House Republicans passed a Trump-backed bill early Thursday morning—and added in late provisions seeking to further restrict abortion coverage and gender-affirming care.Tom Williams/CQ Roll Call/ZUMA Press
In the early morning hours on Thursday, after an all-night session of tense negotiations, House Republicans narrowly passed President Donald Trump’s sweeping domestic policy package.
In addition to the largest cuts to Medicaid in US history, the bill contains provisions that have alarmed health care advocates since they first showed up in earlier versions of the bill. Among them is a plan seeking to defund Planned Parenthood, which the organization warns will affect its ability to provide critical services, including pap smears, cancer screenings, and birth control.
But on Thursday, two last-minute additions went even further: The reconciliation bill that was passed now seeks to ban Affordable Care Act health care plans from covering abortion and gender-affirming care for all Medicaid patients, including adults, after initially proposing to ban care for just minors.
Together, the 11th-hour additions represent an even more extreme version of Trump’s domestic agenda. With nearly one in seven Americans covered through ACA marketplace plans since 2014, the impacts of the proposed abortion ban would be “catastrophic” if passed by the full House and Senate, Reps. Diana DeGette (D-Colo.) and Ayanna Pressley (D-Mass.), co-chairs of the Congressional Reproductive Freedom Caucus, said in a statement. “Donald Trump and Congressional Republicans’ claims that they will not ban abortion nationwide were always a lie. Overnight, the receipts came in,” they added. “We will continue to call out this attack on the people for exactly what it is: a Big Bogus Backdoor abortion ban.”
About half of states already ban ACA plans from covering abortion, while 13 states require marketplace plans to include abortion coverage, according to the health policy research organization KFF and the reproductive rights research and policy organization the Guttmacher Institute. Research from Guttmacher shows that six percent of people who obtained abortions between 2021 to 2022 had insurance through the ACA.
“Abortion coverage on both public and private plans is already severely limited and difficult to access—including on Marketplace plans—and this newly added reconciliation provision seeks to further restrict this coverage,” said Anna Bernstein, Guttmacher’s principal federal policy advisor.
The provision seeking to ban gender-affirming care could affect the 152,000 trans adults who are on Medicaid, according to the UCLA Williams Institute. As of 2019, a dozen states already excluded coverage for such care in their Medicaid plans, but 18 states and DC. included, or were in the process of including, gender-affirming care in their Medicaid plans, according to the Williams Institute.
Jennifer C. Pizer, chief legal officer at Lambda Legal, a civil rights nonprofit supporting LGBTQ rights, told Mother Jones that the inclusion was an “overt, mean-spirited, unjustifiable attack on transgender people by members of the House.” She hopes it won’t pass the Senate, but if it does, it will be challenged. “There’s no legitimate reason for it. And so whatever standard of constitutional review is used, it should fail,” she emphasized.
Kelly Baden, vice president of public policy at Guttmacher, called the bill “a reckless and dangerous encapsulation of President Trump’s health policy agenda that seeks to strip people of health care options and bodily autonomy.”
“We are witnessing an escalating crisis in reproductive health and rights—and this bill would only exacerbate those harms and worsen our economy,” Baden added. “We urge the Senate to reject this bill and eliminate all measures that erode our bodily autonomy and access to essential health care.”
When it comes to defunding Planned Parenthood, Alexis McGill Johnson, president and CEO of Planned Parenthood Action Fund, said in a statement on Thursday that if the budget passes as proposed, nearly 200 of its health centers could be forced to close and more than 1.1 million patients could lose access to health care. The organization has said that more than half of its patients rely on federally-funded programs to access its care, and research has shown that other health centers “would need to dramatically increase their contraceptive client caseloads” if Planned Parenthood was, indeed, defunded.
“Cancers will go undetected, [sexually-transmitted infections] will go untreated, and birth control will be harder to get—all while charging the taxpayers nearly $300 million to do it,” McGill Johnson said, referring to the preliminary estimate from the nonpartisan Congressional Budget Office (CBO) that the provision to defund Planned Parenthood would increase the deficit over a decade, which I previously wrote about. (NOTUS reported Wednesday that some hardline conservatives said they believe Planned Parenthood should be defunded even if it would increase the deficit, with one, Rep. Ralph Norman (R-S.C.), saying he did not believe the CBO’s projection.)
As Rep. Alexandria Ocasio-Cortez (D-N.Y.) said in a speech on the House floor at around 2 a.m.: “When this country wakes up in the morning, there will be consequences to pay for this.”
