It's getting awfully crowded underneath that bus. You know, the metaphorical one that women keep getting thrown under, along with their rights, their health and their money. Women lost much of their insurance cover for abortion during the fight over the healthcare reform bill last fall, but at least they got some good things out of it: cover for millions of uninsured women, preventive care including breast and cervical cancer screenings and a bar on refusing cover for such pre-existing conditions as having been a rape or domestic violence victim. Overall – and assuming the law is not overturned or sabotaged by the Republicans – women will be better off in terms of affordable healthcare, including reproductive healthcare, than if the bill had been scuttled over the Stupak-Pitts amendment.

The budget deal just concluded was no such compromise. The headlines are all about how the Democrats refused to cave to Republican demands to remove funding from Planned Parenthood and saved the day for women's reproductive health – at least until September, when the GOP and its media spokespeople will crank up their misogynistic fog machine all over again.

It's hard to see how they'd go further: Arizona's Jon Kyl claimed on the floor of the house that "90% of what Planned Parenthood does is abortions". It's actually about 3%, and his office later said his statement was "not intended to be factual". Rush Limbaugh claimed that "Planned Parenthood is a money-laundering operation for the Democrat party". Glenn Beck said that only "hookers" use Planned Parenthood. In fact, one out of every five women has visited a PP clinic, including this writer.

Widespread mockery of these weird remarks might lead you to think they backfired. Not necessarily. Look at the fine print: to keep Planned Parenthood's federal funding, Democrats agreed to bar Washington DC from using its own revenues to pay for abortion care for women on Medicaid. And in a tiny footnote, the final budget cuts Title X by $17m. You have to hand it to the Republicans: even when they lose, they win.

The Washington ban is more important than has been portrayed. First of all, it involves a lot more money than reported. "The sound and fury of last week's budget debate came down to a dollar figure that some members of Congress could have covered by writing a personal cheque," wrote Sabrina Tavernise in the New York Times, citing a figure of $62,300 since August. Actually, Laura Meyers, CEO and president of Planned Parenthood of Metropolitan Washington, told me by phone that PPMW, the region's largest abortion provider, had just started accepting Medicaid for abortions in February. Thus, the annual sum paid out by the district would have been much higher than Tavernise implied. I mention this not to suggest that abortion is an expensive budget item – it isn't, especially compared with, say, tax breaks for millionaires or our many ongoing wars – but to point out that this ban is not a trivial issue. There are 105,874 poor women receiving medical assistance, including Medicaid, in Washington; many are in their childbearing years. For them, the cost of a first-trimester abortion is a big deal. "When someone is struggling to feed and clothe their kids," said Meyers, "$400 is huge. Just huge. Women will be scrambling now." She noted that abortion-funding bans do not prevent abortion; they merely push them later in pregnancy, when they are more expensive and more stressful.

This point has been made so often, to so little effect, that I sometimes wonder if the anti-choice plan is not actually to prevent abortion but simply to make it as awful as possible for the woman. Many of the 370-plus anti-abortion bills now wending their way through state legislatures are simply about creating misery, anxiety and fear – forcing women to view ultrasounds, see anti-choice counsellors, listen to scripts claiming falsely that abortions cause breast cancer and infertility, and wait, wait, wait for their procedures. Prevention, after all, would mean birth control – the very thing Title X provides. Now, with $17m less. Because why should hookers have free birth control? If you ever doubted that the next target of the anti-choice movement will be contraception, you need to start paying attention to the fine print.

And if you want a clue to the power of the anti-choice movement to sway conservative ideology, consider this. Conservatives constantly tout the virtues of states' rights, small government and self-determination for taxpayers – except when those taxpayers and that local government want to do something conservatives don't like.

Why can't Washingtonians spend their own money on their own low-income women's abortions? Because Congress, for ridiculous historical reasons, refuses to allow the district the self-government conservatives love to talk about when they are trying to overrule federal environmental regulations and get rid of the Voting Rights Act. Because DC residents are Democrats? Because they are black? Maybe some day Washington will become a Mormon enclave, and we'll find out the answer to those questions. What I'd like to know is, should one of those future women of Washington need an abortion, will she still be a hooker?