By Jordan Rudner
The Dallas Morning News
WWR Article Summary (tl;dr) Women’s health professionals in Texas and elsewhere are crafting recommendations for clients based on the policies they expect to see from a Republican-controlled Congress and a president who has said he wants the Affordable Care Act repealed and Roe vs. Wade overturned.
The calls started coming in just hours after Donald Trump won the presidential election.
Women across Texas wanted to switch their methods of birth control to intrauterine devices, better known as IUDs, said Amy Hagstrom Miller, president and CEO of Whole Woman’s Health.
So many women called, Miller said, that all three of the Whole Woman’s Health-operated clinics in Texas had to order new supplies.
Unlike birth control methods like the pill, IUDs don’t require monthly purchases. After a one-time insertion cost, IUDs work for years, some models provide birth control for up to six years, while others last more than a decade.
In other words, they can outlast a presidential administration.
Women’s health professionals in Texas and elsewhere are crafting recommendations for clients based on the policies they expect to see from a Republican-controlled Congress and a president who has said he wants the Affordable Care Act repealed and Roe vs. Wade overturned.
But experts and advocates say some changes will take effect faster than others because the legislative process moves slowly, and because states, rather than the federal government, are responsible for many reproductive health programs.
Repealing the Affordable Care Act
For years, Republicans have put a repeal of the Affordable Care Act, better known as Obamacare, at the top of their priority list. Trump has often referred to the program as a “disaster.” But plans in the marketplace created by the ACA offer full coverage for a variety of contraceptive methods, and such coverage might not continue under an Obamacare replacement.
That’s why Miller, who calls contraceptive coverage one of the most important aspects of Obamacare, has been urging friends to consider getting IUDs.
Right now, the cost is free for Medicaid users and those on the vast majority of insurance plans. But without insurance, the one-time cost for the procedure, including the doctor’s appointment and the device itself, can be up to $900, according to Planned Parenthood.
And although a full repeal of Obamacare would be a complicated process, the Department of Health and Human Services, which the president controls, is in charge of defining which procedures count as preventive health benefits for women. Even before Obamacare is repealed, Trump could direct the agency to drop birth control from the list of covered benefits.
Roe v. Wade won’t be repealed, for now
As Inauguration Day draws closer, women’s health activists across Texas are preparing for other policy changes a new administration might bring. Although the repeal of the Affordable Care Act might happen quickly, some of Trump’s other stated priorities, like a repeal of Roe vs. Wade, would take years to come to fruition.
In June, Miller and the Whole Woman’s Health clinics successfully defeated tight regulations of abortion providers that had been passed by the Legislature in 2013. The Supreme Court ruled that the regulations placed an undue burden on women seeking abortions.
“The victory we had is not going to be undone by this election,” Miller said. “We’ve got a lot of ground to stand on now that we didn’t have before.”
She and Kyleen Wright, president of the Texans for Life Coalition, don’t agree on much, but they both acknowledge that a functional repeal of Roe v. Wade, the 1973 Supreme Court decision that established, with some limits, a constitutional right to abortion, won’t happen anytime soon, simply because of the way the legal system works.
Although Trump has pledged to fill the vacancy on the Supreme Court left by former Justice Antonin Scalia with a justice who is opposed to abortion, that would leave the balance of the court largely unchanged, with five justices who have generally ruled in favor of upholding Roe.
“One vacancy on the court is not going to tip the balance a whole lot unless we have someone super brilliant and very persuasive,” Wright said.
Given the advanced age of several of the justices, Trump could have the opportunity to put more than one justice on the court.
But even if he successfully appointed two justices, cases typically take several years to make their way up the court system, and justices can’t simply call up cases regarding issues they want to address.
For those reasons, a Roe repeal is not at the top of Miller’s list of concerns.
“There have been a lot of really broad-sweeping statements about what women’s access to reproductive health is going to be like under the Trump administration, and a lot of statements have come from him,” Miller said. “But no one elected official has the power to undo 44 years of Supreme Court precedent since Roe.”
The Hyde Amendment
Even without a full repeal of Roe, Wright said she is optimistic about the possibility of further restrictions on abortion funding at the state and federal level.
“It’s a very exciting time to be a pro-lifer,” Wright said. “Especially to know that we’re not going to have the feds working against us.”
One of the policy changes Wright said she hopes to see is for the Hyde Amendment to be put into law. The amendment bars women from using federal funds to pay for abortion in the overwhelming majority of cases and primarily affects low-income women who use Medicaid.
Although the Hyde Amendment has been attached as a budget rider every year since 1976, it is not a law.
“We hope and very much expect to see that 40-year-old long-standing tradition currently codified into law,” Wright said.
During her presidential campaign, Hillary Clinton was the first Democratic candidate to openly call for a repeal of the amendment, arguing that its real-world impact was to make it “harder for low-income women to exercise their full rights.”
“Clearly, it did not help her candidacy,” Wright said.
Beyond federal policies
Because states hold significant power to regulate abortion access and reproductive health care, the status quo in Texas, where the Legislature remains solidly red, is unlikely to change.
And the status quo isn’t ideal, said Joseph Potter, a sociology professor at the University of Texas who studies women’s health policy.
Potter said the Legislature’s severe funding cuts to family planning clinics in 2011 had a disproportionate effect on unauthorized female immigrants. Although the Legislature later restored most of the money, new state programs to help low-income women, including Healthy Texas Women, which was introduced last year, aren’t enough to make up the coverage gap, he said.
“Coverage for the undocumented, of course, is a political hot potato,” he said.
Potter also noted that the rate of pregnancy-related deaths among Texas women nearly doubled between 2010 and 2014.
“Texas has its own problems,” he said. “You don’t need Trump for that.”