With the election of a Republican president and control of the U.S. Congress by Republicans, you’d think Planned Parenthood is in trouble. Defunding the reproductive health organization has been for years a rallying cry among Republicans, especially Christian conservatives opposed to abortion. With the GOP now in power, it would seem the tide has finally turned.
It hasn’t. In fact, Planned Parenthood has the advantage.
What gives Planned Parenthood the advantage is the insistence among leading Republicans to tie together two things that should not be tied together if Republicans hope to protect their majority. They evidently believe their majority, especially in the House, is impervious, because they have linked the defunding of Planned Parenthood (to the tune of $500 million) with their proposed replacement for the Affordable Care Act.
The Republican Party has always been between a rock and a hard place when it comes to the health care law. Though often called Obamacare, the program is a fundamentally conservative creature that maintains a role for private health insurers when a saner public policy scheme would have been Medicare for All.
So whatever they proposed, the path was always going to be treacherous. But when the Republicans rolled out a replacement Tuesday called the American Health Care Act, it was clear the very same people railing against “death panels” for eight long years still have no idea what they are doing.
The proposed law would cut $600 billion out of the federal budget, but almost all the savings would go to the very affluent. Meanwhile, subsidies to ordinary people would vanish. In their place, the Republicans aim to offer tax credits to buy private insurance. The new law would also repeal the mandate requiring everyone to buy insurance or pay a penalty.
In terms of policy, this is not smart. Subsidies allowed millions to pay for insurance upfront. Under the new plan, people would have to wait for reimbursement after Tax Day. This won’t work. Most Americans can’t pay for insurance now and wait to be paid back later. They do not have ready cash.
Nixing the “individual mandate” means healthy people will leave the insurance pool, leaving sicker people behind, which will in turn raise the cost of health care for everyone, even those already covered. House Speaker Paul Ryan habitually uses the phrase “death spiral” to describe Obamacare. The real death spiral awaits if the Republicans pass this bill.
But policy isn’t why Republicans —specifically, Republicans representing affluent white suburban districts won by Hillary Clinton — are worried. These Republicans face no fallout from constituents getting major tax cuts. They have no fear of constituents losing health insurance, because their affluent white suburban supporters do not require federal subsidies. But there is one thing these Republicans fear, and fear gravely.
An overt assault on women.
If you defund Planned Parenthood, you send a signal to all of your female voters that women’s issues don’t count. That’s what freshman congressman U.S. Rep. John Faso, who represents parts of the Hudson Valley, told the GOP leadership last month during a retreat. He said: “We are just walking into a gigantic political trap if we go down this path of sticking Planned Parenthood in the health insurance bill. If you want to do it somewhere else, I have no problem, but I think we are creating a political minefield for ourselves —House and Senate.”
The Democrats are banking on it. If they stay unified in the Congress, they can squeeze vulnerable blue-state Republicans. The Democrats need 24 seats to retake the House in 2018. You can bet every Republican like Faso has a big fat imaginary bull’s eye on his back.
The minefield isn’t limited to the U.S. Congress. Republican leaders in blue states are concerned, too. Fight for tax relief all you want, the thinking goes, but please please pretty please don’t enrage the women. That’s why GOP Gov. Charlie Baker, of Massachusetts, is talking about replacing whatever might be lost in federal funds with state funds. That’s why Republican moderates are asking the party leadership to decouple Planned Parenthood from health care reform, because if you insist on tying them together, the party may end up losing twice.
There may be another way of looking at this, and it’s upside down. There is no win for the Republicans in repealing and replacing Obamacare. As I said, it is already a conservative program. The party has distorted reality so much that austerity freaks like the Club for Growth, Americans for Prosperity and Freedomworks are already opposing it. So are powerful nonpartisan groups like the American Medical Association and the AARP. If the Republicans mess this up, they will suffer, big league. They may pay a price for gutting Planned Parenthood, but the price will surely be higher if they foul up health care reform.
Which is why some think there’s a reason the GOP leadership insists on coupling Planned Parenthood with replacing Obamacare. If they were separate, the party would have no one to blame when they foul up health care reform. But by poisoning the replacement plan with a defunding plan, they can blame their failure on a familiar foe, Planned Parenthood.
It would be genius if it weren’t so short-sighted.
John Stoehr is a lecturer in political science at Yale and a New Haven resident.