The hits from Bernie Sanders' so-called "plan" on health care just keep on coming. Previously we have explored how Sanders is gambling all of existing public health care with a plan that is majority-funded using a flat tax on the middle class, raises health care costs for the average family with children and still can't make the numbers work.

But the damage Sanders does wouldn't stop there. He isn't content to stop at just putting the bulk of the cost on the back of the middle class and gambling with Medicare, Medicaid and Obamacare, it turns out that he is also gunning for women's health care. His plan would end insurance access to abortions, and possibly even jeopardize access to birth control.

Berniecare and the Hyde Amendment: The End of Affordable Abortion Services for Poor and Middle Class Working Women

Yesterday, Richard Mayhew at Balloon Juice noted that Sanders' plan leaves the federal law status quo intact with respect to federal funding of abortions. A long standing legal principle attached to many pieces of existing legislation is the Hyde Amendment, which prohibits federal funding of abortions except in case of rape or a threat to the mother's life.

Leaving this restriction is particularly troubling under a single-payer system. Sen. Sanders would prohibit the sale of private health insurance that duplicates any benefit of the his proposed federal program, and the likelihood that insurance companies would stick around just to sell abortion insurance is slimmer than that of Donald Trump falling in love with Mexicans.

Hitting poor women the hardest

The Hyde Amendment's mesh with a single payer system would mean that no woman in America would have insurance coverage for abortion. The consequences would hit poor women the hardest (as is becoming usual for Bernie's brand of "progressivism"). Although a majority of abortions are currently paid for out-of-pocket, fully 20% of all abortions are paid for by state Medicaid funds in the 17 states they are available, and 92% of women on Medicaid in those states seeking abortion services use such funding.

Since Sanders would take away federal Medicaid funds as it would be channeled instead to his federally administered single-payer plan, states can hardly be expected to maintain an entire program on their own just to pay for abortion services. Effectively, under Bernie's plan, affordable access to abortion for poor women would end, achieving an important policy goal of right wing religious extremists.

Endangering access for working middle class women

Given that first trimester abortions can cost up to $1,500 and second trimester abortions can cost even more, the Sanders plan, in effect, also takes away access to abortion from working class, middle-income women. More than 80% of employer-sponsored plans cover abortion, which will, of course, all go away under Bernie's plan. Under the Affordable Care Act, insurance companies cannot use federal funds for elective abortion services, but they can charge enrollees who receive federal subsidies a small additional amount and put it into a separate fund. That also goes away if insurance companies go away.

This would be a stunning feather in the cap of the anti-choice camp. This will effectively neuter Roe, something even Republican Congresses and presidents have not yet been able to achieve.

Berniecare and Hobby Lobby: Sanders' Gamble Could Jeopardize Contraception, Too

But affordable access to safe abortions may not be all the Sanders plan ends. It may well endanger contraceptive coverage as well. In the Hobby Lobby case, the Supreme Court granted closely held private companies, based on their religious beliefs, the authority not to contribute to plans that cover birth control. Today, the existence of the private insurance structure allows the Obama administration to still ensure women's access to contraceptives by requiring either insurance companies or a third party administrator to provide that coverage at no cost.

In a single payer system, though, there are no other plans. It is entirely conceivable that Hobby Lobby would apply in such a case, and those companies can demand to be (and be granted the authority to be) exempted from contributing to the federal system by the means of the additional payroll tax, which Sanders, in so many words, sets up as "income based premiums", rather than a tax. That distinction is important, because the government can use tax revenue without consent from every taxpayer. But the Supreme Court held that at least certain companies cannot be forced to pay a premium for a service that they religiously object to. If it's a premium, and companies like Hobby Lobby cannot be forced to pay a penny into a plan that covers contraceptives (regardless of what else it covers).

One outcome of such a case could be that employees of these companies would simply have to go without health coverage. So much for universal health care. But the more likely outcome would be that the since the government single-payer plan is the only available plan and employers are forced to pick it as the only plan, it would be forced to abandon birth control coverage altogether, leaving all women without contraceptive coverage.

A Gamble We Cannot Afford

We cannot gamble what is working in health care reform. Not on the basis of a plan this poorly devised, this easily taken apart. We cannot gamble health care reform on a plan that puts ideology first and women's health somewhere down the line.