This Price Is Not Right

President-elect Donald Trump would have been hard-pressed to pick someone more frightening than Rep. Tom Price, the Republican from Georgia, to direct the Department of Health and Human Services. After all, Trump and Vice President-elect Mike Pence, the outgoing governor of Indiana, have vowed to repeal the Affordable Care Act and its protections for women, the LGBT community, and poor people. Price will undoubtedly work to fulfill those goals.

Both Price and Pence have long-standing histories of extremist views about women’s health needs. They are rabidly anti-abortion, even in the case of serious fetal abnormality or risk to the mother’s health. Price currently enjoys a 0 percent rating from Planned Parenthood and a 100 percent rating by the National Right to Life Committee.

In Indiana, two women of color were imprisoned for fetal losses under Governor Pence’s fetal homicide law. Price and Pence both believe that life begins at the moment of conception. Pence even wants miscarried fetuses to be buried or cremated, although spontaneous miscarriages commonly occur early in pregnancies. Both Indiana and Texas have passed such laws.

In 2012 Price told ThinkProgress^⁠ that there’s “not one” woman who doesn’t have access to birth control. In fact, a Hart research ^⁠survey commissioned by Planned Parenthood found that 55 percent of women aged 18 to 34 reported trouble affording this necessity. If his claims were true, why would more and more U.S. women — 20.2 million as of 2014 — need publicly funded family planning services?

Many women rely on Planned Parenthood for family planning and screening for breast and cervical cancer, HIV, and sexually transmitted diseases. The triumvirate has repeatedly called to defund the group, which serves almost 3 million people^⁠, although they provide essential services not covered elsewhere. This vindictive stance is driven by ideology, not science — and certainly not sound policy. The nonpartisan Congressional Budget Office projects that defunding Planned Parenthood would cost taxpayers $130 million over 10 years due to costs of unintended pregnancies. Further, if curbing abortion rates is the goal, why cut contraceptive benefits and promote inaccurate, ineffective, abstinence based “education?”

Laws criminalizing abortion don’t work. Instead, they drive patients to seek dangerous alternatives to safe abortion. I’ve seen sepsis from abortion; I hope never to again. A recent study^⁠ showed that the abortion rate per 1,000 women fell from 46 in 1990 to 27 in 2014, largely due to the increasing availability of effective contraceptives.

Yet access to contraceptives is likely to be one of Price’s first targets, as he described a requirement for making contraceptives available as “a trampling of religious freedom and religious liberty in this country.” Other “essential services” (now provided by Planned Parenthood) include screening and counseling for domestic violence, screening for diabetes during pregnancy, breastfeeding counseling and equipment, screening for HPV and HIV, and one preventive care visit annually. These benefits weren’t made on a whim — instead, the National Academies of Science’s Institute of Medicine recommended that these preventive services should be covered without cost sharing, and the Health Resources and Services Administration adopted the recommendations. There is concern that the new administration may be able to rewrite the regulations according to the dictates of their fundamentalist ideology, against sound public health and scientific advice. This could be done by administrative fiat without Congressional approval^⁠ or through attempts to repeal the ACA.

Currently, maternity care is mandated under the ACA. But Price’s cynically named alternative, the “Empowering Patients First Act,” eliminates all the current essential health benefits guaranteed by that legislation. Insurers could choose to not cover maternity benefits, and could again deny women coverage because of pre-existing conditions, which in the past have included yeast infections and even domestic violence.^⁠ Insurers could resume the inequality of “gender rating,” or charging women much higher rates than men.

Women of color are at special risk of suffering from funding cuts, as they already face greater health disparities.^⁠ For example, African-American women have a four-fold higher death rate during childbirth than white women, and higher deaths from breast cancer as well. Latinas and Vietnamese women have higher rates of cervical cancer. Native American women are 2.4 times as likely to develop diabetes than white women. The ACA is critical to addressing the health disparities in these groups and among low-income communities.

Price and Pence demand constitutional protections for unborn persons^⁠ from the moment of conception on. But this flies in the face of a woman’s autonomy, relegating her to being viewed only as an incubator for embryos and fetuses. Women could again be forced to have medication or surgeries against their will, or be imprisoned for doing anything that might harm the fetus. The woman’s own survival would be valued less than even a nonviable fetus.

While Price and Pence claim a religious belief in the sanctity of an unborn child’s life, their concern seems to evaporate once that child is born. Both voted repeatedly against public health funding, including the Children’s Health Insurance Program, or CHIP. Price has advocated for state, rather than federal control of some Head Start programs, and he wants to cut assistance for families or people struggling with disabilities.

Price opposed the re-authorization of the Violence Against Women Act and both he and Pence oppose nondiscrimination protections for the LGBT community. Refusal clauses they support basically would allow discrimination against a wide array of people, trumping civil rights in the name of religious beliefs.

If they attempt to repeal the Affordable Care Act without any viable alternative, the wealthy white troika risks rebellion as their base awakens to the reality of a future of insurmountable medical bills and no safety net. Trump lost the popular vote by at least 2.5 million votes. Add the nearly 5.5 million white people who Paul Krugman estimates ^⁠just voted themselves out of health care and the 55 million women who risk losing their preventive care, and Trump will surely face growing opposition to his draconian plans.^⁠

While it’s only a fantasy on my part at this time, maybe if our fears about the destruction of healthcare in this country come to pass, women will take a lesson from the Greek playwright Aristophanes, whose heroine Lysistrata persuaded the women of Greece to withhold sexual privileges until their husbands and lovers negotiated an end to the Peloponnesian War. In this war — which is over women’s health, dignity, and rights — the stakes are clear.

The head of the Department of Health and Human Services has a moral responsibility to care for all people. Based on his track record, Price — an orthopedic surgeon himself, as well as a Christian — seems poised to make basic health care more difficult for millions of women and children. That would make a mockery not just of a doctor’s obligation to do no harm, but also the tenets of his own faith, which call for care and compassion for those in need.

Dr. Judy Stone is a Maryland-based physician specializing in infectious disease, and she is a frequent contributor to Forbes.