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This week, the full text of the previously secret Senate version of the Obamacare repeal was released. The American Health Care Act (AHCA) is the Republican-led effort to repeal and replace the Affordable Care Act (ACA or Obamacare). Both the House of Representatives and Senate versions of the health care bill have been roundly criticized for being harmful to women—de-funding Planned Parenthood, slashing Medicaid funding (which impacts mothers and children), reducing abortion access, and making some "essential benefits" optional for coverage, according to Vox. The Senate plans on voting on the bill prior to the July 4th recess.

Shortly after the House of Representatives version of the bill passed, ATTN:'s Editor-in-Chief Matthew Segal sat down with Planned Parenthood President Cecile Richards to discuss how repealing Obamacare could impact women, among other topics. This interview has been lightly edited and condense for clarity and length.

Matthew Segal: Well Cecile, so what are some of the greatest threats to women’s health today?
 
Cecile Richards: So right now, of course Congress is going to decide whether or not millions of people can come to Planned Parenthood for basic health care, and for so many of our patients, many of whom are young people, that means access to affordable birth control, STI testing and treatment, and maybe just your basically annual exam.
 
Matthew Segal: There’s a lot of misconceptions about Planned Parenthood. Tell us exactly about what Planned Parenthood is and what Planned Parenthood is not. 
 
Cecile Richards: Okay, so Planned Parenthood actually just turned 100 years old. So we’ve been around a century. We were around before birth control was even legal So today, we serve about 2.5 million patients every single year. Most of our patients are young people—not only young women, but a lot of young men come to us. They come to us primarily for birth control—for affordable birth control, for affordable STI testing and treatment. We also are the biggest sex educator in the country, and so so many—thousands, actually—come to us every month online just to text and chat with a Planned Parenthood specialist about all kinds of issues, everything.

Matthew Segal: Sex educators. See, people don’t hear that. What kind of sex education does Planned Parenthood do?

Cecile Richards: So, we do sex education in schools where we can. Unfortunately in some states, they have a policy of not actually doing sex education, so increasingly we do it online. But we are the experts and nothing freaks us out, and so we like to work with young people, because too many young people in this country—and obviously around the world as well—don’t have a trusted place to go to for non-judgemental information about their bodies, about relationships, about sex, and just basic questions that everyone needs to be able to ask.

Matthew Segal: And sex ed is being prevented in certain curriculums. Could you expound upon that? What’s the movement against sex ed happening in districts across the country? 

Cecile Richards: Well, it’s crazy because of course everyone needs sex education, but now even the federal budget—I know that President Trump’s budget proposes actually getting rid of a lot of sex education in America. And so what we have to do is make sure that we can provide it however, whether it’s online, whether it’s on mobile phones, whether it is in person at community centers. I don’t understand the political move against sex education, because again, this is—

Matthew Segal: Yeah, what’s the rationale?
 
Cecile Richards: I mean, I don’t think there really is a rationale. I think some folks are just uncomfortable talking about sex, and that’s mainly older people. Younger people definitely want information, and all of our experience has been is that the more a young person actually has basic, solid, medically-accurate sex education, the less likely they are to become sexually active before they want to be, and when they are sexually active, more likely to use protection and to use birth control.

Matthew Segal: So what is Planned Parenthood not? There’s all these sort of political ads that invoke the name of your organization, oftentimes inaccurately.

Pink out for Planned Parenthood/Wikimedia - wikimedia.org

Cecile Richards: Well, I think there has been an entire sort of movement in this country to not only shut down Planned Parenthood, but to shut down access to reproductive health care. I mean, one of the things we do at Planned Parenthood is we provide access to safe and legal abortion. That’s a right that women have had in this country for more than 40 years, but there are a lot of politicians who would like to end that. Politicians like in my home state of Texas. We think it’s important that everyone have all their options, and have access to high-quality health care. That’s what we provide, and frankly that’s why some folks want to shut us down.

Matthew Segal: So how does funding for Planned Parenthood work? Specifically, because we also hear of course people want to defund Planned Parenthood. How exactly does the whole funding structure work? Explain it to the layman.

