My husband and I were weeks away from wrapping up three years of work at an international boarding school in the foothills of the Himalayas in India when one of the pregnancy tests I bought for 10 rupees in the bazaar came back positive. 

The staff bathroom stalls at the school were ridiculously small- the kind where, upon entering, you practically have to straddle the toilet in order to create enough space to shut the door. But those stalls are an excellent place for a scared woman to receive the news of an unexpected pregnancy, because when you become overwhelmed and are sitting on the toilet staring at your positive pregnancy test, you can lean forward and let the glass door of the stall, only a few inches away, act like a cool, firm hand to rest your head. 

Besides feeling, at that time, totally unequipped to become a mother, I was terrified at the prospect of returning to the United States pregnant, unemployed and uninsured. I, however, had safety nets. I had supportive extended family, access to financial help and a stable partner. As a pregnant American woman, I also had access to Medicaid, the United States’ government sponsored health insurance program. 

I couldn’t imagine having no safety net. Yet, that is the future millions of Americans may soon face if the United States Senate healthcare bill passes. This 142 page proposal, known as the Better Care Reconciliation Act of 2017 (BCRA), dramatically scales back the safety nets for vulnerable Americans, including the sick, poor, elderly, women and children. 

The House version of this bill, referred to as the American Healthcare Act (AHCA) passed the Republican House in May 2017. That bill, intended to repeal and replace the Affordable Care Act/ Obamacare (ACA), left 23 million people uninsured by 2026, severely weakened protections for people with pre-existing conditions and cut Medicaid funding by $880 billion according to the Congressional Budget Office analysis. BCRA, the Senate version, drafted behind closed doors and without a single woman at the table to draft the section on women’s healthcare, is unfortunately no better.  Among other devastating effects, 22 million people are projected to lose insurance by 2026, and besides a proposed $772 billion dollar cut to Medicaid, the very nature of the program is at risk. Medicaid, created to protect the poor and vulnerable, would shift from an open-ended entitlement program to one with strict federal spending limits that would result in far larger negative consequences over time.

COHI advocates for women and babies. But unfortunately, the BCRA does not. Children comprise a quarter of the U.S. population, but make up about half of the entire Medicaid program. That $772 billion dollar Medicaid cut? It will have devastating effects on the services those children receive. And women? Well, they lose, too.

The BCRA (following in the footsteps of the AHCA) strips funding from Planned Parenthood, no longer allowing the 20% of American women of reproductive age who rely on Medicaid for healthcare, to use Medicaid at Planned Parenthood. It puts essential services, like mammograms, birth control and prenatal care, previously covered under the ACA, at risk. Other services, like mental health care and prescription drugs, considered essential by ACA, could be deemed optional by health plans and not covered. In addition to slashing Medicaid, the BRCA eliminates preexisting conditions protections and endangers abortion coverage.

Prominent medical groups and organizations are opposed to the BCRA including the American Medical Association, American Lung Association; AARP; American Diabetes Association; American Cancer Society, and American Heart Association. 

Of the 25 wealthiest nations in the world, the U.S. is the only one that doesn’t secure healthcare for its citizens. The U.S. also has the highest health expenditure per capita of any country, and of the 13 developed nations surveyed by the Organization for Economic Cooperation and Development, the lowest life expectancy and the highest rate of infant mortality. The healthcare model in the U.S. is broken and removing or shredding the few remaining safety nets that exist in our country will only cause more harm. Healthcare is a human right and should not be accessible only to those who can afford it or are lucky enough to have nets. 

After I returned to the U.S., I had my first prenatal appointment at a clinic near my mother-in-law’s home. I was shaky, nervous and fearful. Before I saw the nurse practitioner someone helped me sign up for Medicaid. While I waited for the nurse to call my name I thought about baby names. There was a lot I didn’t know at that point in my life, but I knew if I had a girl, I would name her Jane. It is a beautiful and simple name and I loved the meaning behind it - God is gracious. I needed grace as I journeyed into motherhood- lots of it. When my name was called at the clinic, an older woman, my nurse practitioner, extended her hand to shake mine and said, “Hi. My name is Jane.” We met for over an hour and she did more than a physical exam. She held my hand, dried my tears, and encouraged me. She was my first healthcare contact in the U.S. and she gave me that care because of Medicaid. My first ultrasound and subsequent follow up appointments were also thanks to Medicaid.  And 7 months later, my beautiful, healthy daughter Jane, supported into this world through family, friends and Medicaid, was born.

-Ann Van Zee

COHI Contributor and Advocate

We've taken the liberty of delving into the differences between the ACA and the ACHA- check out our comprehensive infographic here to learn more.