What Are the Implications of the 2016 Election for Women's Health in the US?
BY MARIE BERRY AND JULIA MACDONALD
- President-elect Donald Trump and VP-elect Mike Pence appear to be committed to significantly curtailing women's access to health care, especially reproductive services such as abortion and birth control, through executive action, legislation, and judicial appointments. Trump's administration is likely to initiate the most serious assault on reproductive rights in decades.
- Trump has stated that he plans to repeal the Affordable Care Act, under which many women's health care services are deemed preventative care and covered at no cost.
- The speed at which the Trump administration can unravel women's access to health care depends on the way policies were made. Policies that were unilaterally implemented via executive action will be easiest to undo. Low-income women living in red states or states with family cap policies are likely to be the most immediately and directly affected by changes in access to abortion and reproductive health care.
- While we don't know for sure what the new administration will do once in office, the election appears to have inspired an upsurge in racist, misogynistic, transphobic, Islamophobic, and xenophobic acts. Such acts may make it more dangerous for LGBTQIA+ people, immigrants, women of color, disabled people, and people with other intersecting oppressions to seek access to health care, which may result in new health crises.
The policies proposed by President-elect Trump and his VP-elect Mike Pence pose a profound danger to women's bodies and reproductive autonomy.
Trump says he plans to repeal the Affordable Care Act (ACA), which has greatly expanded coverage of women's health care, including annual wellness exams, birth control, breast pumps, mammograms, prenatal and newborn care, and screenings for cervical cancer without a co-pay. While it is unlikely that his actions can interfere with 2017 insurance plans that have been purchased before he takes office, it is highly possible that 2018 plans will be affected. It is also possible that the dismantling of the ACA will drastically roll back Medicaid coverage, disproportionately affecting low-income communities.
Despite taking deeply inconsistent stances on abortion over the years, Trump's latest position, which is backed up by his selection of Pence as VP, is to ban abortion, with exceptions only for rape, incest, or when the life of the woman is in danger. He has shown support for a ban on abortion after 20 weeks of pregnancy, before many fetal abnormalities can be identified. Trump has announced his intention to defund Planned Parenthood due to its position on abortions, and has stated his intention to make the Hyde Amendment (which prohibits taxpayer funds from being used to pay for abortions) permanent law. Trump has also pledged to nominate anti-choice justices to the Supreme Court. Trump supports giving much of the power in determining the legality of abortion to the states, two-thirds of which are currently governed by Republicans.
These impending restrictions on women's access to health care will affect all women, but will likely disproportionately affect poor women, LGBTQIA+ individuals, women of color, especially those living in "red states" or states with family cap policies that deny needy families further financial assistance after the birth of another child. Further, given Trump's alarming plans to curb immigration and deport millions of undocumented immigrants, undocumented or non-citizen women are likely to be particularly vulnerable to losing access to critical health care services. These restrictions on women's access to reproductive choices are likely to amplify poverty—including child poverty—and reduce women's control over their ability to parent.
Moreover, the rising prevalence of hateful, violent language and acts by Trump supporters during his campaign and after his electoral victory may make it more difficult—and more dangerous—for some women and femmes to access health care. This is particularly true for women of color, queer women, and non-cisgender individuals, especially at clinics known to perform abortions that already face daily protestors aiming to intimidate and discourage women from seeking services.
1. UNILATERAL/EXECUTIVE ORDERS
Dismantling the ACA: It is uncertain how President-elect Trump will go about dismantling the ACA once he reaches office. Republicans will lack the 60-vote supermajority necessary to fully repeal the law in the Senate. As such, they will likely pursue an overhaul of parts of the law through budget reconciliation, focusing on provisions such as the individual mandate, the employer mandate, and the subsidies that make policies more affordable (see here).
There are conflicting reports about Trump's power to erase the ACA's requirement that insurance plans include women's access to birth control and other reproductive services under "preventative care." Vox's Sarah Kliff has warned that if Trump can persuade the Department of Health and Human Services (HHS) to redefine what constitutes "preventative care," women could quickly lose no-cost coverage of birth control. Trump's announcement of Rep. Tom Price as his pick to lead HHS has amplified such fears, as Price is a major opponent of the ACA, an anti-choice advocate, and a supporter of privatizing Medicaid. Such fears have inspired many women to seek IUDs and other forms of long-acting birth control prior to Trump's inauguration in January 2017. However, it is unlikely that any changes to the ACA can retroactively interfere with private insurance plans that have already been purchased as of Trump's inauguration, and therefore these benefits are unlikely to change in 2017 even if the law is repealed. Depending on how the ACA is dismantled, however, access to preventive care could be curtailed in 2018. This is especially concerning for women on Medicaid.
