Source: http://raisingwomensvoices.net/rwvoices/?currentPage=3
Timestamp: 2019-04-24 08:54:27+00:00

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Women lead push to protect our health care!
House hearing on protecting people with pre-existing conditions!
This week, the House Ways and Means Committee held its first policy hearing of the new Congress, highlighting ways that the Trump administration has put people with pre-existing conditions at risk by expanding junk insurance plans, sabotaging ACA outreach and enrollment, and refusing to defend the ACA in court. More than 67 million American women have pre-existing conditions.
The House Energy and Commerce (E&C) Committee is also planning a hearing in the coming weeks into the Texas v. Azar court case that threatens to unwind the entire health care law, including consumer protections for people with pre-existing conditions.
RWV joins advocates from across the country at Families USA Health Action Conference!
Ann Danforth, Senior State Advocacy Manager for the Community Catalyst Women’s Health Program, and Sarah Christopherson, Policy Advocacy Director for the National Women’s Health Network, represented Raising Women’s Voices last week in Washington, D.C., at Families USA’s 2019 Health Action Conference, “Fighting for America’s Families.” We joined national and state leaders in the health care movement for an opportunity to reflect, share stories, learn from one another and re-energize for our work in the year to come.
Sister Simone Campbell spoke about the moral imperative she feels to engage in health advocacy. She is Executive Director of NETWORK and a longtime health advocate who organized the 2014 “Nuns on the Bus Tour” in support of the ACA. Most recently, she and her colleagues took to the road again with their “Nuns on the Bus ‘On the Road to Mar-a-Lago’” tour, which included 54 events in 21 states. The goal of the tour was to hold members of Congress accountable for their multiple attempts to repeal the ACA, and their eventual successful attempt to repeal the ACA’s individual mandate through the 2017 tax bill. She highlighted the power of real people’s stories, and echoed Speaker Pelosi’s call to hold elected officials accountable. “You all need to continue to knock on the doors, engage, and make clear that we, the people, are watching,” she urged.
Experts discuss threats to women’s health and LGBTQ health, and the negative impact of racial and gender biases. During breakout panels, national and state experts covered a variety of RWV priority issues, including state and federal threats to women’s health and LGBTQ health, and strategies for pushing back. Panelists from the Planned Parenthood Federation of America (PPFA), American Conference of Obstetricians and Gynecologists (ACOG), and the Leadership Conference on Civil and Human Rights discussed the harm of recent Trump administration regulations for women, particularly low-income women of color. Examples include rules targeting the Title X family planning program and the ACA’s contraceptive coverage benefit. They also pointed to proactive state work, such as Oregon’s Reproductive Health Equity Act and New York’s recent Reproductive Health Act, as a means to protect women at the state level against harmful federal threats.
At a panel focused on LGBTQ health, Out2Enroll’s Katie Keith talked about the health coverage gains for trans people under the ACA, as well as the remaining work that needs to be done. In 2013, 59% of trans people didn’t have health insurance, whereas in 2017, 25% of trans people didn’t have health insurance, she said. Luc Athayde-Rizzaro from theNational Center for Transgender Equality discussed the implications of the anticipated Trump administration rollback of the Obama administration’s rule interpreting the ACA’s Section 1557 non-discrimination provision, often referred to as a “health care civil rights law,” as well as some of the opportunities that exist at the state level to secure health care protections for transgender people.
At a breakout panel entitled Listen to us! How racial and gender biases undermine women’s health, Ann Marie Benitez of the National Latina Institute for Reproductive Health, Joia Adele Crear-Perry of the National Birth Equity Collaborative and Community Catalyst board member (pictured above), Rachel Hardeman of the University of Minnesota School of Public Health and Aisha Liferidge of the George Washington University School of Medicine and Health Sciences, talked about how racial and gender biases drive health inequities. Using a reproductive justice framework, speakers grounded the conversation by first explaining the history of eugenics in the U.S. They discussed the history of forced sterilization, coercion, and medical experimentation targeting women of color. They talked about the ways in which this legacy of racism has led to providers minimizing the pain of women of color, as their needs go unmet and racial health disparities among women of color persist. The panel concluded with a conversation about state policy efforts to begin to address disparities, such as Medicaid coverage for doulas, and requirements that health care providers undergo implicit bias trainings.
