There's something rotten in the state of women's health. As this article is being written in July, Republicans in Congress are engaged in a frenzied effort to repeal and replace the Affordable Care Act (ACA) put in place by the Obama administration. At least 22 million Americans would lose medical insurance by 2026 under the latest version of this plan—which includes large cuts to Medicaid—and lack of insurance means more sickness and death for thousands, data show. These cuts threaten to affect women more than men—whether by removing basic health coverage, cutting maternity care or sharply limiting reproductive rights.

It's time to take a stand against this war on women's health.

Current events are just the latest insult in a long history of male-centric medicine, often driven not by politicians but by scientists and physicians. Before the National Institutes of Health Revitalization Act of 1993, which required the inclusion of women and minorities in final-stage medication and therapy trials, women were actively excluded from such tests because scientists worried that female hormonal cycles would interfere with the results. The omission meant women did not know how drugs would affect them. They respond differently to illness and medication than men do, and even today those differences are inadequately understood. Women report more intense pain than men in almost every category of disease, and we do not know why. Heart disease is the number-one killer of women in the U. S., yet only a third of clinical trial subjects in cardiovascular research are female—and fewer than a third of trials that include women report results by sex.

The Republican assault on health care will just make things worse. The proposed legislation includes provisions that would let states eliminate services known as “essential health benefits,” which include maternity care. Before the ACA made coverage mandatory, eight out of 10 insurance plans for individuals and small businesses did not cover such care. The proposed cuts would have little effect on reducing insurance premiums, and the cost would be shifted to women and their families—who would have to take out private insurance or go on Medicaid (which the proposed bill greatly limits)—or to hospitals, which are required by law to provide maternity care to uninsured mothers.

The bill, in its current form, would also effectively block funding for Planned Parenthood, which provides reproductive health services to 2.4 million women and men. The clinics are already banned from using federal funding for abortions except in cases of rape or incest or when the mother's life is in danger, in accordance with the federal Hyde Amendment. So the Planned Parenthood cuts would primarily affect routine health services such as gynecological exams, cancer screenings, STD testing and contraception—and these clinics are sometimes the only source for such care. Regardless of which side you are on in the pro-life/pro-choice debate, these attempts to remove access to such basic services should alarm us all.

The Trump administration also has been chipping away at the ACA's birth-control mandate. A proposed regulation leaked in May suggested the White House was working to create an exemption to allow almost any employer to opt out of covering contraception on religious or moral grounds. Nationwide, women are increasingly turning to highly effective long-acting reversible contraceptives (LARCs) such as intrauterine devices (IUDs). The percentage of women aged 15 to 44 using LARCs increased nearly fivefold from 2002 to 2013. Decreased coverage for contraceptives translates to less widespread use and will likely mean more unintended pregnancies and abortions.

And abortions will become harder to obtain. After Roe v. Wade, many states tried to put in place laws to hamstring abortion clinics. These efforts have only ramped up in recent years, as many states have enacted so-called TRAP laws (short for targeted regulation of abortion providers), unnecessarily burdensome regulations that make it very difficult for these clinics to operate. Recognizing this fact, the Supreme Court struck down some of these laws in Texas in 2016, but many are still in place in other states. Rather than making women safer, as proponents claim, these restrictions interfere with their Supreme Court–affirmed right to safely terminate a pregnancy.

Whether or not the repeal-and-replace legislation passes this year, these attacks are part of a larger war on women's health that is not likely to abate anytime soon. We must resist this assault. Never mind “America First”—it's time to put women first.