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Early Saturday morning, Senate Republicans eked out a narrow win for their widely discredited tax bill, the Tax Cuts and Jobs Act, with 52 of the party’s senators voting in its favor and just one joining 48 Democratic lawmakers in a no vote.
Like so many of the GOP’s congressional maneuvers, the plan promises to be especially disastrous for women. Not only does it threaten to raise taxes on all but the very wealthy, it also takes unwarranted aim at both the social safety nets and the reproductive health services Republicans couldn’t manage to tank with their attempted Affordable Care Act repeal.
“This is bad medicine, bad policy, and not what Americans want,” Planned Parenthood Action Fund Vice President Dawn Laguens said in a statement. “Ultimately, women and their families will be hurt the most.”
“GOP leaders are so hell-bent on undermining the healthcare of millions, they are sneaking it into a tax bill,” she added. “Attacks on health coverage have no place in any legislation, especially not in a tax bill.”
The bill’s passage was a rush job, even by recent Republican standards—the final almost-500-page iteration presented before the Senate had impactful edits handwritten into the margins. Last week, however, the Congressional Budget Office (CBO) released its report on the legislation, finding that it would add $1.4 trillion to the national deficit over the coming 10 years. As the Washington Post reported, the bill promises a gradual but very real financial loss for those making under $75,000 per year, while people in higher income brackets—$100,000 and up, plus big corporations—stand to accrue gains.
While not unexpected from congressional Republicans, this imbalanced equation comes as the direct result of trimming the Obama-era individual mandate, or the tax penalty imposed on most of those who don’t buy insurance. Without the mandate in place, the CBO predicts a mass exodus from the insurance market as healthy people decline coverage, driving up premiums by an estimated 10 percent for most years in the next decade. The report also estimates that 4 million fewer people will have health insurance by 2019, that number climbing to 13 million by the end of 2027. The reason? Low-income earners who have been awarded tax credits up until now (to blunt the financial blow of insurance) won’t be able to afford anything at all.
Currently, qualifying low-income applicants can rely on Medicaid to access medical services, but adding over $1 trillion to the deficit will require budget cuts elsewhere, and recent experience offers some clues as to what will land on the chopping block: Social security, Medicare, and Medicaid—all welfare programs the GOP has been itching to scrap for years and targeting with special vehemence in the months since Trump’s inauguration.
When you put all of this together, you get a clusterfuck for women, who are not only paid less than men across the board, but also more likely than men to occupy low- and minimum-wage jobs—especially if they are women of color—and more likely to occupy the tax brackets hardest hit by the GOP’s plan. What’s more, minimum-wage jobs don’t tend to offer benefits—healthcare must be procured through other avenues, like the ACA’s state marketplaces. When we talk about low-income people fleeing those exchanges, we are talking in part about a huge pool of women who want to stay insured but suddenly find themselves unable to afford health insurance and thus simply drop their plans.
Which is a shame, because measurably more women have signed up for healthcare since it became accessible. In 2016, the number of uninsured U.S. women came in at half what it was in 2010, when the ACA became law. Before that point, insurance companies charged women higher premiums than they did men, simply because women may need services like maternity care and contraception. In identifying essential health benefits insurers must cover, the ACA enabled women of very modest means to go to the doctor.
Part of that enabling involved expanding Medicaid qualifications in participating states to include single young women whose incomes registered at or below 138 percent of the federal poverty line. Now, the roughly 40 million women on Medicaid—who, again, are disproportionately women of color—make up 53 percent of patients in the program, according to a report from the Center on Budget and Policy Priorities. Medicaid also happens to pay for 75 percent of all government-funded family planning services: contraception, testing for sexually transmitted infections (including HIV), pap smears, and sexual health counseling.
We know that access to contraception keeps unintended pregnancy rates low: Obstructing that access means more women—particularly low-income women—will become mothers. There, too, the Republican tax plan gouges them. As the National Women’s Law Center (NWLC) points out, the bill cuts personal and dependent deductions, and while it does double the child tax credit—from $1,000 to $2,000—that increase won’t help low-income parents, because the credit is no longer fully refundable. By the NWLC’s reckoning, someone who makes an annual $14,500 can now hope to receive a $75 credit for their child, but the situation will be quite different for wealthier parents. As certified public accountant Tony Nitti explained in a Forbes op-ed, the plan extends Child Tax Credit (CTC) eligibility to single people making $250,000 per year, substantially higher than the old $75,000 earning cap. People in this much higher income bracket will see returns from the CTC, along with lower tax rates over time.
This latest legislative slap stings particularly because Republicans seem to really want women having babies, continually engineering policy that places basic reproductive healthcare out of reach, works to shutter abortion clinics, and winnows access to contraception—each and every time reserving the heaviest blow for low-income women and women of color. Even the tax bill takes a subtly anti-abortion tack: It includes language that allows prospective parents to set up untaxed college savings plans for “an unborn child,” which is to say, “a child in utero”—or another means of undermining national law, which clearly states that a fetus does not gain human rights until the third trimester of its stay in the womb.
After a year of large-scale losses, the party in power needed a win, and a tax overhaul represented their final chance—especially since, to the average voter, tax legislation seems like a much duller and complex issue than repealing Obamacare. Now, the Senate and House must reconcile their marginally different versions into a single plan to place before the president. It seems unrealistic to hope that they might take a moment to more thoroughly familiarize themselves with their indecipherably annotated 479-page document and prioritize the health and wealth of the country’s people at the expense of their sole legislative victory. But especially for Republican voters, the party’s consistent placement of political gains before actual people should be telling.
“As a doctor, I care about families and their healthcare, and this bill makes it harder for everyday people to stay healthy and raise a family,” Dr. Anne Davis, consulting medical director of Physicians for Reproductive Health, said in a statement. “My patients need Congress to stop playing politics with their health.”
Claire Lampen is a lifestyle reporter who covers sex, gender, and reproductive rights. Formerly a Fulbright fellow, she has published work with Vogue, Gizmodo, Refinery29, Teen Vogue, the BBC, Vice, Marie Claire, and more.