A presidential election and a new Supreme Court justice: What’s at stake for reproductive health

Reproductive Health and Election
Planned Parenthood offers many more reproductive health services beyond access to abortions. Health providers educate patients on contraception, perform cancer screenings and discuss family planning. (Credit: Planned Parenthood)

By Shivani Majmudar
Medill Reports

After last week’s confirmation of Amy Coney Barrett to the nation’s highest court, reproductive health advocates across the country say they fear a serious threat to equitable health care access.

Barrett was confirmed exactly one month after President Trump nominated her to fill late Justice Ruth Bader Ginsberg’s seat, one of the fastest confirmations in history. In a narrow 52-48 vote, only one GOP senator crossed party lines to vote against her. Barrett now sits as the sixth conservative justice on the bench, the most it’s been since the 1930s.

The 48-year-old has spent most of her career in academia. She’s never tried a case to verdict or argued an appeal in court, which led many opponents to question her qualifications for a lifetime appointment to the Supreme Court.

Barrett has been transparent with her ideological views, as indicated by her previous voting records, statements from her 2017 confirmation hearing to the 7th U.S. Circuit Court of Appeals and essays as a University of Notre Dame law professor. They align closely with President Trump’s —anti-Roe v. Wade and anti-the Affordable Care Act.

“Given Judge Barrett’s record, we have reason to be extremely concerned that the Supreme Court has shifted to the most conservative court in our lifetime,” said Brigid Leahy, senior director of public policy at Planned Parenthood Illinois Action, the advocacy and political arm of Planned Parenthood Illinois. “Many of our rights are at risk.”

Over the last four years, President Trump has worked to dismantle the Affordable Care Act, better known as “Obamacare.” During the 2016 election, he campaigned on the promise that he would repeal the act, including its controversial individual mandate. When his administration failed to formally do so under the law, they found other ways to deregulate it and subsequently endanger coverage for thousands across the country, said Stephani Becker, associate director of healthcare justice at the Shriver Center on Poverty Law in Chicago.

Many fear Barrett’s confirmation signals a threat to a woman’s right to an abortion. The 6-3 conservative majority on the Supreme Court makes overturning Roe v. Wade plausible. But health experts fear that the looming threat to the ACA could have even greater implications for reproductive health justice.

Under the ACA, contraception such as birth control is considered preventative care and is required to be covered under all plans in the Health Insurance Marketplace. The act’s protections for people with preexisting conditions, which include common pregnancy procedures such as a C-section, saved women in particular from skyrocketing premiums.

Reproductive women’s health care is often falsely equated with abortion access. In reality, it’s just a small sliver, according to Dr. Ann Borders, executive director and obstetric lead at the Illinois Perinatal Quality Collaborative. Cries like “defund Planned Parenthood” or “repeal and replace [Obamacare]” threaten much more than the ability to have an abortion—they take away women’s access to contraception, cancer screenings, STI testing, family planning and counseling services, Borders said. She largely credits the ACA for making these services accessible for women across the financial spectrum.

But in some places in Illinois, comprehensive reproductive health care access is already eroding. For example, changes to the eligibility requirements for national grants last year forced Planned Parenthood out of the Title X program. The ripple effects of decreased funding are amplified in rural settings. Without this critical funding, reproductive health care providers struggled to meet the growing demand for primary care, like contraception and cancer screenings, especially during the pandemic.

The ripple effects of clinic closures are amplified in rural settings, where there is generally less access to providers and women have to travel much further, Leahy said. She added that ultimately, the patients in the middle — those who have incomes higher than the threshold to qualify for Medicaid, but not enough to afford adequate health coverage — suffer the greatest.

“The losers in all this are low-income women who rely on clinics for their care,” Borders said. Wealthy women can better navigate the social barriers to health care access like transportation and costs, but low-income women often do not have these options, she explained.

Further restrictions on organizations like Planned Parenthood or other provisions of the ACA could cause thousands to lose much-needed coverage, including 900,000 people in Illinois, according to estimates from the Illinois Department of Healthcare and Family Services. The Supreme Court is set to hear more arguments against the ACA on Nov. 10, just one week after the presidential election.

Right now, organizations like PPIA are working to defend the ACA, but even that is imperfect, Becker said. She added that there is still a high need for better coverage for undocumented immigrants and more generous subsidies to low-income individuals.

“Vote like your healthcare depends on it,” Becker said. Because it does.”

Shivani Majmudar covers health, environment and science at Medill. You can follow her on Twitter @spmajmudarr.

Editor’s note: This story has been updated to clarify the Title X program’s funding.