On Thursday, June 22, Senator Mitch McConnell and his colleagues unveiled the long-awaited details of the Better Care Reconciliation Act (BCRA), the Senate's counterpart proposal to the House's Affordable Health Care Act (AHCA) that would repeal and replace the Affordable Care Act (ACA, aka Obamacare).
While many people are freaking out that their birth control coverage might suddenly stop, for a large portion of the population, reproductive rights have never been a sure thing.
I spoke with several advocates and experts on the potential impacts of the Senate's new bill. Not surprisingly, the communities that have always been most vulnerable are even more so now.
Women of color and indigenous women, women living at or below the poverty line, and women with lower education levels are in general at the highest risk for unintended pregnancies, according to research from the Guttmacher Institute.
The factors are so intertwined in part because women of color are disproportionately likely to be in poverty.
This history of lack of reproductive rights for minority women especially isn't anything new. However, Michelle Batchelor, Deputy Director of National Black Women's Reproductive Justice Agenda, says the Senate's bill takes things a step further:
Historically, there have been health disparities, but this separation that this [bill] further creates between the haves and the have-nots is creating a separate but equal society, or attempting to go back to that. Our healthcare system will look greatly different from the wealthier of society.
For women of color and poor women especially, reproductive care is a double whammy. About one third of black women and a quarter of Latina women of reproductive age are Medicaid recipients, according to the Guttmacher Institute, and the rates of women with insurance has risen thanks to the Affordable Care Act.
If women can't afford or access birth control in the first place, it's likely they can't afford or access abortions, either.
Without access to abortions, women are at higher risk of falling into poverty, says Destiny Lopez, co-director of abortion rights group All Above All. The cycle is vicious.
"We were expecting the worst and the worst actually came true," says Lopez. "[This bill] hits low income people and communities of color the hardest."
When asked to rank the bill on a scale from 1 to 10 with 1 being the worst, Lopez says,
It's a zero. It's that bad. ... This is the worst healthcare we've seen for women in a generation. This is going to strip women and families from access to vital care. ... This bill not only makes it harder to prevent unintended pregnancy, but has provisions that would penalize women for having children.
According to the Guttmacher Institute, about 95 percent of unintended pregnancies are accounted for by inconsistent use or lack of birth control altogether, a sign of their effectiveness when used properly.
Some two-thirds of unplanned births were paid for by Medicaid and other public programs. About one third of black women and one quarter of Latina women rely on Medicaid, Lopez says.
Without contraceptive care, the teen pregnancy rate in the U.S. would've been 73 percent higher, research from the Guttmacher Institute shows, and the public cost of unplanned pregnancies could've been 75 percent higher.
The economics are of particular concern with women of color, who statistically face a much larger pay gap than their white counterparts.
Batchelor points to the financial hardship as another aspect of disproportionate damage. She says,
This health policy is going to force black women in particular to make choices between having quality healthcare, or pay the rent. These are going to be life and death decisions that black women are forced to make every day.
LGBTQ+ individuals, who have double the uninsurance rate of non-LGBTQ+ people, are also at acute risk, according to the research from the Center for American Progress (CAP).
The ACA helped secure a higher insurance rate for this population, CAP shows. That coverage is now jeopardized thanks to the Senate's bill, according to CAP's Sejal Singh, communications and campaign manager on the LGBT team.
Discrimination drives disproportionately high rates of economic insecurity and uninsurance among LGBT people. After all, you can't get employer-based insurance if you're fired from your job for being trans.
Also under the Senate's bill, Planned Parenthood will be defunded for one year. This would cut off a major resource for many women.
The thing is, women aren't fitting into just one identity box or another -- they're often fitting many at once. What happens when a women is vulnerable to many of these risks at once? The impact is even harder on those members of our community, and the BCRA could make it a lot worse.