- The proposed Republican health care plan defunds Planned Parenthood
- For some patients, it could create long waits for care
(CNN)All Ariana and Kevin Gonzalez want is birth control.
As far as health care needs go, that's pretty simple.
But the California couple says that if the Republican alternative to Obamacare becomes law, they'll be driving over the border to Mexico to get it.
It's not that the Gonzalezes don't have insurance; they have very good insurance through Ariana's job as a high school teacher.
The problem is that "Trumpcare," as Ariana calls it, would probably run her health clinic out of town. It's Planned Parenthood, which the Republican health care proposal defunds because it performs abortions.
The Gonzalezes live in the Imperial Valley, an agricultural area two hours east of San Diego, with a severe doctor shortage. On average in California, there's one primary care physician for every 1,341 people. In the Imperial Valley, there's one physician for every 4,170 people, according to the University of Wisconsin Population Health Institute.
For Ariana, that means it takes well over a month to get an appointment with her gynecologist and then four or five hours in the waiting room to see him, which means she has to take the day off work. At Planned Parenthood, she gets an appointment the next day and is in and out in about 30 minutes.
If the Republican plan passes and Planned Parenthood leaves town, Ariana says, her best option would be to cross the border, where she can see a gynecologist immediately. It's an option she doesn't want to take but will if she has to.
Ariana has a message for senators as they contemplate whether to pass the law, also known as the American Health Care Act.
"If (Planned Parenthood's) doors are shut, you'll be driving your own constituents to an entirely different country in search of health care, and that's not America," she said. "I don't think that's who we are as a country."
Pregnant at 15
Ariana, 23, knows what life would be like without Planned Parenthood in her town because she's lived it.
Before Planned Parenthood opened in the Imperial Valley two years ago, she became pregnant when she didn't want to, and then later she couldn't get pregnant when she did want to.
Without easy access to birth control, Ariana became pregnant at 15. A doctor tried to convince her to have an abortion, saying she was one of countless teen moms he'd seen just that week.
"He said it would be better for me, and we could have it done in 10 minutes if I just said the word," she remembers.
But Ariana, now 23, says her "maternal instinct kicked in," and she never considered termination.
In the summer of 2011, when her son, Oliver, was 18 months old and she was 18 years old, Ariana met her future husband.
She wasn't looking for love -- in fact, she'd shunned dating to focus on caring for Oliver and preparing to study at San Diego State University in the fall.
But one day, she was visiting a friend when Kevin and his brother showed up to visit. They were hanging out in the front yard, and she excused herself to go inside and check on her napping son.
"I was expecting 'you have a child?!' " she remembers. "But he just said, 'OK, no problem.' He didn't blink an eye."
Kevin proposed a few months later and adopted Oliver. They tried to have another child so Oliver would have a sibling close in age, but Ariana suffered three miscarriages, including one with twins. Then, an ectopic pregnancy permanently damaged one of her fallopian tubes, and she was unable to get pregnant for nearly two years.
With each medical failure, Ariana sought advice from her gynecologist, and each time, the wait for an appointment was about six weeks. The Gonzalezes' hope for another child seemed to be stuck in an endless cycle of complications and long waits to see the doctor.
They say they wish Planned Parenthood had been in their town then, as the clinic, unlike her gynecologist's office, treats infertility without long waits.
Finally, after nearly four years of miscarriages and infertility, Ariana's doctor prescribed steroids, and she became pregnant with their daughter, Bailey. She wanted to see her obstetrician immediately, but again she faced a six-week wait.
"We needed to make sure that this pregnancy was going to stick and it was going to be healthy, and in order to do that, off to Mexico we went," she said.
A ride across the border
It was about a 20-minute drive from the Gonzalezes' home in El Centro, California, to Avenue de Francisco I. Madero in Mexicali, Mexico. The busy thoroughfare is lined with doctors' clinics that await Americans like the Gonzalezes who face a shortage of doctors back home.
The doctors at Almater Hospital wouldn't take Ariana's health insurance, but it didn't really matter, because the care was so inexpensive. For just $25, a blood test and an ultrasound confirmed her healthy pregnancy.
After the appointment, Ariana and Kevin sat in line at the border for three hours to get back home to California, but they said still it was faster than waiting a month for her gynecologist and then waiting four or five hours in his waiting room.
Ariana's pregnancy with Bailey went well, but the birth didn't. She hemorrhaged so much blood during the cesarean section that she needed several blood transfusions.
When her obstetrician discharged Ariana from the hospital, he urged her to follow up with him shortly. But when she called to make an appointment, she was told she'd have to wait a month.
That's when Ariana started going to Planned Parenthood.
She said it scares her to think what will happen if her clinic closes.
"I don't think this is the direction that our country needs to be going. I think we're taking steps backward," she said.
She thinks about a photo that made the rounds on social media in March. It showed Vice President Mike Pence and a group of congressmen discussing the passage of the GOP plan, called the American Health Care Act.
"I see a bunch of men sitting around a table, discussing what I should be allowed to do with my body," she said. "My husband and I can decide what's best for us."
Proposal 'devastating' to Planned Parenthood
Although Ariana's not on Medicaid, 87% of patients going to Planned Parenthood in California are on the government health program.
The Republican plan calls for the federal government to stop paying Planned Parenthood when a patient on Medicaid comes in for care.
The effect would be "devastating," according to Planned Parenthood Affiliates of California Action Funds.
"If these health centers do not get federal reimbursement for the care they provide, Planned Parenthood health centers will close," according to the group.
But Republicans say a network of federal community health centers can care for Planned Parenthood patients.
At a CNN town hall in January, House Speaker Paul Ryan pointed out that there are many more community health centers than there are Planned Parenthood clinics, and community health centers don't provide abortions.
"For every Planned Parenthood, there (are) 20 federal community health centers," Ryan said. "They're vastly bigger in network, there are so many more of them, and they provide these kinds of services without all the controversy surrounding this issue."
But many experts say community health centers can't easily absorb the nearly 5 million patients who visit 600 Planned Parenthood clinics annually, even with the additional $422 million that the GOP bill would provide to the community health centers.
An analysis by the Guttmacher Institute shows that in 27 states, community health centers would have to at least double their contraceptive client caseloads to absorb Planned Parenthood's patients, and in nine of these states, they would have to triple their caseloads.
California community health centers would be put under "untenable stress" if Planned Parenthood centers were defunded, according to a group representing the centers.
"We do not have the capacity for such an increase in care," Carmela Castellano-Garcia, president of the CaliforniaHealth+ Advocates, wrote to Sen. Dianne Feinstein in February. "We strongly believe enactment of (the GOP proposal) would negatively impact the health of our community."
As for Ariana, she doubts that the community health center in her town could meet her needs. She remembers going there to get care for Oliver when he was a baby, and she had to wait four hours to get in to see the doctor.
Now, Oliver is 7, and Bailey is almost 2. Busy with them and her full-time job, all Ariana wants is a place to get regular birth control without having to take a day off work.
That brings her back to her plans to go to Mexico if "Trumpcare" passes. She places her faith in senators to stop a plan that she says would send her out of her own country to get health care, a plan she calls un-American.
"I think it's shameful, and I think that they should be embarrassed," she said.