The health care bill sponsored by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA) was already the most sweeping of any Obamacare repeal effort in its restrictions on reproductive health coverage. A new version released on Sunday night would go even further than its predecessor in rolling back protections that have allowed millions of Americans to get affordable birth control.

This version would give states even more leeway to bypass the requirements of Obamacare — including those that guarantee coverage for contraception. In so doing, it may please conservatives who want states to have greater say over what is covered, and those who have opposed the contraceptive requirements from the beginning. But it will also threaten a benefit on which many people rely to maintain their health and plan their families.

Starting in 2020, states can make their own rules when it comes to coverage

Allowing insurance plans to cover less has been one focus of the Obamacare repeal effort. As of last week, Graham-Cassidy accomplished this by letting states seek waivers from some of Obamacare’s requirements. States that received waivers could allow insurers to sell bare-bones policies that didn’t cover everything required under Obamacare.

Under the new version released Sunday night, however, states don’t even have to get waivers, said Adam Sonfield, senior policy manager at the Guttmacher Institute. They can simply set their own rules about what insurance plans have to cover.

The new bill is also explicit about which provisions states can override, Sonfield said. These include the essential health benefits requirements for individual and small-business plans, which include birth control coverage as well as maternity care and prescription drug coverage. States could also choose whether to override the preventive services requirement under which most private plans have to cover birth control with no cost sharing. More than 55 million women have copay-free coverage of birth control under this requirement, according the Department of Health and Human Services.

The Trump administration is reportedly considering weakening the preventive services requirement in a different way, by offering an exception to any employer that has a moral or religious objection to birth control coverage. Graham-Cassidy would go further by allowing states to lift the requirement entirely.

All this would take effect in 2020, when Graham-Cassidy converts Obamacare’s tax credits and the Medicaid expansion into a system of block grants for states.

Gutting birth control coverage requirements could drive up costs for the millions of Americans who use contraception to prevent pregnancy while they finish school or look for a job or to otherwise plan their reproductive lives, as well as those who need hormonal birth control to manage medical conditions like endometriosis. In particular, allowing states to get rid of the requirements would make it harder for Americans to afford the long-acting contraceptives that are most effective at preventing pregnancy. The out-of-pocket cost of an IUD, for instance, averages around $1,000.

The new version of Graham-Cassidy also leaves in place other provisions that have concerned reproductive health advocates, including abortion restrictions tied to the block grants and a provision to strip funding from Planned Parenthood. It also keeps a provision that would ban abortion coverage on the exchanges beginning in 2018, potentially causing chaos in many states.

The bill also includes some funding provisions that would benefit Alaska, presumably in an effort to get the support of Sen. Lisa Murkowski (R-AK), who has voted against past repeal efforts. Sen. Murkowski has not yet taken a public stand on the bill. On Monday, four Planned Parenthood patients from Alaska sent her a letter asking her to vote no, arguing that the bill would harm women and families.

“We would like to ask you to stay strong for Alaskans,” they wrote.

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