During the final plenary, And Still We Rise: Women Leaders who Resist and Thrive,Chirlane McCray, Founder of ThriveNYC and First Lady of New York City, spoke about the importance of prioritizing mental health care. “There is no health without mental health,” she said. The panel of social justice leaders who followed her – including moderator Sinsi Hernandez-Cancio of Families USA, Keisha Bradford of Health Center Association of Nebraska, Cristina Jimenez of United we Dream, Monica Simpson of SisterSong, andAnna Chu of the National Women’s Law Center – reiterated First Lady McCray’s message, speaking to the importance of mental health for everyone, including yourself. “Not taking care of yourself is an act of violence against yourself,” Jiminez said, when asked how she continues to fight for what’s right, even in the face of adversity and burnout.
What did the government shutdown cost?
This week, the Congressional Budget Office estimated that the 5-week shutdown of the federal government cost the US economy $11 billion. Although most federal health programs were protected because HHS was already funded through this coming September, the longer-than-expected shutdown had serious health-related consequences for hundreds of thousands of Americans. Federal employees faced a reset of their deductibles right as they weren’t getting paid, federal contractors couldn’t make premium payments on their employees’ plans, and ACA marketplace enrollees dependent on the IRS to certify their income couldn’t receive financial aid to help offset their premium costs. And of course, Indian Health Service workers were asked to continue to serve 2.2 million Native Americans and Alaska Natives without pay, putting all non-emergency care on hold.
Late last Friday, Donald Trump caved to growing pressure from rank-and-file Senate Republicans and agreed to support a clean continuing resolution funding the government through February 15 without any money for the wall or other new anti-immigration measures. After preemptively declaring himself solely responsible for the shutdown in December, public opinion polls consistently showed that a majority of Americans oppose the wall and blamed Republicans for the longest government shutdown in history. In exchange for re-opening the government without wall funding, congressional leadership agreed to convene a bipartisan bicameral conference committee on the Homeland Security appropriations bill to negotiate the president’s demands, along with protections for the Dreamers and other outstanding immigration concerns.
Democrats are not expected to agree to more than fig leaf funding for Trump’s signature issue—for example, they may agree to additional funds to improve existing fencing—raising questions about whether parts of the government will once again shut down in two weeks. But even among Senate Republicans there appears to be very little appetite for another“kick from the mule,” in GOP Leader Mitch McConnell’s words.
Continuing its seemingly relentless attack on Medicaid recipients, the Trump administration revealed earlier this month that it is working on guidance to allow states to institute Medicaid block grants through the existing 1115 waiver process. A long-time conservative goal, Republicans in the previous Congress repeatedly tried and failed to block grant Medicaid as part of their ACA repeal attempts. The proposal CMS is considering would allow states to apply for less money in exchange for greater “flexibility” to spend it how they want instead of on protected groups like pregnant women and people with disabilities.
It’s not clear whether the administration actually has the legal authority to offer block grants under current law. But at least one important voice is adamant that they do not. House E&C Committee Chairman Frank Pallone (D-NJ) said bluntly: "CMS doesn’t have the legal authority to block grant Medicaid. Block grants undermine the protections of the Medicaid program and put our most vulnerable citizens at risk.” Any move to issue such guidance would almost certainly prompt immediate oversight action by the new House majority.
Celebrating the 46th anniversary of Roe v. Wade!
Today marks the day—46 years ago—of the landmark Supreme Court decision Roe v. Wade, which established the constitutional right to abortion in the U.S. But even as we celebrate the anniversary of this momentous decision that gave women the right to choose if and when to have a family, we also recognize its limitations as well as its potentially uncertain future.
We are heartened by movement in progressive states to enact state-level protections for legal abortion, such as the Reproductive Health Act expected to finally pass both houses of the New York State Legislature later today. But in conservative states, women needing abortion care are facing increasing obstacles.
As we’ve noted before, Donald Trump has worked to fulfill his campaign promise to nominate only judges who would overturn undermine Roe v. Wade. With the appointment of Brett Kavanaugh, Trump did just that. Kavanaugh has made clear his position on abortion rights, giving a speech praising Justice Rehnquist’s dissent in Roe v. Wade, and dissentingin last fall’s Garza v. Hargan case about an undocumented immigrant minor seeking an abortion.
