After accounting for amendments to the American Health Care Act (AHCA) currently being considered by the U.S. House of Representatives, the latest estimate from the nonpartisan Congressional Budget Office (CBO) found that the GOP’s plan still would increase the number of uninsured people in the country to 24 million by 2026.

Even before CBO released its initial report, health policy experts and pundits across the board were warning that more people will be left without insurance than ever before under the GOP’s health bill.

“To be okay with 24 million people not having access to the care they need amounts to nothing more than a blatant disregard for the lives of Americans,” said the Black Women’s Health Imperative, a D.C.-based advocacy organization, in a recent email. “By moving forward with this repeal legislation, Congress is sending a message to the American people that their health is secondary to savings in the federal budget.”

While there may be some debate among Republicans over the AHCA’s ultimate impact on people around the country, it is clear that older, sicker, and poorer Americans—especially those who are Black—will fare worse under President Donald Trump’s plan than under former President Barack Obama’s. And with news that Republicans in the House are willing to drop “essential health benefits,” including pregnancy, maternity, and newborn care, which qualified health plans in the marketplace must currently cover, it’s clear Black women stand to lose more than most under the AHCA.

As numerous studies show, Black women “bear the greatest risk for maternal death.” The reproductive injustices we experience begin in the clinic, extend to the hospital, and are exacerbated by a proliferation of low-quality health-care providers in racially segregated communities. Health policy decisions are a literal life-or-death issue for us. So when Trump and his administration are making plans to “have insurance for everybody,” he needs to mean us too.

Despite Trump’s critique of the Affordable Care Act, the health-care law known as Obamacare benefited millions of people. In 2010, the uninsured rate for Black Americans was 27.2 percent. Under Obama’s plan, it dropped to 15.1 percent by 2016.

Proponents of the AHCA argue the bill will help people buy their own insurance by offering them tax credits. However, the amount each person will receive is largely determined by their age. Thus, a 60-year-old making $20,000 a year could qualify for the same amount of aid as a 60-year-old making $55,000. Health care will become even less available to poor and vulnerable populations than it’s ever been, as the credit system seems to overlook key factors that reduced out-of-pocket expenses for individuals and families under Obamacare.

Aside from the ACHA’s glaring discrepancy in its consideration of people with low incomes, the proposal does not fulfill any of President Trump’s campaign promises. A significant portion of the bill deals with Medicaid, ending the expansion that was put in place under Obamacare, and changing how the program is paid for. Under the AHCA, federal spending will be provided on a per-capita basis, which would gradually shrink the program as it stands today.

The most vulnerable of our nation are sure to be negatively affected. If Medicaid expansion and help from the marketplace are repealed or modified, millions risk losing their health-care access, primarily people of color, low-income people, and those who are unemployed, according to health policy experts.

Medicaid covers a wide array of services, such as family planning, prenatal care, childbirth, and health screenings, and, some states’ funds cover abortion. Women comprise about 68 percent of Medicaid enrollees. And as many as 30 percent of all Black women rely on Medicaid for their health care. The AHCA would end or substantially reduce access to health-care services for many of these women.

One of the AHCA’s most maligned targets is Planned Parenthood. The health-care provider primarily serves low-income patients, and 27.4 percent of Black people live in poverty. Roughly 20 percent of women in the United States will use Planned Parenthood’s services at some point in their lives.

Although Planned Parenthood is already prohibited from using federal funding for abortions, the AHCA strips the organization of Medicaid reimbursements for one year. This so-called defunding would bar Medicaid recipients from using public insurance at Planned Parenthood to access a wide range of services, including preventive services like Pap smears, contraception, and sexually transmitted infection testing.

Within the first year of the AHCA’s enactment, nearly 400,000 women would have to go without preventive care, and another 650,000 would only have access to a significantly reduced level of care. This means that hundreds of thousands of women would lose access to cancer screenings and other services that would increase their health outcomes, well-being, and overall quality of life. Black women, in particular, are more than 40 percent more likely to die from breast cancer than other women, in addition to facing other health disparities. 

With the loss of critical services currently insured by Medicaid coverage of family planning services, Black women are left especially vulnerable. Another significant health issue disproportionately faced by Black women is the development of uterine fibroids. Approximately 80 percent of Black women will have them by age 50. With routine screenings, such as the ones provided by Planned Parenthood and independent reproductive health-care clinics, uterine fibroids are fairly easy to treat and are less likely to leave a serious impact on women’s lives. Without such screenings, however, uterine fibroids can increase in size and lead to other health complications down the line.

Additionally, Black trans women are likely to bear the brunt of the AHCA’s disastrous effects. Some 34 percent of Black trans people earn less than $10,000 annually, which already makes insurance premiums and health-care costs not currently covered by Medicaid staggeringly out of reach.

Twenty percent of Black trans people reported being uninsured in the National Center for Transgender Equality’s most recent survey. Overall, 34 percent of Black trans people reported having one or more negative experience with a health-care provider. And in a different study, 21 percent of Black trans people reported having been refused medical care because of transphobic bias. As resources that are uniquely poised to cater to diverse communities risk being cut under the AHCA, Black trans women are more at risk than ever.

Access to basic health care is an internationally recognized right, according to the World Health Organization. But some people believe otherwise, such as Rep. Ted Yoho (R-FL), who told NPR that he does “not believe that the federal government role is to provide health care for the individual.”

It is no secret that access to health care leads to healthier and more vibrant communities. Yet the AHCA’s hollow promise leaves many people out in the cold. And as is often the case, those who will be hurt the most are Black women who rely on Medicaid or help from the marketplace to get the coverage we need.