Pro-life conservatives aren't wrong to push for the defunding of Planned Parenthood. But we also have to be honest about who's likely to be hit hardest by such a defunding, and by the repealing of ObamaCare's requirement that insurers cover a suite of essential health benefits. In both cases, it is low-income women who will largely feel the effects.
Women have abortions for many reasons. But more than 70 percent of abortions are driven by economic reasons, according to the Guttmacher Institute — either because a baby would interfere with the mother's work, because she already cares for other dependents, or because she feels she cannot afford a baby.
If Republicans defund Planned Parenthood while also cutting essential health benefits for mothers, they must acknowledge the message they're sending. Sure, it may make their pro-life constituents happy. Yes, it may check the "pro-life" box in the minds of many voters. But defunding Planned Parenthood does very little to turn needy women toward the choice of life.
This puts a greater burden on Republican lawmakers to provide for the people they're pushing to choose life.
Republicans say they want to help the most disadvantaged and vulnerable: the unborn. But unless they help empower mothers to reject abortion and choose birth, they are doing little to help incentivize that choice. Instead, they show themselves as being, as many critics of the pro-life movement put it, interested in the life of the child only up until the moment they're born.
The proof is in the proposed legislation. The Senate's Better Care Reconciliation Act would waive ObamaCare's essential health benefits requirement — which demands that insurers provide (among other things) pregnancy, maternity, and newborn care, as well as pediatric services. Before ObamaCare, only 12 percent of individual market plans included maternity care. Those that did often provided it via an expensive rider that could be added to an insurance plan, but it generally involved a waiting period. And many insurers considered pregnancy itself to be a pre-existing condition, which could prevent a pregnant mother from getting coverage in all but five states.
To return to the situation we had before ObamaCare — in which maternity care was difficult and expensive to procure — should be a giant red flag to pro-life Republicans. Conservatives believe the market should provide greater freedoms and more choices to consumers. But if health insurers are allowed to stop offering comprehensive maternity plans, that will severely limit women's choices.
Meanwhile, Medicaid insures two in five children, and pays for nearly half of all births in the United States. A lot of Republicans see Medicaid as a top-down program broken by bureaucracy, unlikely to truly offer help and long-term wholeness to the people relying on it. And it's true that Medicaid reflects uncurbed costs and growth, with projected federal spending that outstrips projections for our entire economy. Republicans are getting a lot of flak for proposing to get rid of ObamaCare's Medicaid expansion, but it's important to note that, as The Wall Street Journal put it, "ObamaCare increased Medicaid enrollment by 29 percent to 74.5 million Americans — one of four citizens — in a program originally meant for poor women and the disabled. … The real scandal is Medicaid's poor health outcomes and a funding formula that doesn't encourage states to prioritize the neediest Americans."
The problem for conservatives making that case is that Medicaid per capita caps and block grants could easily threaten care and coverage for exactly the sort of people Medicaid was originally supposed to protect. If states get a fixed pot of money for their needy populations, they'd eventually have to raise taxes or restrict eligibility if those funds become inadequate — whether due to population growth, an aging population, or other unforeseen complications.
Congress must make sure that any changes to Medicaid focus on the program's core population of users. But they should also acknowledge how changes to essential health benefits could hurt other mothers — mothers who may not be covered by Medicaid, but who will still face the difficulties and costs associated with unforeseen pregnancy. And in this regard (as well as many others), the GOP's bill falls short. As The New York Times' Ross Douthat put it, this is "still the act of a party dedicated primarily to rescuing the rich from their tax rates, rather than stewarding the common good."
This isn't to say our status quo is anything near perfect. One of my co-workers has struggled to get reliable health-care coverage since ObamaCare passed. She lost her insurance plan two weeks after her husband died, as a 7-months-pregnant widow with a toddler. The promise that she could keep her plan if she liked it turned out to be false. Meanwhile, her premium went up 96 percent last year. Many have struggled with insane deductibles under ObamaCare, which makes their insurance nearly impossible to use.
The GOP plan falls far short of fixing those problems. But it doesn't have to.
Conservatives should provide assistance to pregnant mothers through child tax credits and a larger earned-income tax credit, as Douthat and other reform-minded conservatives have pointed out. This helps mothers — especially single mothers — post-birth, as they work to raise their child or children. Paid parental leave could help mothers deal with some of these difficulties — and there's overwhelming bipartisan support for paid family and medical leave throughout the nation. We should also consider more flexible income arrangements for Americans, ones that allows expectant mothers to allocate "comp time" toward maternity leave or potential medical expenditures.
But there are a host of needs associated with giving birth to a child — prenatal checkups, birth, breastfeeding help, postnatal care, postpartum depression, pelvic floor therapy, and others — that are intrinsically health needs. If not properly attended to, they can cause complications that not only disincentivize future birth, but also jeopardize a mother's economic, physical, and emotional wellbeing (and, by extension, that of her child).
If we honestly want to tout a pro-life platform in an economically struggling and culturally fragmented society, we should put our money where our mouth is. Because bringing new lives into the world is no easy or inexpensive task, even if it is one of the greatest blessings life can bestow. And — let's be honest — it's more pro-life to build a comprehensive pro-family, anti-poverty platform than it is to provide massive tax cuts for the wealthiest Americans.