You may be familiar with the Republican rallying cry—”Defund Planned Parenthood!”—in an otherwise fractious process to repeal President Obama’s signature health-care reform law.

Unraveling the Affordable Care Act (ACA) is proving more difficult than Republicans might have thought after taking control of the White House in January. Amid the drafts and drama circulating on Capitol Hill, through a formal measure dropped Monday evening, Republicans have remained unified—with few notable exceptions—in their opposition to Planned Parenthood.

Republicans in the U.S. House of Representatives and the U.S. Senate have never wavered in their one-two punch to repeal the ACA and “defund” Planned Parenthood, regularly propping up myths about the ability of community health centers to make up the resulting gap in care. 

But congressional Republicans plan to deny the health-care organization of some $390 million in Medicaid reimbursements for only one year. Another $60 million in funding comes from Title X family planning and less than $1 million jointly from the Children’s Health Insurance Program and Medicare, for a total of about $450 million in federal funds, according to nonpartisan Congressional Budget Office (CBO) data from 2015.

President Trump tried to extort Planned Parenthood into abandoning abortion care with an informal promise to preserve federal funding, according to a New York Times report. Abortion services comprise just 3 percent of all Planned Parenthood health services. And they’re not going away.

“Offering money to Planned Parenthood to abandon our patients and our values is not a deal that we will ever accept,” Dawn Laguens, executive vice president of Planned Parenthood Federation of America, told the Times. “Providing critical health care services for millions of American women is nonnegotiable.”

A limited, but unquestionably devastating blow to reproductive health-care access then seems like an odd choice for a party that consistently, and inaccurately, portrays Planned Parenthood as an abortion mill. Why wouldn’t congressional Republicans at least try to undercut their sworn enemy forever?

Congressional Republicans directly involved in the process could not or would not answer. House Speaker Paul Ryan’s office punted to the House Energy and Commerce Committee, which has partial jurisdiction over ACA repeal. A committee spokesperson only confirmed the scope of the plan, but not the rationale behind it. On the Senate side, a spokesperson for Majority Leader Mitch McConnell (R-KY) similarly had no comment beyond what was publicly available about ACA repeal.

And so Rewire will attempt to provide an answer through extensive research and interviews. By our account, Republicans were either unprepared, unable, or unwilling to touch Planned Parenthood for more than one year. Join us as we explore each—and determine which one is the likeliest.    

The Case of the Unprepared GOP

Let’s talk about the past, which is perhaps disproportionately informing the present.

Planned Parenthood moved to the top of the GOP’s hit list in 2015. That summer, the Center for Medical Progress, an anti-choice front group, launched a smear campaign alleging Planned Parenthood profited from fetal tissue donations.

A lack of credible evidence whatsoever did not stop congressional Republicans from targeting Planned Parenthood in a failed ACA repeal effort that met President Obama’s veto in early 2016.

Their collective thinking at the time: Let’s block Planned Parenthood’s primary source of federal funds for a year while we examine the unfounded claims on our own. Three House committee investigations, a secretive Senate Judiciary Committee majority staff inquiry, and a highly publicized $1.59 million “witch hunt” later, Republicans succeeded not in proving the existence of an illicit market in “baby body parts,” but in reinforcing inflammatory rhetoric linked to escalating anti-choice violence.

Flash forward to 2017. At the same February press conference where she said Republicans won’t preserve the ACA’s popular birth control benefit, House Budget Committee Chair Diane Black (R-TN) confirmed that Planned Parenthood would again be subject to a one-year moratorium on Medicaid reimbursements.

“We plan that it will mimic what we did in 2015,” Black said of the plan.

Republicans kept that promise, perhaps because they had no better idea. By their own account at the beginning of 2016, they had railroaded through measures to repeal the ACA in part or in full more than 50 times. But they seemed woefully underprepared when they finally wrested veto power away from the White House.

A leaked House GOP draft from mid-February revealed a party in “total disarray” over policy and strategy. A formal House GOP repeal bill finally released Monday evening revealed a plan at odds with ultra-conservative House members and rank-and-file Senate Republicans.

One goal remains, right there on the second page of the Energy and Commerce portion of the plan. Just like Diane Black said, Republicans mimic what they did in 2015 and defund Planned Parenthood for one year.

The Case of the Unable GOP

Next, let’s lift the wonky shroud over the legislative process.

Congressional Republicans intend to repeal the ACA through a fast-track process known as budget reconciliation requiring a simple 51-vote majority in the Senate instead of the 60-vote threshold typically needed to bypass a filibuster and pass controversial legislation. Both the House and the Senate have passed what’s known as a budget resolution to kick off the process. They now need to pass a reconciliation bill that includes the actual repeal language and their own replacement proposals.

But there’s a hitch: Reconciliation is subject to the “Byrd rule.” Named after the late Sen. Robert Byrd (D-WV), the rule puts the kibosh on provisions that are “merely incidental” to the budget. In other words, Congress can’t wield the reconciliation process for the sake of a political agenda—or a partisan vendetta against Planned Parenthood.

