Congressional opponents of the Affordable Care Act and reproductive health — with support from the White House — spent the majority of last year attempting to repeal the act and cut off people’s access to Planned Parenthood. Yet when members of Congress went home last year for the July 4 recess, women spoke out and rallied against the Obamacare repeal efforts.

Through letters, calls, and rallies, they made it clear to their elected officials that the ACA was the greatest health advancement for women in a generation and Planned Parenthood is an essential source of care.

Because of the incredible public backlash, attempts to roll back the act failed. Now, as we are once again in the midst of the July 4 break, the administration has been quietly issuing rules — and could even pick a Supreme Court justice — to sabotage the ACA in ways that will erode access to health coverage and reproductive health care, and the same congressional opponents from last year are supporting these efforts.

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We see four main ways the administration’s actions will harm women’s access to health care.

Junk insurance

Opponents of the ACA have tried to undermine coverage for health care services women need, such as maternity care, birth control, and behavioral health services. All of the congressional repeal bills included provisions to undermine essential health benefits — categories of services that health insurance plans must cover — and at least one bill would have eliminated the requirement that insurers cover no-cost preventive services, including birth control.

The Trump administration is now undermining the quality of insurance plans. It recently finalized a regulation that expands the sale of health insurance plans that are exempt from key ACA protections, which would leave women without critical preventive or necessary care. And it has already issued a rule that seeks to eliminate the guarantee that women have access to birth control without cost sharing, which has benefited 62 million women.

Pre-existing conditions

Outrage over discriminatory pricing against people with pre-existing conditions was a leading reason people overwhelmingly opposed the repeal bills that failed in Congress. But the Trump administration seems like it won’t stop until it has taken women back to the pre-ACA days when discriminatory insurance coverage was rampant on the individual market.

In the most direct blow to the ACA, the Department of Justice said in June that the administration would not defend the constitutionality of the act, and specifically asked the court to strike ACA provisions that protect people living with pre-existing conditions. The case threatening these protections — and the entire ACA — is (thankfully) nowhere near reaching the Supreme Court, but with the recent announcement that Justice Kennedy will retire, Trump could nominate a judge who opposes the ACA to the highest court in the land. This court vacancy places at risk the health and financial stability of approximately 67 million women and girls with pre-existing conditions. Black and Latina women are most affected by certain chronic illnesses such as breast and cervical cancer, and this proposed rule would exacerbate these health inequities.

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Blocking access to Planned Parenthood health centers

Each version of the ACA repeal bill contained provisions that would have prohibited people covered by Medicaid from obtaining essential services like birth control, cancer screening, and testing for sexually transmitted infections at Planned Parenthood health centers. Individuals with low incomes would be especially affected because at least 60 percent of Planned Parenthood’s 2.4 million patients rely on publicly funded programs, such as Medicaid and the Title X family planning program, to access this essential care.

On July 31, the window will close for the public to comment on the recently proposed “gag” rule, which is designed to make it impossible for specialized reproductive health providers, including Planned Parenthood, to serve patients in the Title X family planning program. It would also take away funds unless the provider agrees not to refer patients for abortion, regardless of the circumstances. This adds an extra barrier for all, but particularly for people of color, who already face systemic barriers to accessing care.

Gutting the health care safety net

The congressional repeal bills would have slashed the amount of federal support that state Medicaid programs receive and forced states to scale back the benefits or kick people off the program. Women would have been particularly harmed by this, since Medicaid is the largest payer of reproductive health care coverage and the program pays for nearly half of all births in the United States.

For the first time since the inception of Medicaid in 1965, the Trump administration is allowing states to take away individual’s health coverage if they are not employed. Make no mistake about it: Work requirements are nothing more than a subversive attempt to take away Medicaid coverage. Because women are more likely to provide informal — and undervalued — caregiving for their families and not have traditional jobs, they account for 62 percent of the Medicaid enrollees who would lose coverage because of this enrollment restriction. Kentucky was the first state to try to impose these burdensome requirements, which were thankfully blocked by a federal court last week.

The Trump administration is dead set on rolling back the gains made under the Affordable Care Act and eroding women’s access to essential health care. It’s imperative that we fight back against these egregious attacks that could once again leave women without access to the care they need.

Jamille Fields is senior policy analyst at the Planned Parenthood Federation of America. Stephanie Glover is senior policy analyst at the National Partnership for Women & Families.

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