What’s at Stake – The (Uncertain) Future of Women’s Reproductive Health Care

On July 19, 2017, in an event cohosted by UC San Francisco, UC Hastings, and the UCSF/UC Hastings Consortium in Law, Science and Policy, a panel of health policy experts discussed how proposed legislation and efforts from the Trump administration could affect women’s access to health care.  The session was held while the U.S. Senate was still discussing the Better Care Reconciliation Act (“BCRA”) and the Obamacare Repeal Reconciliation Act (“ORRA”) – two bills aimed at repealing and replacing the Affordable Care Act (“ACA”).  You can view the recording of the event here.

Claire Brindis, DrPH, Director of the Philip R. Lee Institute for Health Policy Studies at UC San Francisco, served as the moderator and provided an introduction to the various policy challenges facing women’s access to reproductive health services.  In her opening statement, she detailed how the ACA extended coverage of all FDA-approved contraceptive methods without co-payment or out-of-pocket costs to 55 million women.

The event’s topic was brought into sharp focus with a clear statement from Alina Salganicoff, PhD, Vice President and Director of Women’s Health Policy at the Kaiser Family Foundation: right now is the most critical time for our society to be engaged and informed in health policy matters.  Current federal legislative proposals threaten to cut coverage for millions of people, including essential health benefits which offer maternity care for every person with medical coverage.  Dr. Salganicoff further detailed other ways President Trump could disrupt women’s access to healthcare, including through the use of executive orders seeking to limit access to contraceptives and his budgetary proposal that would reduce financial support to the National Institutes of Health (“NIH”) and the Centers for Disease Control and Prevention (“CDC”).  These policies would have a long-reaching negative impact women’s health.

Jennifer Templeton Dunn, JD, Lecturer in Law at UC Hastings College of the Law, also warned that federal efforts to reform healthcare would have a major impact on California law.  According to Professor Dunn, California has demonstrated the legislative will and the public initiatives to promote the availability of women’s reproductive services.  For example, state law provides access to contraceptives beyond what the ACA requires.  Furthermore, California has made great strides in lowering the maternity mortality rate to well below the national levels which are amongst the highest in the developed world and continue to rise.

Yet if federal Medicaid funding shifted to block grants or per capita grants as proposed by both the BCRA and the House bill, California likely could not afford extension of coverage to Medicaid Expansion enrollees.

“How will we pay for it once repeal goes into place?” Professor Dunn asked.  “We would have it all on the books, but there would be no way to pay.”

Professor Dunn also warned that federal attacks on Planned Parenthood could severely limit low-income individuals’ access to cancer screenings, sexually transmitted infection prevention and treatment, and prenatal care.

Yet, even without adoption of these policies, the positions of the Trump administration and the Republican Party have already had serious ramifications in clinics.  Jane Garcia, MPH, Chief Executive Officer of La Clínica de La Raza explained that many immigrant families have refused to come in for services since Trump took office.  Fear of federal agents has strained patients’ trust in the healthcare system.  Garcia explained that several months following the election, rumors circulated that Immigration and Customs Enforcement (“ICE”) was in the neighborhood, drastically reducing the number of patients coming to La Clínica de La Raza out of fear of federal retaliation.  For example, the clinic recently examined a five-month-old baby who had never received medical care and had been born in a home.  The parents were afraid that receiving health care services would make them targets for immigration enforcement.

On top of that, women are requesting multiple months of contraceptives to avoid having to return to the clinic on a regular basis.  Additionally, many patients have reported that they are not sending their children to school because they do not want to be separated from them if they are deported.

Garcia explained that this only reflects the atmosphere that the administration has promoted publicly.  In addition, federal proposals would further heighten the strain between healthcare providers and patients in these vulnerable communities.  For example, if Congress repealed the ACA, La Clínica de La Raza would lose $13 million in funding.  Garcia explained that they simply would not be able to offer services to the same numbers as they had been under the ACA.

All three experts agreed, however, that remaining vigilant in the face of these challenges would have a positive impact.  Finally, they reminded the audience that repeal of the ACA is not the only thing that could impact healthcare.  Other initiatives can have significant, albeit less comprehensive, negative impacts.  They recommended vigilantly watching for these incremental initiatives, and reaching out to representatives, even if they have already taken a pro-ACA stance.

This event was hosted by the UCSF-Kaiser Building Interdisciplinary Research Careers in Women’s Health (BIRCWH), the UCSF Philip R. Lee Institute for Health Policy Studies, the UCSF Bixby Center for Global Reproductive Health, the UCSF/UC Hastings Consortium on Law, Science & Health Policy, and the UCSF National Center of Excellence in Women’s Health.

This event was supported in part by the California Health Care Foundation.