Even through Roe decriminalized abortion in 1973, Roe has yet to become a reality for allwomen. Because of racial and socioeconomic disparities, age, immigration status, geographic barriers and other factors, many women are already living in a post-Roe world in which it’s virtually impossible to get abortion services.
According to the Guttmacher Institute, states have been growing increasingly hostile towards abortion rights. Guttmacher’s research found that the number of states with policies hostile to abortion rights grew from only four states in 2000 to 21 states that have policies hostile or very hostile to abortion rights in 2019.
In 2018 alone, 23 abortion restrictions were enacted. State-level abortion restrictions, such as waiting periods, targeted regulation of abortion provider (TRAP) laws, and more, make it increasingly difficult for women to get the health care they need. As a New York Times editorial from today notes, 43 percent of all women of reproductive age, or approximately 29 million women, live in areas that are hostile to abortion rights. There are currently seven states that each have just one abortion clinic left.
What have advocates been doing to “back up” Roe and secure other reproductive health protections at the state level?
If Roe v. Wade were overturned or gutted, what might abortion rights and access look like across the country? In a “post-Roe” world, the authority to regulate abortion would go to the states. Currently, nine states – including California, Connecticut, Delaware, Hawaii, Maine, Maryland, Nebraska, Oregon, and Washington – have adopted laws that protect the right to abortion at the state level prior to viability or when necessary to protect the life or health of the woman.
In addition, states with archaic pre-Roe abortion bans that are still on the books have a renewed sense of urgency to repeal them. For example, last year, our Boston-based regional coordinator, NARAL Pro-Choice Massachusetts, successfully advocated for the repeal of the state’s 173 year-old abortion ban through their Negating Archaic Statues Targeting Young Women Act.
Now, NARAL Pro Choice Massachusetts is working to build on that success as they advocate for the ROE Act, or the Act to Remove Obstacles and Expand Abortion Access. The proposed policy would reform state abortion laws to ensure that anyone, regardless of age, income, insurance or immigration status, can access safe and legal abortion. This bill would codify the right to abortion in state law; remove mandatory parental consent to abortion, which disproportionately impacts low-income teens and teens of color; allow for abortions after 24 week in case of grave fetal abnormalities; update medically inaccurate definitions of abortion and pregnancy in the law; remove a mandatory 24-hour waiting period for abortion care (though currently unenforced due to litigation); and establish safety net coverage for abortion care for those without health insurance.
In New York, RWV-NY has worked alongside its women’s health colleagues to successfully advocate for the adoption of the Reproductive Health Act, which secures and protects access to abortion in New York by strengthening and updating New York state law and bringing it in line with the standard of Roe v. Wade. It also protects health care providers who perform abortion services, and treats abortion as health care, not a criminal act. The state Senate, where Republicans blocked passage of the bill in the past, is now controlled by Democrats, who are poised to approve the bill later today. Governor Cuomo is expected to sign this piece of legislation, alongside the Comprehensive Contraception Coverage Act, which protects and expands the ACA’s contraceptive coverage requirement, and the Boss Bill, which prohibits employers from discriminating against an employee because the employee or their dependent made a reproductive health decision that conflicts with the employer’s personal beliefs.
In 2017, our Portland-based regional coordinator, NARAL Pro-Choice Oregon, successfully advocated for the adoption of one of the most far-reaching reproductive health policies to date. The Reproductive Health Equity Act requires coverage of the full range of reproductive health related services with no cost-sharing for all Oregonians, including undocumented immigrants and trans people. The new policy covers contraceptives, abortion, screenings for cancer and sexually transmitted infections and prenatal and postpartum care. Our Denver-based regional coordinator, Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR), as well as our Seattle-based coordinator, Northwest Health Law Advocates, are pushing for similar measures in Colorado and Washington this year.
Advocates in somewhat more conservative states can also take action to begin building the foundation for establishing abortion protections in their state. For example, pro-choice advocates are pursuing a lawsuit in Pennsylvania that would overturn the state’s ban on Medicaid funding for abortion. As the New York Times notes, currently, only 16 states allow for Medicaid coverage of abortion. This puts abortion out of reach of low-income women who rely on Medicaid for the health care they need.
