On March 23rd, President Obama signed the history-making federal health care reform bill into law. Over the last year, Planned Parenthood Mar Monte worked with Planned Parenthood Federation of America, Planned Parenthood Affiliates of California, and coalition partners to make sure that our health centers are included as “essential community providers” in the new insurance exchanges and women will have access to the full scope of reproductive health care, including abortion. We also successfully achieved expansion for state family planning programs across the country.

This journey was long and we have had triumphs as well as disappointments. We should take a moment to celebrate the positive even as we make plans to change the negative.

The Good
Our health centers – which have always been critical to ensuring access in the communities we serve – are now assured a place in the new delivery system. Women insured under the new plans will be able to have screenings for breast and cervical cancer, check-ups and other preventive services without making co-payments.

The families we serve – including childless adults who lacked coverage before – will benefit from Medicaid expansion to more of the working poor. Our clients will no longer fear being dropped from or denied access to insurance because they have a pre-existing health condition. Young adults can now continue to be covered under their parents’ plans up to the age of 26, and insurance companies will no longer be able to discriminate based on gender.

The families we serve, who live in some of the most impoverished areas of the country and have lost their jobs and homes, need no longer fear that seeking medical care will result in financial ruin.

The Bad
We knew we would have to battle anti-choice members of Congress from both sides of the aisle. We were disappointed to see that two previously pro-choice representatives in our affiliate’s California territory voted for Rep. Bart Stupak’s amendment in the House bill that would have banned all abortion coverage. We made sure that the two Congressmen received thousands of calls voicing our disappointment, and we were heartened to see that they voted for the final health care reform bill without the Stupak amendment.

We also called upon our friends in the Senate to help us remove the draconian restrictions in the Stupak abortion-coverage ban. We met with the Senate Majority Leader Harry Reid of Nevada and California Senators Boxer and Feinstein. The Senate indeed voted down the Stupak ban only to replace it with the problematic and burdensome Nelson amendment that sets up accounting and administrative obstacles to women seeking an abortion.

The Nelson amendment – which violates the promise of President Obama that “no person would have less coverage” after health care reform – may be the lesser of two evils in health care reform. However, it threatens abortion coverage for every woman buying insurance through the government health care exchanges, even those paying with all private dollars. Over time, it has the potential to erode all abortion coverage for insurance, as it has done in states with similar laws.

More Bad
The practical effects of President Obama’s Executive Order on implementation of the Nelson amendment, a last-minute concession to anti-choice House members whose votes he needed, are unknown at this time. But, at a minimum, the symbolism is sobering.

The Ugly
It was clear that anti-choice groups were prepared to sabotage all of health care reform to achieve their objective to deny women access to abortion. We saw both Houses of Congress and the president make painful concessions as a result of their aggressive tactics. Their relentless attacks on access to abortion won’t stop with the passage of health insurance reform. We will need to remain vigilant at every step of implementation at both the federal and state levels.

Meanwhile, however, millions of women, children and families who previously lacked access to health insurance will now have the peace of mind that health coverage can bring. Many of them are our clients.