A new era is upon us, one filled with uncertainty and lots of hostile rhetoric and harmful policy ideas directed at the most vulnerable in our society.
For example, we know that President Trump is itching to fill a seat on the U.S. Supreme Court with a jurist as conservative as the late Justice Antonin Scalia. If the president succeeds, the landmark case Roe v. Wade will be endangered. On January 22, 1973 the high court in a 7-2 opinion concluded that a woman's right to obtain abortion care is a constitutional one - protected by the due process clause of the 14th Amendment. So what happens if this landmark law is gutted or reversed? It means wealthy women will be able to afford to travel to states that do provide abortion care, and women struggling to make ends meet on limited or insufficient incomes will suffer and be denied access to quality health care.
On this anniversary of Roe, in a month designated to raising awareness of the country's ongoing inability to defeat poverty, it is disturbing and disheartening that our nation, beset with festering inequalities, is facing an administration and Congress bent on pushing an agenda that will have the greatest adverse impacts on the lives of our most vulnerable.
There are millions of stories nationwide being told of the great need for women to access abortion care. See NARAL Pro-Choice America's "Our Stories," for a start. Sarah, 26, who discovered she was pregnant while she was working to earn a graduate degree, wrote that she "chose to have an abortion and it was undoubtedly the hardest decision I've made in my life. Deep down I knew that I could not consciously choose to keep a child in the position I was in and I couldn't do that to my partner either. And especially to a child. It wouldn't have been fair to anyone." Sarah notes she has finished her graduate degree, and is employed in a job she loves. These are decisions any woman should be able to make. Overturning Roe would eviscerate that right, and access to quality health care for women.
Even before appointing an arch conservative Supreme Court justice, Congress and Trump are plotting action to roll back progress, thereby punishing - you guessed it - the people who can least afford to lose rights. The Trump administration wants to cut federal Medicaid funding in the guise of giving the states more "flexibility." Don't be fooled. This is about limiting health care spending on low income individuals and it will have a major impact on women. As the National Health Law Program's (NHeLP) Susan Berke Fogel and Catherine McKee write in a piece for Rewire, Medicaid is the "single largest provider of reproductive health services to women of childbearing age. The program accounts for 75 percent of all public funding for family planning services. In 2015, more than twenty percent of all women ages 15 to 44 were enrolled in the Medicaid program."
Some Republican governors recognize what's at stake. For example, in a Jan. 11 letter to House Majority Leader Kevin McCarthy, Republican Massachusetts Governor Charles D. Baker, concluded that turning Medicaid into block grants or capping the funding would actually limit states' flexibility in operating Medicaid. "We are very concerned that a shift to block grants or per capita caps for Medicaid would remove flexibility from states as the result of reduced federal funding. States would most likely make decisions based mainly on fiscal reasons rather than the health care needs of vulnerable populations."
Republicans in Congress also have vowed to cut off funding to Planned Parenthood clinics that provide health care services, as Nancy K. Kaufman writes for All Above All, to "2.5 million people through Medicaid." This type of policy - excluding low-income women from vital health care services -- has been championed to devastating effect by ideologically driven state legislators, as Fogel and McKee note. They write that "motivations behind these laws have nothing do with women's health, and everything to do with further stigmatizing and punishing abortion providers and making abortion services unavailable." (It's not just abortion services that are being yanked from women; Planned Parenthood clinics provide myriad preventive care services, such as cancer screenings, STD testing and treatment, contraception and health care education and information. Fogel and McKee note that in Indiana where state law effectively ended funding to Planned Parenthood, clinics were forced to close including "the only publicly funded clinic in Scott County, which later became the center of an HIV epidemic that erupted in the state. Ironically, the shuttered clinic did not perform abortions, but did offer HIV education and testing.")
The other Trump administration goal, repealing the Affordable Care Act, would also dramatically impact our nation's poorest. The ACA has expanded Medicaid in 32 states and D.C and added 30 million people to the rolls of the insured, 82 percent of whom are in working families and many of whom have gone without health care to put food on the table. It's estimated that repeal of the ACA would quickly strip those 30 million Americans of health care coverage.
On both fronts, there is hope - especially if enough sensible lawmakers come together to defeat this austerity agenda that would increase profits for the super wealthy, while sending more people into poverty and driving up health care costs again. We are seeing some Republican governors expressing concern about the hasty effort to undo health care reform. Republican Arizona Gov. Doug Ducey, for example, said, "I don't want to see any Arizonan have the rug pulled out from underneath them in terms of changing this law." If sensible heads prevail and Congress rejects the effort to repeal the ACA without a replacement plan, then those pushing for repeal will have to face the challenge: come up with a system that protects access to quality health care for everyone, including those with challenging health conditions, that works better than what we have now.
And as I wrote earlier this month with former U.S. Solicitor General Donald Verilli in a piece for The National Law Journal, those pushing to roll back health care reform have failed to answer the tough questions about destroying a popular reform law. It's also a just law - one that is improving the lives of millions of Americans and providing them opportunities to be full participants in our democracy. This is no time to regress. It is an era for liberals, progressives and all other Americans who care for this country, to come together and resist and agitate and defeat a wrongheaded, mean-spirited political and economic agenda.
The same rigorous analysis must be given to proposals to cut Medicaid funding. Per capita caps and block grants must be seen for what they would be: radical cuts in a program that, for fifty years, has effectively and efficiently provided health care to our nation's most vulnerable. States would no longer have the federal financial support they need to provide quality care to everyone entitled to that care. They would have to foot the bill themselves or skimp on care.
Our country cannot afford to return to the days when health care was a privilege reserved for the wealthy.
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