Pain-Capable Unborn Child Protection Act: During the Presidential campaign, Trump vowed to support the Pain-Capable Unborn Child Protection Act (PCUCPA), a bill that would ban most abortions after 20 weeks, before many fetal abnormalities are identified. This law would require a woman survivor of rape to file a police report before obtaining an abortion at 20 weeks, essentially requiring her to get the permission of local law enforcement. The House passed the PCUCPA in 2015, but the bill failed to garner sufficient support in the Senate. With backing from the President-elect and Republicans in control of both the House and Senate, the PCUCPA may be signed into law soon after Trump takes office.
Hyde Amendment: The so-called "Hyde Amendment" prohibits federal funding for abortion services (subject to certain narrow exceptions). The Hyde Amendment is a legislative rider first introduced in 1976 and has been extended annually by Congress every year thereafter. During the campaign, Hillary Clinton called for the end of the Hyde Amendment. President-elect Trump, by contrast, has announced support for making the Hyde Amendment a permanent law. The legislation disproportionately affects low-income women and women of color who rely on Medicaid for insurance.
Defunding Planned Parenthood: Planned Parenthood provides low-cost family-planning services, STI and cancer screenings, HIV testing, and other health care services to millions of people every year. Speaker of the House Paul Ryan has promised a bill that will permanently defund Planned Parenthood and President-elect Trump supports defunding Planned Parenthood so long as it continues to perform abortions. While in Congress and as Governor of Indiana, VP-elect Mike Pence spearheaded the effort to defund Planned Parenthood and is likely to be a vocal supporter of continued efforts. It is unclear whether such legislation would survive judicial scrutiny, as a federal judge previously struck down an analogous Indiana law that purported to ban Medicare users from accessing Planned Parenthood.
Supreme Court Nominations: Both Trump and Pence have stated their desire to see the Court overturn Roe v. Wade. With one current vacancy on the Supreme Court and both houses of Congress under Republican control, Trump is likely to succeed in his stated goal of appointing one or more anti-choice justices to the Supreme Court.
Regardless of whom Trump appoints, a majority of Supreme Court Justices may still be reluctant to overturn Roe, a precedent that has survived for over 40 years and was reaffirmed by the Court in the 1992 case of Planned Parenthood v. Casey . That said, if Roe is overturned at any point in the coming years, we are certain to see a major crisis with devastating consequences for women—and especially low-income women and women of color—as there is abundant evidence that prohibitions on abortion do not halt abortions, but rather restrict access to safe abortions.
Lower courts: Even if Roe v. Wade remains at the Supreme Court level, abortion laws are certain to change under a Trump administration due to judicial appointments to the federal bench (including trial and appellate courts). This is likely to affect policies such as mandatory waiting periods before abortions, informed consent procedures, mandatory ultrasounds, and laws aimed at making abortions prohibitively expensive.
What can you do?
- The U.S. Supreme Court: If you want your senators to at least put pressure on the process, you can contact your senators here and tell them you oppose any Supreme Court nominee who would overturn Roe v. Wade or limit abortion access. Another way to take action is to vote for pro-choice candidates in your local state elections. State legislatures are the ones who write many of the laws that make it to the federal courts and eventually the Supreme Court, so applying pressure at that level can help.
- The Pain-Capable Unborn Child Protection Act: Support pro-choice candidates in Congress and vocalize your opposition to such a bill.
- Support Reproductive Justice Organizations: Donate to the many smaller organizations doing critical reproductive justice work, many of which are led by women of color. Some of these organizations serve regionally-specific populations (e.g., Vermont Access to Reproductive Freedom, La Frontera Fund, California Latinas for Reproductive Justice, Colorado Organization for Latina Opportunity and Reproductive Rights, New Orleans' Women with a Vision, New Voices Pittsburg, New Voices Cleveland, Georgia's SPARK Reproductive Justice NOW, New Mexico's Young Women United, California's ACCESS Women's Health Justice), while others are focused more regionally or nationally (e.g., SisterSong, Black Women Birthing Justice, National Black Women's Reproductive Justice Agenda, National Black Network for Reproductive Justice, National Latina Institute for Reproductive Health, and the Native American Women's Health Education Resource Center). These organizations are at the core of an essential movement for reproductive justice and will be critical players in preserving the ability of women—and especially women of color—to access contraception, sex education, STI prevention and care, alternative birth options, adequate prenatal and pregnancy care, domestic violence assistance, adequate wages to support families, safe homes, and the right to parent (source: SisterSong).
- Planned Parenthood: In addition to contacting your lawmakers, you can donate to Planned Parenthood to make sure it can continue to provide essential women's health services to the underserved.
(in addition to the organizations linked to above)