Trump Budget Strikes Blows to Women’s Health

Photo credit: Gage Skidmore

Consistent with the Trump Administration’s attacks on women’s health, Trump’s 2019 Budget seeks to gut health care programs that are vital for women and limit women’s access to needed reproductive health care. Here are a few ways that Trump’s Budget continues the Administration’s attacks on women’s health:
It calls for repeal of the Affordable Care Act (ACA)—which only compounds the recently-passed tax bill’s gutting of a key component of the ACA that will cause 13 million people to lose their health coverage. It also seeks to replace the ACA with a bill like the one introduced by Senators Cassidy and Graham, which would leave millions of women with pre-existing conditions without the protections they need to access affordable and robust health insurance coverage that better meets their health needs—returning us to a time when being a woman was considered a pre-existing condition.
It decimates the Medicaid program—which not only provides access to vital care for over 17 million nationwide women enrolled in the program, but also supports nearly 4.4 million health sector jobs held by women nationwide. It would end the ACA’s Medicaid expansion, which has been instrumental in expanding women’s health coverage in the last few years, and allow states to convert the program into a block grant or per capita cap system, either of which would result in cuts to enrollment or benefits that would be devastating for women. It also supports allowing states to condition Medicaid on completion of punitive work requirements. Work requirements are based upon a false racialized narrative of Medicaid enrollees, go against the very purpose of Medicaid,  and ignore the reality that many enrolled in Medicaid who can work do work with the help of health coverage that enables them to do so.
Trump’s Budget completely eliminates funding for the Teen Pregnancy Prevention Program (TPPP), which enables parents and the community to support the healthy development of young people by funding local programs that provide medically-accurate, comprehensive sex education and support. The Administration is being sued for cutting funding for the TPPP early—cuts that it announced this summer that are effective in June 2018—two years ahead of schedule. Instead of supporting effective programs like TPPP, Trump’s Budget would increase investment in abstinence-only education, despite studies demonstrating that these programs are completely ineffective.
Trump’s Budget also singles out abortionand continues the Administration’s attacks on Planned Parenthood health centers by prohibiting family planning funds from the Department of Health and Human Services to clinics and health centers that also happen to offer abortion services. This comes on the heels of the Administration’s recent rescission of Obama-era guidance to states clarifying federal law barring discrimination against certain Medicaid family planning providers—namely Planned Parenthood health centers. This ideological attack not only jeopardizes access to care, including vital preventive services, but also threatens women’s ability to see a family planning provider of their choice that they trust.
The Budget also outlines the Administration’s intent to bar Medicaid funding to providers that offer abortion—this is despite the existing harmful Hyde Amendment—a provision that first became effective in 1977 and has been reauthorized every year by Congress as part of funding for the Department of Health and Human Services, which restricts Medicaid coverage of abortion to extremely limited circumstances.
The Budget also underscores the Administration’s prioritization of personal beliefs over patient care by supporting refusals to provide abortion services, compromising women’s access to the care that they need. Coupled with the creation of a new division within the Department of Health and Human Services’ Office for Civil Rights (OCR) focused on protecting health care providers and institutions seeking to use personal beliefs to deny patient care and the recent issuance of a proposed rule that seeks to allow providers and other health care workers to deny virtually any health service, Trump’s Budget sends a clear message to patients that providers’ personal beliefs are more important than the care that patients need. Rather than using its limited resources on those who want to discriminate, OCR should be enforcing the actual non-discrimination provision of the Affordable Care Act, which protects people from discrimination in health care based on race, color, national origin, sex—including sex stereotyping and gender identity—age, and disability.