Cecile Richards: Absolutely. So it’s really important, because there’s this term ‘defunding’ as being thrown around, but we’re not in the federal budget. Planned Parenthood is actually a health care provider just like other—like your local hospital. We get reimbursed to provide preventive services to folks. And again, most of that is birth control, it’s STI testing and treatment. About 3 percent of our services are abortion services. Those are not funded by the federal government. So in fact, these efforts to block people from coming to Planned Parenthood is really going to impact folks who are trying to prevent an unintended pregnancy or get their basic preventive health care. 

Matthew Segal: When you hear the majority parties in congress saying that they want to repeal Obamacare, what does that mean for Planned Parenthood and women’s health?

Cecile Richards: So, Speaker Paul Ryan made this big pledge that he was going to defund Planned Parenthood as part of repealing Obamacare. And of course, we’re not in the federal budget. That just means he’s going to block folks from coming to Planned Parenthood.

Associated Press

Matthew Segal: But how can he do that?  

Cecile Richards: Well, what he can do is say that if you’re a person with low income and maybe on Medicaid or other public assistance and you use that to Planned Parenthood, you can’t go there any more.

Matthew Segal: He won’t accept that as sort of a currency is what you’re saying.

Cecile Richards: That’s right. And they won’t reimburse Planned Parenthood for providing services. I mean, that’s the irony, is the Republicans who are leading congress in this fight—

Matthew Segal: So it’s not like they’re just gonna not write a check, it’s really they're not going to allow Medicaid to be used as a form of paying for reproductive health services.

Cecile Richards: What they’re saying is yes, you can no longer if you are on Medicaid, you can’t use that insurance and go to Planned Parenthood. And about more than 1.5 million folks come to us through those programs. But the other thing that’s important is that President Trump has gone one step further, and he’s basically put in his budget that no one for any public program can come to Planned Parenthood. That includes HIV/AIDS screening programs, that means breast cancer screening programs. Any program that’s related to the federal budget, those are funds that can’t be reimbursed to Planned Parenthood. This is going to cause complete havoc and chaos, and particularly among young people and folks who depend on Planned Parenthood as their only source of health care. 

Matthew Segal: It seems that Donald Trump has had some degree of a flip-flop on Planned Parenthood. It was notable that during the primary campaign, he was one of the few Republicans on stage to say that Planned Parenthood does good work, and that women’s health care is something that he didn't necessarily want to mess with. And now President Trump seems to be pretty anti-Planned Parenthood. To what do you attribute that shift or that flip-flop? And do you even agree that there was a flip-flop?

Cecile Richards: Well he definitely—President Trump said during his campaign that he knew thousands of women that would use Planned Parenthood, that had gotten their birth control there, that we did so much good. But now President Trump is really appealing to I think the most extreme elements of the Republican Party, saying he’s gonna block access to Planned Parenthood.  He said he wants to make—I mean, he’s appointing justices that would make abortion illegal in this country. Look, that’s why women and young people are not only terrified, it’s why they are so active, and frankly leading the resistance in this country. 

Matthew Segal: So is it politically advantageous to be a Republican today, to hate Planned Parenthood?

Cecile Richards: You know, the interesting thing is patients come to us from all walks of life. The folks that come to our health centers—we have more than 650 health centers in the US—they come to us for affordable high-quality health care. And they don’t come to make a political statement. So I actually, what we have seen repeatedly, is for anyone in public office who goes out and says they want to get rid of Planned Parenthood, it’s never a politically good idea. And it’s absolutely against the very best interests of the folks in their community. A great example, I was just in Paul Ryan’s own district. Speaker Paul Ryan. We have three health centers. One in Kenosha, Wisconsin. These are health centers where we provide basic health care. These are centers where women would now get turned away, and young people. And I’m telling you, folks in Kenosha are really upset. They’ve now organized Forward Kenosha, they’ve got 1,500 members. And folks are gonna run for office. I think this is actually compelling people to get active in the political process in a way that I've haven’t ever seen in my lifetime.

Matthew Segal: Which is the ironic upside to the attacks on your organization. You’ve met with Ivanka Trump.

Susan Walsh/AP - apimages.com

Cecile Richards: I did.

Matthew Segal: How did that go?

Cecile Richards: Well, as I’ve said, I represent the millions of folks who count on us for health care. I’ll meet with anyone to talk about the great work we did.

Matthew Segal: Which includes Republican women, conservative women, pro-life women even?

