The GOP health care bill's one-year ban on Planned Parenthood is a bigger problem than you think

People at a save planned parenthood rally

There is an abundance of policies for people to hate in the Senate version of the American Health Care Act: cutting and capping Medicaid; revamping credits for people to buy insurance to age-based versus income-based; eliminating essential benefits like maternity care; and the 22 million people who are likely to lose coverage by 2026.

For the millions of people whose health and lives could be in jeopardy should the Senate bill pass, the decision by Republican leaders to include a provision to prevent Planned Parenthood from receiving any form of federal funding for a full year might seem as impactful as a hangnail. But regardless of whether the bill passes and is signed into law — or it turns into yet another of the Republican party's more than four dozen attempts to overturn the Affordable Care Act — it's fairly likely that at some point, in some bill, a one-year moratorium on Planned Parenthood funding will become reality.

If so, that could be more devastating than most are aware.

Planned Parenthood clinics currently receive reimbursements from Medicaid for birth control and other sexual health services it provides to the lower-income individuals who represent a significant proportion of its client base. It is those reimbursements, not significant amounts of direct funding, that would be eliminated should a one-year ban be enacted. In March, the Congressional Budget Office estimated that removing Planned Parenthood as a participating provider in the Medicaid program would mostly affect those who are low-income and/or live in rural areas, with approximately 15% of that population experiencing reduced access to health care.

That was three months ago. Since then, Planned Parenthood has already begun to contract for a variety of reasons, including preparation for less state-based funding and a streamlining of services ahead of possible federal defunding, especially if the GOP remains in control of Congress and the White House in the longer term.

If the past is any guide, the organization is right to be concerned. In 1976, just three years after abortion was made legal nationwide, Congress first passed the Hyde Amendment. Named after the philandering Rep. Henry Hyde of Illinois, the amendment forbid Medicaid from covering abortion procedures unless the life of the woman was in danger or, in more recent years, the pregnancy was a result of rape or incest. The outcome has been a maze of restrictions that often denies patients who should qualify for coverage; according to the last available estimate, the federal government paid for 331 abortions in 2010.

The original Hyde Amendment lasted for only one year, and yet each year thereafter — regardless of who was in the White House or which party controls the House and Senate — the Hyde Amendment has been extended for an additional 12 months, just like clockwork.

For more than four decades, the Hyde Amendment has been the third rail of abortion politics; its repeal was only first addressed during the 2016 presidential election. That abortion opponents gleefully point to the fight over the Hyde Amendment as one of the reasons why Hillary Clinton did not win the White House shows how thoroughly a one-year ban can become an established standard.

Would a ban on Planned Parenthood accepting Medicaid patients become an untouchable annual tradition in the same vein as Hyde? Maybe not. Planned Parenthood's reproductive services have an aisle-crossing popularity— far more so than in Congress itself, where only two Republican senators oppose defunding the organization. Even now, those two senators — Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska) — are saying they may not vote in favor of the AHCA if it defunds Planned Parenthood. Both of them could potentially be recruitable for an effort to reverse the ban should political conditions in the House and Senate were more hospitable to the organization.

But even a single year without funding could be highly detrimental to the organization. As it stands now, Medicaid reimbursements don't always cover costs in full, according to organization leaders, a gap that has led Planned Parenthood to close and consolidate clinics in some regions. (Medicaid reimbursement rates, though, are notorious for not covering medical providers' costs across the board.) A year with no funds could easily accelerate that process. Meanwhile, even if private donations compensate for some of that loss, the result could actually bolster GOP claims that Planned Parenthood doesn't need government money in the first place.

The pattern of clinic closures suggests that in the absence of Planned Parenthood, individuals seeking reproductive health care services will face significant geographic barriers. The states that have just one abortion clinic — all located in southern, plain and and mountain states — will see birth-control and sexual health care access reduced. In those states with a stable number of abortion providers — usually on the coasts or clustered around the nation's largest cities — birth control and sexual health care will remain accessible.

Planned Parenthood has already shuttered clinics in Iowa, Colorado and New Mexico (and California, too, although that market was more saturated to begin with), and has no presence at all in Wyoming and North Dakota (though those states each have one abortion provider). Unsurprisingly, in the rural and red areas where birth control will be more difficult to obtain should the ban on Planned Parenthood funding pass, abortion will be a near impossibility should the inevitable unwanted pregnancy occur.

Of course, little of this matters to Republican leaders, the (mostly) men who say they believe sex should only occur in marriage, with one partner for life and only when you are willing to accept a pregnancy and child as a result of your coupling. In their world, no one dies trying to end an unwanted pregnancy, is sickened by HIV or needs a screening for cervical cancer, so banning Planned Parenthood from receiving Medicaid reimbursements for providing reproductive health services to low-income women won't hurt anyone.

In the world in which the rest of us live, however, the Republican plan to "defund Planned Parenthood" by restricting Medicaid recipients' access to the organization's services might add a few more bodies to the growing tally that could result from AHCA passage. But given the vast number of people expected to lose insurance coverage — and thus access to timely, affordable and/or preventive medical care — are a few more bodies even that noticeable?