Across a broad range of issues, the policy priorities of the Trump administration and conservatives in Congress are likely to have a devastating impact on many Americans. One group at particular risk from current efforts to undo the Affordable Care Act (ACA), gut Medicaid and slash domestic programs are women of color, their families and communities.

Women of color have long experienced stark health disparities in areas like cervical and breast cancer, unintended pregnancy, and pregnancy-related complications. The root causes stem from a long history of racism and discrimination, including lack of access to high-quality, affordable health insurance and care and, for some, a lingering mistrust of the medical community. And yet, even in the face of these many challenges, women of color in recent years have seen marked improvements, such as increases in insurance coverage and declines in unintended pregnancy.

These gains, incomplete as they may be, are now acutely threatened. In particular, the bill to repeal major pieces of the Affordable Care (ACA), which may be up for a vote in the U.S. Senate next week, would cause immense damage to communities of color; the damage of this legislation would be further magnified by other harmful policy proposals, including deep spending cuts and outright elimination of key programs sought by the administration and Congressional conservatives. Among the various areas under threat are:

  • Health insurance: The ACA has extended quality, affordable health insurance to over 20 million previously uninsured Americans, including many women of color. Under the ACA, the proportion of Black and Hispanic women of reproductive age without health insurance fell by 36 percent and 31 percent, respectively. These declines were driven by gains in private coverage and, in particular, the ACA’s Medicaid expansion. Women of color are disproportionately likely to be insured through Medicaid: 31 percent of Black women and 27 percent of Hispanic women aged 15–44 were enrolled in Medicaid in 2015, compared with 16 percent of white women.
  • Pregnancy-related care: At last count, Medicaid covered 51 percent of all births in the United States. But conservative policymakers are determined to impose devastating cuts on the program, potentially leaving millions of women without the care they need to protect their health and that of their infants. Likewise, conservative lawmakers want to undo the ACA’s various protections for maternity coverage in private insurance plans. This could make a bad situation even worse, in particular for Black women who have much higher rates of pregnancy-related deaths than white women.
  • Insurance coverage of preventive care: The ACA not only expanded access to insurance, it also greatly strengthened privately insured women’s coverage of preventive services with no out-of-pocket cost, including well woman visits, cancer screenings and18 distinct contraceptive methods. Among the beneficiaries are many of the 15 million women of color who are privately insured and of reproductive age. Undermining the ACA’s contraceptive coverage guarantee could once again mean high out-of-pocket costs for many.
  • Title X family planning program: Even with the ACA’s gains, millions of U.S. women—including many women of color—continue to rely on publicly funded contraceptive services. For them, safety net family planning providers are a major source of care, including almost 4,000 health centers that are supported by the Title X federal family planning program. But Title X is threatened with deep cuts or outright elimination.
  • Planned Parenthood: Another major threat to this vital family planning safety net are ongoing attacks against Planned Parenthood, including through efforts to roll back the ACA. In some communities, Planned Parenthood is the sole source of publicly funded contraceptive care, and in many areas of the country other safety-net providers could not readily replace services provided by Planned Parenthood. Excluding Planned Parenthood health centers from state and federal funding streams, including Medicaid and Title X, could therefore deprive women of vital care, including contraceptive services, breast and cervical cancer screenings, and STI testing and treatment.
  • Abortion access: Already, 57 percent of U.S. women of reproductive age live in states Guttmacher classifies as hostile or very hostile to abortion rights. Now abortion policy at the federal level is poised to worsen dramatically as well, including by potentially imposing new restrictions in private insurance plans’ coverage of abortion care and permanently enshrining the discriminatory Hyde amendment. This deeply unjust policy prohibits the use of federal funds to pay for abortion care for low-income women enrolled in Medicaid, except in rare circumstances. Fifteen states use their own funds to cover abortion services for Medicaid enrollees, but 7.5 million women in other states lack such coverage — 51 percent of whom are women of color.

It is dismaying that our federal government is making the conscious decision to try and worsen healthcare access for many Americans. For women of color this means an end to the progress seen in the areas of reproductive health, rights and justice; instead, the burden will now grow as obtaining quality, affordable family planning and abortion care and other critical health services becomes more difficult.

Moreover, these attacks come as communities of color grapple with an onslaught of other policies — including “law and order” executive orders that reduce police accountability and encourage aggressive immigration raids — that threaten to tear apart the nation’s families and communities.

To be sure, women of color have long demonstrated remarkable resilience and strength in the face of systemic inequality. But all U.S. women, including women of color, deserve to make their own decisions about whether and when to become pregnant, and to raise and nurture their children safely and with dignity. It is shameful that this basic principle of self-determination is now at stake for so many.

Marcela Howell is the Executive Director of In Our Own Voice: National Black Women’s Reproductive Justice Agenda.

Ann M. Starrs is President and CEO of the Guttmacher Institute. 

This article was originally published on The Hill’s Congress Blog.