Cecile Richards: Absolutely. Includes Trump voters. I mean, half of our health centers are in medically-underserved communities, and that means we serve anyone in that community who needs access to care. I explained to Ivanka Trump everything about Planned Parenthood, the health care we provided. She seemed incredible sympathetic. She thinks we do good work. But so far, I’ve seen no action out of the White House that would indicate they’re willing to protect the interests of women and young people in this country to get access to health care. 

Matthew Segal: I want to get into this issue of women’s health, Planned Parenthood as an economic justice issue. Can you walk us through it from the lens of income involving America?

Cecile Richards: So, the biggest reason that women are now half the workforce and more than half the college students, and participating in all parts of our economy is because they finally got the right to decide when and whether to have children. And it is like a huge economic issue. And one of the things we fought for so hard—

Matthew Segal: Because before they had that right, what did the look like? Paint that picture first.

Cecile Richards: I mean before, when we first started 100 years ago, birth control was illegal. Information about birth control was illegal. Our founder was thrown in jail for handing out pamphlets about birth control. The great thing is she went to jail and then she taught all her fellow inmates about birth control. And that’s been, I hope the spirit of Planned Parenthood is constantly breaking down barriers for folks who have less access to care. It was the decision that finally made birth control legal. You could mark every single advance that women have had in this country. Their ability to finish high school, to finish college, to get a career, to support their family, is directly linked to their ability to get family planning. And it’s ironic, because there’s a lot of politicians, most of whom will never have to worry about getting pregnant, who say that birth control is not an economic issue. But when we fought to get birth control covered under insurance plans, under Obamacare, 55 million women now have birth control coverage on their insurance plans at no cost. The first year alone, women saved $1.4 on birth control pills, just to give you a sense.

Danielle DeCourcey

Matthew Segal: So that’s $1.4 billion more dollars in women’s pockets.

Cecile Richards: And look, we know at Planned Parenthood, because most of our patients are, you know, they may be uninsured, they may be in their first job, they may be still in school. And we know the difference between, you know, you’ve got $50, you can spend it on birth control pills or you can spend it on rent, or food, or school supplies for your kids. So the reason why this matters is we’re now at a record all time low for teenage pregnancy in the US. We’re at a 30 year low for all women in unintended pregnancy. And the more we can do to make sure that everyone has access to affordable health care including birth control, we can lower these numbers and allow women to pursue whatever they want to do in their education and in their career, and frankly to live their best life. 

Matthew Segal: What’s the logic, then, of someone who says women should pay for their birth control?

Cecile Richards: It’s completely crazy. I see men write all the time, like ‘Why should we be paying for your birth control?’ Well you know what? Men like birth control, too. Because it’s an economic issue for couples, for families. Because no one is actually interested in helping pay for the cost of unintended pregnancy. Unintended pregnancy costs the taxpayers $21 billion a year in the US, okay? So, if you just wanna look at it from sheer economic investment--

Matthew Segal: Because these unintended pregnancies end up in emergency rooms and—

Cecile Richards: It’s the health care costs. All the health care costs. And that isn’t even factoring in what women, why women understand this is an economic issue is the costs of an unintended pregnancy aren’t just the maternity care and then the postpartum care. You’re being a mother for the rest of your life, and responsible. And all of us who are moms know the awesome and incredibly important responsibility that is. I can’t tell you a single person who doesn't believe helping women wait and have children when they’re ready to support them, when they have a career, when they can do what they want to do with their life isn’t a good thing. There’s a small number of people who think that women shouldn't have access to birth control. Unfortunately, a disproportionate number of them are politicians serving in the U.S. House of Representatives. 

Matthew Segal: Sort of break down how that is, it costs to you and me, the taxpayers in America. And ultimately how that can be saved with better planning.