Advocates in even redder states can work to counteract the anti-choice narrative by introducing pro-choice legislation, which, despite its unlikely passage, has the potential to start an important conversation and raise awareness about the need for state-level abortion protections.
While the future of Roe remains uncertain, advocates can act now to shore up protections at the state level for abortion as well as other reproductive health services. In addition, advocates can expand our focus beyond abortion, and push for policies that will help to achieve true reproductive justice, including policies relating to immigrants’ rights, voting rights, paid family leave, maternal health for women of color, living wages and access to health care for incarcerated women.
This week, federal judges in California and Pennsylvania issued injunctions halting implementation of the Trump administration’s attacks on birth control coverage under the ACA. Under the Trump rules first proposed in October 2017, employers would be able to deny their employees birth control coverage because of the employer’sreligious or moral objections.
While the injunction in California affects only the 13 states and DC that are parties to that case, the injunction in Pennsylvania blocks the Trump rules nationwide on the same day that they were set to take effect. Like Hobby Lobby and Zubik, the two previous court battles to determine whether religiously-affiliated employers must provide coverage, the current fight is likely to end up at the Supreme Court sometime next year.
As we wrote in 2017, the Trump rules throw out the existing Obama-era accommodation for religious employers. While not ideal, the Obama accommodation is a compromise that gives women access to seamless birth control coverage at no cost, while also allowing employers with religious objections to avoid paying for it themselves. Instead of an accommodation that protects employers’ religious views and women’s access to vital health care, the Trump rules would simply allow almost any employer to strip birth control coverage from their employees for either moral or religious objections to contraception. Universities can also deny birth control coverage in student health plans for religious or moral reasons. In addition, insurance companies can deny coverage for religious or moral reasons as long as the employer agrees.
What makes the administration’s position even more galling is that it argues the harm will be mitigated as more women use Title X family planning programs to replace their missing contraceptive coverage. Of course, we are waiting any day now for the administration to issue final regulations gutting the Title X program and sharply limiting the ability of women to access real contraceptive choices at real family planning clinics. The rule would change the definition of “family planning” to include non-medical approaches such as abstinence-only or “fertility awareness” methods that have high failure rates.
If the administration is ultimately successful in all of its schemes, women denied employer-sponsored contraceptive coverage on religious or moral grounds may find that the only “Title X provider” in their community is a religiously affiliated fake clinic offering abstinence-only counseling in lieu of birth control.
Women are marching again on Saturday!
For the third straight year, women will be marching in the streets in cities across the nation on Saturday. The first women’s march in January of 2017 was a mass expression of women’s dismay over the election of Donald Trump, who was being inaugurated that month. Last year’s march targeted many of the policies the Trump administration and Republican Congressional leaders had been pushing – including repeal of the Affordable Care Act. Raising Women’s Voices-NY staff and interns are shown above, participating in last year’s march in New York City.
This year’s march comes just after a major victory for women – the election of dozens of women to Congress and the return of Nancy Pelosi as Speaker of the House of Representatives, with Democrats now in control of the House. That’s means some of the more egregious things the previous Congress tried will likely be off the table for now.
WV Free, the RWV regional coordinator in West Virginia, will be joining the West Virginia Women’s March, ACLU-WV and Planned Parenthood South Atlantic on the steps of the West Virginia State Capitol in Charleston for a rally at which WV Free’s Anduwyn Williams and Katie Wolfe will be speaking. The rally will be followed by a march and ending with a happy hour (great idea!).
There is also much to celebrate this year. Joan Lamunyon Sanford, Director of the New Mexico Religious Coalition for Reproductive Choice (RCRC), which is the RWV regional coordinator for that state, will be speaking at Saturday’s march in Albuquerque. She and other women’s health advocates in New Mexico have been celebrating the election of a new progressive governor, Michelle Lujan Grisham, and the election of a Native American woman from New Mexico, Deb Haaland, to Congress.
Some RWV regional coordinators are doing alternative actions this weekend. For example,Northwest Health Law Advocates (NoHLA) Seattle is participating in a Womxn's Day of Action on Sunday and will be co-presenting with the Somali Health Board on immigrant access to health care in Washington state. NoHLA will be discussing federal, state, and local policies that impact immigrant access to care and Somali Health Board will provide client stories to highlight how those policies impact community members directly.
