, expressed dismay over the Planned Parenthood defunding. There’s already a group of House Republicans opposed to defunding Planned Parenthood as well. But if just those three senators vote against repealing the ACA, that brings Republicans down to 49 — not enough to pass the budget resolutions that would cripple the law.

Meanwhile, Minority Leader Chuck Schumer announced this week that Democrats will not take Republicans efforts to #MakeAmericaSickAgain (in Schumer’s words) lying down. A united front of Democrats versus an ever-so-slightly divided Republican party provides a glimmer of hope to this staunch defender of the ACA. While the reconciliation rules don’t allow Democrats to filibuster, they do get what sounds like a terrible amusement park ride, the “vote-a-rama” that could last anywhere from days to weeks, allowing Democrats to draw out the process. And they get two of these, the first when the bill reaches the Senate and the second before it’s ultimately passed. These vote-a-ramas are a major opportunity. Democrats can, for example, demand amendments for multiple different pre-existing conditions, use the time to mobilize grassroots support, explain to the public how demonstrably harmful and even life-threatening repealing the ACA would be to millions of Americans, and show that destroying the unpopular parts of the ACA like the mandate would also mean destroying accessibility of care to folks with pre-existing conditions (as just one example). And “pre-existing conditions” can be interpreted quite broadly, as has historically been the case. If Democrats use the vote-a-ramas wisely, that’s where we come in. Now is the time to call your representatives and tell them your story, your friend’s story, your family member’s story, your neighbor’s story, your college roommate’s second cousin’s story — I really don’t care whose, just pick a story. Make your voice heard and express your support for the ACA, how it has improved the quality of life of millions of Americans of all ages and backgrounds across the country, how it has saved lives. The ACA was a lifechanger for me, since it prevented insurance companies from refusing me coverage or charging me exorbitant premiums simply because when I was a young child I was diagnosed with a chronic autoimmune disease, and have continued to collect them into my teens and twenties. What can I say, it’s more quirky than collecting stamps, although I imagine being a philatelist would be less high maintenance. But tell me, can you look someone with a chronic disease in the eye and say that you support their not receiving essential healthcare? If you believe in healthcare equity, keep an eye on Schumer and the Democrats and follow their lead.

But anyway, what exactly is the Republican plan? Well…they’re not exactly sure, either. Their strategy at present is to repeal and delay, which basically means that they would follow the reconciliation process to repeal critical measures of the ACA, those that provide the necessary funding for it to function, without an immediate replacement. Doing so, however, would be to everyone’s detriment. It would cause chaos in the market because insurers would want to pull out, since they wouldn’t know where their payments would come from. The market has already been facing trouble because not enough young and healthy people signed up, making it harder for insurance companies to cover the elderly, disabled, and chronically ill. If Republicans gut the law altogether and then wait to replace it, that will only create more instability. This spring is the deadline for insurance providers to announce if they’ll offer plans next year, as Sarah Kliff of Vox pointed out. If Republicans repeal significant elements of the ACA, what motivation do insurers have to do so? So the Republican promise that no Americans would suffer during such a transition period rings incredibly hollow. Millions of Americans would quickly find out that, unlike The Princess Bride, there’s no such thing as the good-parts version of the ACA. Some Republicans recognize that repeal and delay is deeply risky, like Lamar Alexander, Rand Paul, Susan Collins, and Bob Corker. So that’s two additional senators right there. That 51-vote margin is looking a little shakier.

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