Cecile Richards: So the current estimates are that taxpayers --the cost to taxpayers for unintended pregnancy is $21 billion a year. So it’s all the health care costs associated with unintended pregnancy. And of course that doesn't factor in the cost to the woman of an unintended pregnancy. The crazy thing to me is we know that every dollar you invest in family planning services, it saves about five or six dollars. And so it’s a good investment. It’s also just good for women to just be able to have children when they’re ready to have children. The thing that’s really upsetting is right now, The White House is saying they’re going to repeal this birth control benefit that we fought so hard to get for 55 million women in the US. I’ll just give you an example. So, to get a really good form of birth control like an IUD, which lasts for years and is highly effective, and you don’t have to remember to take a pill every day. That can cost $2,000. So the upfront cost is prohibitive for a lot of women, a lot of folks we see. But over time, it’s an incredibly good investment. That’s what’s going to now get lost for so many women. They’re not gonna have a good effective means of birth control, and we’re gonna see more unintended pregnancy as a result. I mean, one of the crazy ironies that was right after this election, we at Planned Parenthood—

One of the incredible ironies is that after this election, immediately after, we had a 900 percent increase in women trying to get into Planned Parenthood to try to get an IUD. Because they are terrified that the Trump administration and this congress would take away this benefit, and now of course that is coming to be true, and that women wouldn't be able to afford birth control anymore. This is outrageous in the 21st century.

Andy Tullis/The Bulletin via AP - apimages.com

Matthew Segal: I want to talk about a viral photo that we covered, viral for us. It went viral for a lot of publishers, which was Mike Pence having a meeting with dozens and dozens of his colleagues in congress, all of whom are men. And that was apparently a meeting discussing women’s health care issues. What was your reaction that photo?

Cecile Richards: So I was at the Capitol the day before they were going to take the vote on the house health care bill, the Republicans’ health care bill, or TrumpCare. And we heard that the Freedom Caucus had gone to The White House to negotiate the final deal. And I actually said to my colleague, I said ‘I wish I could get a photograph of that meeting, because I’m sure that it’ all white men. And of course Vice President Mike Pence tweeted it out. Beautiful photo. And that’s what it showed, is essentially a roomful of men negotiating away family planning benefits, maternity care benefits, and all the other things that we’d fought for. Now today, the United States Senate that’s in the same kind of backroom meetings, determining what the health care bill would be in the Senate. No women represented in these deliberations. And that’s why women—Again, that’s why we’re seeing thousands of women at town hall meetings protesting and calling Congress. Estimates are that 86 percent of the calls coming into congress are being made by women. And that’s because women are deeply concerned, and for good reason. 

Matthew Segal: And what if there were women in those rooms?

Cecile Richards: Well look, I think that if we had more people in Congress who could get pregnant, we wouldn't be arguing over Planned Parenthood. In fact, we would be increasing the budget for family planning. And that’s what we need. We need equity and representation, and we’re far from that place.

Matthew Segal: One other Trump administration-related question. Trump’s budget director loves to say that he can’t ask a coal miner in West Virginia to pay for prenatal care or birth control of a woman in California, when they’re making only 25, 30 thousand dollars a year.

Cecile Richards: Well, I would be really interested if you talked to a coal miner who—it could be a woman, too—what they think about paying for prenatal care for their family. Prenatal care—It is an outrage that at this time in the U.S., we do one of the worst jobs in the entire globe in making sure that women not only have—they have a healthy pregnancy, and then they’re able to raise their children. And in fact, the stupidity of any economic argument like that is investing in prenatal care leads to healthier pregnancies and healthier children. It’s such an incredibly good investment in the future, and it is supported by people all across this country. I mean, I’ve been in rooms in Washington though, where men are questioning why insurance coverage should cover maternity benefits. And now in the president’s budget, this would become optional. And in fact, women who wanted to have maternity coverage in their insurance plans would have to pay they’re now estimating $1,000 more a month just to have it covered.

Matthew Segal: I want to talk about case studies. Are there any other states, any particular states or even other countries that do a good job that we should be looking to as a model in funding, protecting, expanding access to women’s health?

Cecile Richards: Yeah. I mean, we have a great example in the state of Colorado, where they did essentially sort of the first work on making sure that women could get access to no-cost family planning. And what they saw was teenage pregnancy dropped, unintended pregnancy dropped, and the abortion rate dropped. That model essentially was a precursor for what now exists under the affordable care act. And it’s why we’re seeing such success. We’re at a record low for abortion in this country. My fear is now, with the proposals by President Trump and this congress, that trend is now gonna go backwards. And there’s no reason for it.

Matthew Segal: And why are things going backward? Is this just religion? Are these religious interests that are curtailing the movement’s ability to step forward?

