Trump’s Global Gag Rule
On his first work day in office, Donald Trump signed an executive memorandum imposing a radically expanded version of the Global Gag Rule. The language in that memorandum, however, was vague enough that for several months it was unclear exactly what impacts the expansion would have.
In mid-May, when the State Department released additional details about the policy, we finally learned more about what it is going to mean for our global health programs.
Previous versions of the Gag Rule have applied only to family planning funding controlled by the United States Agency for International Development (USAID). It has always been a stupid, counterproductive policy, cutting off funding to effective, experienced providers of family planning around the world — and, according to the research, actually resulting in higher abortion rates in a lot of places.
And in that respect, this new version of the Gag Rule is no different. We’re already seeing significant harm from the restrictions. Family Health Options Kenya, for example, will likely have to close half its clinics. In Nepal, experts are worried about a collapse of the healthcare system. In Colombia, public health outreach to rural communities trying to recover from decades of war will likely be eliminated.
These sorts of outcomes weren’t enough for Donald Trump and Mike Pence though. The Trump administration went out of its way to make this already disastrous policy even more destructive, applying it not only to family planning programs, but to an estimated $8.8 billion in overall global health funding. Programs that have never been subject to the Gag Rule before are now scrambling to assess how the policy is going to impact them. In many cases, there’s a real risk that the expansion may undermine the effectiveness of their efforts. A grantee that receives money to do work on HIV/AIDS, for example, might not offer family planning services, but may partner with a provider that does. If that family planning clinic offers any kind of abortion-related services, the HIV/AIDS group may have to sever the relationship, perhaps leaving them with nowhere to send clients who want birth control.
It’s impossible to know right now exactly how many such programs could be impacted. But it’s clear that this expanded Gag Rule could prove catastrophic for global health efforts. Programs combatting HIV/AIDS, tuberculosis, malaria, Zika, and even child hunger may be under threat.
2018 Budget Fight Gets Underway
Ever since the Trump administration released a Fiscal Year 2018 budget blueprint calling for the complete elimination of international family planning funding, supporters of these programs have held their breath, waiting to see if Congress would go along with this dramatic cut. On July 12, the House released its draft of the State Department/Foreign Operations Appropriations bill. The best thing we can say about it is that at least it doesn’t zero out family planning. It does, however, cut the program by nearly $150 million, capping it at $461 million. It also codifies both Trump’s expanded Global Gag Rule and his ban on funding for the United Nations Population Fund.
During the mark-up of the bill in the House Appropriations Committee, Ranking Member Nita Lowey (D-NY) offered an amendment to eliminate the Gag Rule and UNFPA provisions. Rep. Barbara Lee (D-CA) offered an amendment to strike the Gag Rule and UNFPA provisions, as well as increase the amount of money directed to family planning programs.
Despite strong statements of support from multiple committee members, both amendments failed 23-29. Every Democrat voted in favor. Only Rep. Charlie Dent (R-PA) crossed party lines to join them.
It’s a disappointing outcome, but it’s not the end of the line. The Senate still has to do its version of the bill, so we’re going to get another chance at the fight. It’s not over yet, and we’re not giving up.
Zombie Healthcare Bill Rises Again. And Again. And Again.
Activists celebrated on March 24, when House Speaker Paul Ryan withdrew the American Health Care Act (AHCA) without a vote. Despite intense pressure from leadership, he was forced to admit that the bill, which included $880 billion in cuts to Medicaid, simply lacked the support to pass. But only a week later, the bill was back. And it was worse.
The original bill already cut coverage for the poor, ended funding to Planned Parenthood, and allowed insurance companies to charge much higher premiums for older people. But to win the support of the ultra-conservative House Freedom Caucus, Ryan altered the bill to overturn regulations that guarantee that certain health benefits are covered and that people with preexisting conditions can still get insurance.
With these changes in place, the bill squeaked by, earning 217 votes, the absolute minimum required to pass. Multiple House members admitted to voting for the bill only because they believed that the Senate would “fix” the legislation.
The House took the wholly unprecedented step of voting for the bill without waiting for a score from the Congressional Budget Office (CBO). That score, when it came, was brutal. The CBO estimated that the bill would lead to 24 million more Americans without health insurance, as well as undermining protections for people with preexisting conditions.
And then it was the Senate’s turn. Rather than taking up the House bill, Majority Leader Mitch McConnell (R-KY) created a group of 13 (all male) senators and set them to coming up with a plan behind closed doors.
The first version of the Better Care Reconciliation Act (BCRA) was initially far more of a tax cut than a healthcare bill. It gave a giant tax cut to the 400 richest American families and paid for it by taking health insurance away from more than 725,000 people. Yes, really.
There was enough outcry against the measure to scare multiple senators from all across the ideological spectrum away from supporting it. After having promised a vote before the July 4 recess, McConnell was forced to back down.
In late July, McConnell finally held a series of votes on multiple versions of the bill. The final, decisive vote was on a stripped down version of the bill dubbed a “Skinny Repeal.” In a dramatic midnight vote, Sen. John McCain (R-AZ) joined Sens. Lisa Murkowski (R-AK) and Susan Collins (R-ME) in voting against it, killing the bill and ensuring that, for now, the Affordable Care Act remains the law of the land.
At our press deadline, the White House and some members of Congress were still pushing for another attempt at repeal. However, the essential conundrum for Republicans remains: Pushing the bill far enough to the right to win the support of conservatives alienates the more moderate members, and the GOP has almost no room for error.