Wisconsin women’s health is threatened like never before

As a board-certified OB/GYN, I have the privilege of providing health care to women throughout their lives. In some ways, health care has gotten better for women and girls, even since the beginning of my career.

The first major improvement was passage of the Affordable Care Act (ACA) during President Barack Obama’s first term. Before the ACA, one-third of women who tried to buy a health plan on their own were either turned down, charged a higher premium, or had specific health problems — like pregnancy — excluded from their plans. Insurance companies would sell plans to young women that didn’t cover contraception or pay for maternity care, the most common reasons a young woman is most likely to seek health care.

Just being a woman was a preexisting condition, and insurance companies didn’t want to pay for it. Because of those barriers, at least 1 out of every 5 women in America didn’t have health care coverage.

The ACA changed all of that, ensuring more women could get health insurance to begin with, that it was more affordable, and that they couldn’t be denied coverage for essential health care like pregnancy and contraception. The law also ensured that necessary preventive services for women — your annual exam, pap and pelvic, birth control, breastfeeding support — all had to be provided at no cost. It was a good start.

This year, the Inflation Reduction Act (IRA) built on the ACA’s momentum by going even further. Prescription drug costs will be lower, especially for seniors on Medicare, and people who purchase their health insurance on the ACA exchange will see lower premiums for at least the next three years.

Unfortunately, those two massive steps forward that ensured access and affordability to quality health care could only garner a single Republican vote. You read that right. One Republican voted for the Affordable Care Act, none voted for the Inflation Reduction Act. Nearly every Republican voted against your ability to access quality, affordable health care, twice. Without Democrats in Congress and the White House, women wouldn’t have made the progress we have in the last dozen years.

But now, all of that progress seems unimportant as we find ourselves careening helplessly backwards on an issue central to the health of women and families everywhere — abortion. Abortion is health care, not a binary choice that some politicians want you to make as either “for” or “against.” Abortion care is part of the spectrum of pregnancy care, from fertility treatment to miscarriage management to caring for women with complicated pregnancies and, since the Dobbs decision overturning Roe v. Wade, abortion care is not available for women in Wisconsin.

Instead, our bodies are being governed by an 1849 law enacted 70 years before women could even vote. This law does not have exceptions for rape. There are no exceptions for incest. The only exception is for the life of the mother. But pregnant people don’t have a warning light that comes on when they have crossed that threshold. Physicians have to use our clinical judgment — developed through years of formal education, experience, and commitment — to make complicated, sensitive, individualized decisions in partnership with our patients and their families.

The effects of this criminal ban are chilling, and not just for the 1 in 4 women who will have an abortion in their lifetimes. People in our state are being denied medication for miscarriage management. Wisconsin women are being denied treatment in emergency departments while actively bleeding.

Even before Dobbs, our maternal mortality rates were among the worst in the developed world, especially for Black moms who, in Wisconsin, are five times more likely to die as a result of pregnancy than white moms. This rate will rise dramatically as women with physical and mental health conditions are forced to take on the significant risk of carrying unwanted pregnancies to term because they have lost access to essential, life-saving health care.

The stakes are high. We are in the midst of a health care crisis, an economic crisis, and a moral crisis. But our Republican leaders don’t seem to care. These so-called leaders make their own choices: they double down on politics, control, and fear instead of working together to solve problems and save lives.

As a physician, I took an oath, made a promise to take care of my patients and their families. I hear them and understand that only they can make decisions about their bodies within the context of their lives. That, to me, is the most personal, most impactful, most essential choice in this election. And it has never been more important than it is right now.