Cecile Richards: I think the real problem is we have too many people in congress who don’t care about women’s health. They’re not women. They haven’t ever faced an unintended pregnancy. They’ve probably never found a lump in their breast and had a panic about whether or not they have breast cancer. So many patients that we see come to Planned Parenthood because there’s nowhere else they can go. And I’ll tell you, I was just with a woman in upstate New York, rural upstate New York, found a lump in her breast. Couldn’t afford to go anywhere, came to Planned Parenthood. It was because of our clinician who demanded that she get not only one opinion, but then a second opinion, that she’s now—She had a radical mastectomy. Three weeks later, she’s now cancer-free. That’s the kind of work that we do. And it is really distressing to see the lack of empathy, and frankly caring, of politicians about what’s happening to folks back in their home state.

Matthew Segal: Polls that you have on your own website show that the majority of Americans support Planned Parenthood.

Cecile Richards: Absolutely.

Matthew Segal: Yet, Congress is not representing their interests. Why?

Cecile Richards: Well, it’s really ironic. So, one in five women in this country come into Planned Parenthood at some point in their lifetime. So we have an enormous alumni association, and they’re out in force. What’s is frustrating about Congress is any member of Congress can choose wherever they want to go to for health care. They’ve probably never paid a health care premium. They’ve never been uninsured. They’ve never worried about their children not having access to care. I just think there’s a fundamental lack of caring, lack of understanding about what it’s like to be trying to make ends meet and not have health care coverage. That’s what’s so terrifying about this bill.

Matthew Segal: Back to my other question, were there any other countries that are interesting model for sex education, reproductive health being excellent? What can we learn from them, and if so, what country?

Cecile Richards: Yeah. This isn’t—it’s not like we have to create a cure for some mysterious disease. We know what works. You can look at Western Europe, where sex education, it’s just part of what they do in the schools, and it’s talked about openly. And in fact, in those countries where they have sex education, young people become sexually active later. And when they do, they use protection. So we know what works. All that’s keeping us from doing that in the U.S. is politics. And so I think we can look—we can absolutely look at success stories. That’s why at Planned Parenthood, we’re constantly looking at ways to get around politics to make sure that we’re getting access to care. We now text and chat with thousands of young people every single month, giving them information that they need that they can’t get from someone in their community. And it’s everything from ‘Am I normal?’ ‘Do you think I might be pregnant?’ ‘How do I get tested if I’m worried that I might have been exposed to an STI?’ That’s what we’re about at Planned Parenthood, is taking away barriers for care and making sure that everyone, regardless of their income, their race, their ethnicity, their geography, their ZIP code, their gender identity, has access to affordable and high-quality care.

Matthew Segal: Final question: Men. Planned Parenthood serves a lot of men, and not a lot of people know that. What does Planned Parenthood do for men? 

Cecile Richards: So, the fastest-growing population coming to Planned Parenthood are men, and a lot of young men, who come to us for STI testing and treatment, because we are a no-judgement zone. The other thing is I was just in San Diego at our health center, and the waiting room was full of men. They’re watching ESPN on the TV. And I found out it was vasectomy day. So we do vasectomies at Planned Parenthood, too. And the other thing that I see, and so many young men coming to us as patients, but also coming as partners. And to me, we’re never gonna win the fight for full reproductive autonomy until everybody’s involved. And I think men play a critical role, and I have so much hope for this next generation. 

Matthew Segal: Well Cecile, thank you so much for your time. I really appreciate it.

Cecile Richards: Can I say, there’s one other thing that you didn’t ask, but I just wanna mention because I think it’s really important. One of the fastest-growing services that we’re providing at Planned Parenthood health centers is transgender care, because we recognized—Folks come to us for non-judgmental sexual and reproductive health care. And one area that is very difficult for folks, particularly in different states in the country, to get high-quality care from a trusted provider is transgender care. So we’ve been expanding this across the country. We’re one of the largest providers now of transgender services. And this is something that we’re very proud of. We know we need to be doing more, and I look forward to expanding all across the U.S.

Matthew Segal: And anything for the gay community in particular, outside of the trans community?

Cecile Richards: I mean, the LGBT community has always been such a strong part of Planned Parenthood, not only as patients, as activists and advocates. Because all of these issues overlap. We may have started 100 years ago as a family planning provider, but we do LGBT services and welcome LGBT community into health centers all across America.