In New York, where unresolved disputes have resulted in there being two separate Women’s March events on Saturday, RWV-NY will be conducting leafleting seeking women’s stories about problems with confusing and unfair medical bills. RWV-NY is part of a coalition advocating for state action requiring simpler medical bills and holding consumers harmless when they when go to a health provider they had been assured was in their health plan network, but later receive an out-of-network bill.
Tues deadline for comments on Trump abortion coverage rule!
The deadline is almost here for submitting comments on a Trump administration proposal that would impose burdensome requirements on coverage of abortion services in health plans being offered through Affordable Care Act (ACA) marketplaces. We fear the proposed rule would confuse health plan enrollees and could even prompt insurers to drop abortion coverage. Comments are due by midnight on Tuesday, Jan. 8, on this proposal, which the administration rolled out right after the mid-term elections.
How would this proposed rule undermine abortion coverage? Under the current system, insurance companies can include abortion coverage in the comprehensive health plans they offer in ACA marketplaces, so long as: 1) abortion coverage is not prohibited by state law and 2) insurers do not use any federal funds to pay for the portion of the premium that covers abortion. Under the Nelson amendment to the ACA, insurers must charge at least $1 a month in premiums to cover the cost of abortion coverage.
In the states that permit or require abortion coverage, insurers have been able to send enrollees one monthly itemized premium bill charging, for example, $1 for abortion coverage and $99 for the rest of the health plan. Federal subsidies can be applied to lower premium costs for the rest of the plan, but individuals must cover the $1 abortion premium themselves.
Under the Trump proposal, ACA insurance plans that cover abortion would be required to issue two separate bills and ask enrollees for two separate payments. What happens to people who are confused by the new requirements and don't write a separate $1 check each month? We don't know for sure, but there are reasons to worry they might lose their entire health coverage. Moreover, we fear that insurance companies would find the new requirements too burdensome and decide to drop abortion coverage.
The current system isn't perfect. Coverage for abortion care shouldn't be treated differently from coverage for any other kind of routine health care. But until we have successfully repealed the Hyde Amendment, it’s a system that satisfies Congressional intent without unduly burdening individuals. By contrast, it’s clear that the administration’s goal is to create so much onerous red tape that insurance companies stop offering comprehensive plans with abortion altogether.
Public comments are due by midnight Eastern time on Tuesday, Jan. 8. We strongly encourage you to join us in submitting comments explaining why you oppose these new barriers to abortion coverage. You can submit comments electronically HERE.Note that the title of the proposed rule that includes the abortion coverage restrictions is this: Patient Protection and Affordable Care Act, Exchange Program Integrity NPRM, CMS-9922-P.
Last Thursday, Nancy Pelosi (D-CA)—arguably the most successful Speaker in recent history and the first woman to ever hold the post—reclaimed the gavel, swearing in the new Democratic House majority.
The new House’s first order of business was passing a bill to re-open those federal agencies that have been shut down since late last month. Most of the programs and agencies we cover, including Health and Human Services, were funded in last September’s year-long appropriations bill and have been relatively insulated. But the ongoing federal government shutdown has had significant implications for Native women and families who receive their health care through the Indian Health Service. As NPRreported, services that meet "immediate needs of the patients, medical staff, and medical facilities" are still open, but staffed by employees currently working without pay. And many preventive services funded through IHS remain shuttered. So far, Senate Republicans are refusing to pass a clean funding bill and it’s not clear how long the shutdown will continue.
The new House majority’s second order of business was to set the stage for a vote on January 9 to formally join in defense of the ACA against the threat posed by a federal judge’s ruling last month. Given the shocking scope of Judge Reed O’Connor’sdecision overturning the law – including all of its consumer protections, subsidies, Medicaid expansion and other provisions --we’ll be watching to see if any House Republicans feel pressured to support the ACA’s defense on appeal to the Fifth Circuit.