Republicans circumvented the Byrd rule in 2015 when the Senate parliamentarian, the supposedly nonpartisan arbiter of the chamber’s rules and procedures, gave the green light for the ACA repeal bill that defunded Planned Parenthood for one year.

The CBO at the time “scored,” or priced, two different scenarios to defund Planned Parenthood. Doing so for one year would save the government $235 million over ten years because taxpayers would no longer be underwriting the ability of Medicaid recipients obtaining care at Planned Parenthood. Doing so permanently, however, would cost the government $130 million over ten years because of the unintended pregnancies that would arise without Planned Parenthood’s contraceptive care.

By the numbers, the one-year plan appears to be the only scenario to meet the Byrd rule’s standards, forcing Republicans to go with it again.

The nonpartisan Brookings Institution’s Molly Reynolds, who has dissected the interplay between Planned Parenthood and the Byrd rule, wasn’t so sure.

Losing $130 million to permanently defund Planned Parenthood was “relatively small” in the context of the $474 billion in savings that the CBO initially estimated (and later updated to $516 billion), Reynolds said. That consideration “suggests to me that a longer-term provision on Planned Parenthood isn’t what would have pushed the bill into Byrd rule violation territory,” Reynolds said in an email.

As for the alternative, Reynolds could not say why defunding Planned Parenthood for one year might have passed or failed the Byrd rule’s “merely incidental” test. The parliamentarian rules on a case-by-case basis and proved Reynolds wrong in 2015 when she predicted that the ghost of Robert Byrd would save Planned Parenthood.

A Senate Democratic aide attributed the one-year plan less to the Byrd rule and more to its CBO score. Going that route allows Republicans to tout how they’re saving the government money—at the expense of access to quality, affordable health care for the most marginalized people.

The Senate parliamentarian will presumably have to make another Byrd rule judgment on Planned Parenthood if the GOP’s embattled ACA plan proceeds. Sarah Lipton-Lubet, vice president at the National Partnership for Women and Families, told Rewire that any such action represents a “clear violation of the Byrd rule and a political attack on the ability of Planned Parenthood to provide basic health care to millions of people.”

“Other providers cannot meet the needs of Planned Parenthood’s patients.”

The Case of the Unwilling GOP

Finally, Republicans may be coming to the same realization.

Cutting off Planned Parenthood from Medicaid reimbursements really means cutting off Medicaid recipients from Planned Parenthood, and for those patients, one year can mean a death sentence.

“Had I have waited a day, had Planned Parenthood have waited a day, I would’ve had stage four cancer, and I wouldn’t be here,” said Jamie Benner, a Rodman, New York-based woman who turned to the health-care organization in 2013. “I wouldn’t be raising my daughter. I wouldn’t be taking my sister to college.”

Benner spoke at a Capitol Hill rally with other Planned Parenthood patient advocates. The group then splintered to meet with about 250 lawmakers, including 100 Republicans, in the House and Senate.

Hearing stories like Benner’s may speak to the most urgent reason for why Republicans are only pursuing a one-year defunding: Fear. 

A week after Inauguration Day, freshman Rep. John Faso (R-NY) raised concerns that defunding Planned Parenthood as part of the ACA repeal would backfire on Republicans, according to a surreptitious recording of a House-Senate GOP retreat leaked to select media outlets. Faso defected from a March 1 party-line vote to shred Title X family planning safeguards for Planned Parenthood and other clinics that provide abortion care.

The Budget Committee’s Diane Black denied that Faso spoke for anyone but himself. But Republicans, especially those who stubbornly repeated dubious GOP talking points about Planned Parenthood, faced hordes of angry constituents during the recent congressional recess. Independent polling reinforces voters’ opposition to defunding efforts.

Faso’s comments revealed that defunding Planned Parenthood is a “tougher issue for Republicans” than initially portrayed, according to the Senate Democratic aide.

“I wouldn’t assume that all of them are rabidly trying to defund Planned Parenthood,” the aide said. “It’s not politically easy for some of them to own this.”

Count out at least two mixed-choice Republican senators, Alaska’s Lisa Murkowski and Maine’s Susan Collins. Should both defect over Planned Parenthood, Vice President Mike Pence would have to cast a tie-breaking vote in the Senate. And again, more GOP senators may defect over their own problems with the underlying ACA repeal.

Trump’s victory, as far as Cecile Richards is concerned, did not amount to a mandate to take away people’s access to health care.

“This is the fight. It’s right now. It’s not about a year, it’s about forever,” the Planned Parenthood Federation of America president told Rewire in an interview after the Capitol Hill rally.

“What Speaker Ryan is actually saying is, women in America no longer can choose the health-care provider they want,” Richards said. “Two-and-a-half million patients choose Planned Parenthood voluntarily every single year, and we’re simply saying, women in this country should have the same rights as members of Congress, the right to choose the health-care provider that provides them high-quality, affordable care in their community.”