The big reveal on the Trump administration’s fiscal year 2018 budget came late Monday evening, and health experts across the nation took it as jarring statement about the future of women’s health in the United States.
Ilyse Hogue, president of NARAL Pro-Choice America, did not mince words. “Donald Trump’s budget makes clear his view that women and children are at the bottom of the barrel,” she said in a statement.
Neither did Sen. Patty Murray, D-Wash. “By slashing key investments in health services that women rely on, including the largest cuts yet proposed to Planned Parenthood, President Trump’s budget doubles down on extreme Republican efforts to interfere with women’s personal health decisions and attacks women’s health in just about every way possible.”
Here’s a breakdown of all the ways the Trump budget would affect women’s health, packing the most severe punch for low-income women and women of color.
1. It Singles Out Planned Parenthood
The Trump budget singles out Planned Parenthood, prohibiting the reproductive and sexual health care provider from participating in any program funded through Congress’s annual appropriations bill funding the Department of Labor and the Department of Health and Human Services. The exclusion of Planned Parenthood marks the first time in history that an individual health care provider has been named and barred from participation in federally funded programs.
While past Republican attempts to “defund” Planned Parenthood — or, eliminate the group as a Medicaid provider, thus ending funding in the form of reimbursements for services rendered — have focused on Planned Parenthood’s participation in Medicaid and Title X only, the Trump budget would prevent Planned Parenthood from receiving funds from any federal program. This includes Violence Against Women Act (VAWA) grants for domestic violence screening and care, cancer screenings through Centers for Disease Control (CDC) grants, and AIDS testing funds through a variety of federal sources.
The Trump budget is historic in the way it seeks not just to stop Medicaid and Title X patients from seeking care at Planned Parenthood for their reproductive and sexual health care but stops all Planned Parenthood patients from potentially being able to access services.
2. And Cuts Funds to Title X for Teen Pregnancy Prevention
While the Trump budget does not explicitly eliminate Title X — the only federal program solely dedicated to birth control and family planning services — by prohibiting Planned Parenthood from serving the program, it effectively cuts the program’s delivery of services, and as a result, the federal government’s expenditures on the program.
Planned Parenthood health centers comprise just 13 percent of Title X-funded clinics nationally but serve 41 percent of all Title X patients.
In 2015, 6.2 million women in the U.S. received publicly supported contraceptive services, with Title X serving 3.8 million of these women. Services provided by Title X are believed to have averted 822,300 unintended pregnancies in 2015, thus preventing 387,200 unplanned births and 277,800 abortions. Without Title X, the U.S. unintended pregnancy rate would have been 31 percent higher and the unintended pregnancy rate among teens specifically would have been 41 percent higher.
3. It Adds Fund for Abstinence Programs
The Trump budget also allocates $277 million for “extending abstinence education and personal responsibility programs” — despite overwhelming evidence that abstinence-only education programs simply don’t work.
4. And Suggests Deep Medicaid Cuts
Though as a candidate, Trump promised that “there will be no cuts” to Medicaid, Trump’s budget proposal could cut approximately $800 billion dollars from the federal healthcare program for the lowest-income Americans over the next 10 years.
Cuts to Medicaid funding pose a significant threat to the health of women and children. One in five women of reproductive age is insured through Medicaid, and it covers nearly half of all births in the U.S. each year.
Even before the passage of the Affordable Care Act (ACA), the Obama-era health reform bill that the Trump budget commits to repealing, women comprised the majority of Medicaid beneficiaries. The passage of the ACA allowed states to expand Medicaid eligibility, with additional federal funding being made available to get more low-income Americans insured in this way. Thirty-one states and the District of Columbia elected to expand Medicaid eligibility for individuals earning up to 138 percent of the Federal Poverty Level (FPL). Presently, the federal government funds 95 percent of this expanded coverage, which is estimated to have benefited 11 million adults nationwide since the ACA’s passage.
The Trump budget, through its commitment to the repeal of ACA and the passage of its replacement, the American Health Care Act (AHCA), would roll back Medicaid expansion. As a result, eligibility in some states for Medicaid coverage might be incredibly stark. As the Kaiser Family Foundation points out, under the Medicaid expansion rollback guaranteed by the AHCA, a single mother of two living in Louisiana or Indiana would not qualify for Medicaid coverage if her annual income exceeded $4,687.
The Trump cuts to Medicaid would force states to find their own funding to continue Medicaid coverage for residents as it exists today. And again, women — and disproportionately, women of color — will be most likely to lose health care access via Medicaid program cuts.
5. It Cuts Food Stamps and Nutritional Programs
The Trump budget includes a cut of more than $190 billion from nutritional assistance programs such as the Temporary Assistance for Needy Family (TANF) program and the Supplemental Nutrition Assistance Program (SNAP). This cut represents a cut of 25 percent from current funding levels.
A 2013 analysis done by the Pew Research Center found that one in five Americans has received SNAP benefits, or food stamps, at some point. Twenty-six percent of Americans live in a household with a current or former food stamp recipient.
Once again, women are disproportionately impacted by these cuts. Women are twice as likely as men to have received food stamps at some point in their lives, and minority women are much more likely than men — both men of color and white men — to have received food stamps in their lifetime.
Seven of the 10 states with the highest rate of SNAP participation relative to population voted for Trump in the presidential election.
6. And Wipes Out Foreign Aid for Women and Girls
The budget eliminates the international family planning assistance programs run by the U.S., which amounted to $607.5 million in fiscal year 2017 for 26 million women and couples receiving services.
A report published earlier this month by the Guttmacher Institute estimated that eliminating U.S. assistance for international family planning and reproductive health programs would result in 3.3 million more abortions, 15,000 more maternal deaths, and 8 million more unintended pregnancies.
The elimination of the international family planning budget comes on the heels of the Trump administration’s announcement last week of an expansion of the global gag rule. For the first time, the global gag rule — which prohibits foreign aid groups from using non-U.S. funds to provide information about abortion as a method of family planning — now also applies to funding related to HIV and AIDS care and treatment, maternal and child health, malaria, global health security, and other global health programs.
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