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The Republican replacement for the Affordable Care Act could reduce women’s access to healthcare, including birth control and preventative services.

Repealing and replacing the Affordable Care Act has been a rallying cry of the GOP for eight years. Now that they’re finally getting their chance, Republican leaders are struggling to find a politically acceptable replacement for the Affordable Care Act. Obamacare greatly expanded women’s access to healthcare, so Republican attempts at repeal pose a direct threat to millions of women. Here’s what could change.

Republican Replacement for the Affordable Care Act: Changes Now, Changes Later, and an Uncertain Future

The Republican replacement for the Affordable Care Act is a fiscal reconciliation bill. It’s also, they say, just the first in a series of legislation. So we don’t yet know how extensive the changes will be, or when they will come. So far, Republican changes include only defunding Planned Parenthood, draconian abortion regulations, and a massive scale back of Medicaid.

Planned Parenthood Funding

Republicans have been at war with Planned Parenthood, a major provider of women’s healthcare, for years. Unsurprisingly, their new plan completely defunds the organization. This could leave millions of women without access to birth control, reproductive health counseling, and other vital services.

Abortion Coverage

The Hyde amendment already prohibits any public funding of abortion. The new Republican replacement for the Affordable Care Act would go further. Tax credits for healthcare coverage are a signature feature of the new legislation. But Republicans want to prohibit tax credits for any plan that covers abortion—even if the plan recipient never has an abortion. This could reduce the number of plans eligible for tax cuts, while encouraging insurers to refuse to cover abortion care.

Medicaid Access

The Republican replacement for the Affordable Care Act would scale back Medicaid coverage. Funding for Medicaid would be given to the states. However, funding would be capped, and coverage would be limited, reducing the total number of people eligible for care. This could have disastrous effects on preventative care, including for women’s health.

Birth Control Coverage

For now, birth control coverage is safe. As one of the most popular features of the ACA, coverage for birth control has saved countless women thousands of dollars. To anti-choice Republicans, birth control access should be a no-brainer. Research shows that birth control access can prevent abortions. Yet Republican opposition to abortion seemingly has little to do with protecting life. Republicans have steadfastly opposed the ACA’s birth control mandate. It’s likely that as soon as they get the chance, they’ll remove birth control coverage, throwing millions of women’s reproductive futures into uncertainty.

Maternity Coverage

Republicans apparently aren’t sufficiently pro-life to want to fund the costs of carrying a baby to term. For years, Republican men have insisted they shouldn’t have to cover pregnancy and childbirth, even as they insist that women cover male-specific treatments such as prostate cancer screening and Viagra.

The Affordable Care Act requires all insurance plans to cover maternity care. Prior to the law, most employer-backed policies offered maternity coverage, but other plans rarely did. Moreover, even employer-supported plans often featured significant coverage gaps. While Republicans have not yet moved to eliminate the maternity care mandate, their long-time opposition to this piece of the legislation suggests they may soon attack it.

With average birth costs ranging from $10,000-$40,000 without insurance, this could put many women into bankruptcy solely because they chose to have a baby.