Meanwhile, the 17 Democratic attorneys general who have been defending the ACA in place of the Trump administration were joined last week by an 18th Attorney General. Colorado’s newly-elected AG Phil Weiser, who made it his his first official act. In two more states, Wisconsin and Maine, newly-elected Democratic AGs are looking for ways to withdraw from the GOP side of the lawsuit. In Maine, former Governor Paul LePage, a Republican, did not have the legal authority to join the lawsuit in the first place. In Wisconsin, former Republican Governor Scott Walker’s last act was to lock his state into the lawsuit and by signing legislation that would gut the powers of incoming Democrats.
Finally, the new House Democratic majority is likely to be more “ideologically and geographically cohesive” than the Democratic majority that controlled the House from 2007 to 2010, which could give progressives a bigger say in its priorities. House leadership has committed to holding hearings in the next few weeks on Medicare for All as part of a longer-term process on educating the public, working through complicated details, and setting the stage for the 2020 presidential election. Democrats were successful in passing the ACA, and Republicans unsuccessful in repealing it, in part because the former spent years using hearings to work through the legislative details that would ultimately become the ACA while the latter skipped the refinement process and sprung poorly drafted legislation on their members at the last minute.
In other positive health care news last week, Maine’s incoming Democratic Governor Janet Mills used her first executive order to finally move forward with Medicaid expansion, more than a year after voters passed expansion on referendum by an overwhelming margin.
ACA still in effect, so start using your new health coverage!
Get the most from your new ACA health coverage!
As we start 2019, the Affordable Care Act (ACA) remains the law! Over the weekend, the federal judge in Texas who ruled last month that the law should be struck down declared that the ACA will remain in effect as his decision is appealed to higher courts by 17 state Attorneys General. U.S. District Court Judge Reed O’Connor stayed the effect of his own ruling, writing that otherwise, "many everyday Americans would otherwise face great uncertainty during the pendency of appeal.
That means millions of women, LGBTQ people and families are starting 2019 with health insurance they purchased through healthcare.gov and state-based marketplaces during the 2018 ACA open enrollment period. If you’re one of them, here are six insider tips from the pros at Raising Women’s Voices on how to get your money’s worth from your insurance.
1. Breathe a sigh of relief! You have quality insurance that complies with the ACA’s high standards. That means you’re covered for pre-existing conditions, hospitalizations, maternity care, prescription drugs and all the basics you’d expect a health plan to cover!
2. Pay your monthly bill on time! It’s especially important to pay that first bill--it was due December 31--so that your coverage actually goes into effect. If you haven’t paid it yet, call your health insurance company right away to work it out.
3. Schedule a FREE check-up! You get preventive care at no additional charge to you. So, make that appointment now with your primary care provider and/or ob/gyn. A woman’s annual check-up is called a “Well-Woman Visit.” If you need to see two different providers (such as a primary care provider and an ob-gyn) to get all of the needed preventive care, it’s still covered 100%. If you have children, schedule their preventive check-ups, too.
4. Find doctors you trust. The key to getting the most value out of your health plan is finding doctors and other health care providers you trust who take your insurance. A good way to start is by calling your health plan for help. Tell the representative what is important to you in a doctor, such as office location, languages spoken, gender, hospital affiliation or office hours. If you are looking for an LGBTQ-friendly doctor, try searching the glma directory. You can also ask friends, family or colleagues for recommendations. If you try a new doctor and you do not like him or her, you do not have to go back. You are entitled to try someone different next time.
5. Get FREE birth control. While you are at your Well-Woman Visit, discuss your options with your doctor and make the choice that's best for you. All FDA-approved forms of birth control must be 100% paid for by your health plan. Some brands may not be covered by your particular health plan, so discuss it with your provider before she writes the prescription.
6. Take care of your mental health. The ACA requires health plans to cover mental health care the same way they cover physical health care. You will pay a deductible or co-payment. After that, your insurance will pay the rest, without limits on the number of visits or cost, as long as you see a mental health provider participating in your health plan.
Need more help getting started with your new health insurance? Raising Women’s Voices has created a website where you can learn much more. It’s called My Health, My Voice. There you can learn five important steps to getting started using your health plan, and understand the four types of costs you may pay to use your coverage (your monthly premium, co-pays, deductibles and co-insurance.) You can also download free copies of our publications: A Woman’s Step-by-Step Guide to Using Health Insurance and My Personal Health Journal.

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