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Watch out! Stealth campaign to give us Trumpcare, after all!

New Trump administration rules threaten our health care
Having failed to pass Trumpcare through Congress last year because of widespread public opposition, the Trump administration has been steadily working to quietly implement it through rule changes issued by the Executive Branch. Last week, the administration finalized rules for the individual and small business marketplaces that significantly weaken core consumer protections under the Affordable Care Act.
Using an annual rules update -- known as the Notice of Benefit and Payment Parameters (NBPP) -- as the vehicle, the administration announced sweeping changes to everything from the 10 essential health benefits (EHBs) that health plans must cover to how much insurance companies can charge in premiums. 
EHBs such as maternity care, prescription drug coverage, hospitalization and mental health care are guaranteed under the Affordable Care Act (ACA).  But under the new rules, the administration is granting states significant leeway to determine which services are actually covered under each broad category of benefits. It’s not hard to imagine, for example, a state approving a plan with maternity care that only covers a few prenatal visits and screenings. Even more troubling, states can shift coverage between categories, skimping on, say, mental health care, while increasing coverage for physicians’ visits. States will have significant freedom to design coverage requirements that help politically powerful groups at the expense of marginalized groups.
What can you do? Start talking to your state officials now to make sure they aren’t considering harmful changes to your state’s current EHB standards. States have until July 2, 2018, to change what is known as the “benchmark” plan for 2020. The ACA created guidelines for EHBs, but left the specific details up to each state. The benchmark plan is the plan each state designates as the standard for EHBs. So, it’s important to act quickly to get a seat at the table, and speak out to make sure the process is robust, transparentand open to public input. In future RWV newsletters, we will be sharing more ideas about how to oppose state actions weakening coverage requirements.
As the Center on Budget and Policy Priorities notes, the new Trump rule could have an impact on health benefits at large employers, too. Under the ACA, insurance companies must limit how much a patient can be expected to pay out-of-pocket for essential health benefits and insurers are prohibited from imposing annual or lifetime limits on those benefits. By weakening EHB standards, the rule could mean even employees at large firms could find themselves subject to new limits on coverage or higher out-of-pocket expenses.
The new rule also expands on last year’s efforts to sabotage the open enrollment period by slashing support for in-person navigators to help people enroll. States could establish a single navigator per state (up until now it has been at least two), permit navigators to be based outside of the state and eliminate rules intended to ensure that navigators are offering help to groups that may not be able to navigate the marketplace on their own due to language barriers, lack of internet access or other factors.
The rule also makes it easier for insurers to raise premiums. Insurers will be able to raise rates up to 15% (instead of the current 10%) without being reviewed by a state insurance regulator first.  Moreover, health plans won’t have to spend as much of the premiums they collect on actually providing care. By loosening the medical loss ratio (MLR) provision, the administration will give insurers much more flexibility under the rule to raise premiums and spend the increase on executive salaries and bonuses and other administrative expenses.
Meanwhile, comments close next Monday on another proposed rule to gut the ACA, this time to radically expand so-called short-term health plans into full-year “junk” plans that offer only barebones coverage and discriminate against people with pre-existing conditions.
Under current law, short-term health insurance plans intended to cover very short gaps in coverage don’t have to comply with the ACA’s consumer protections. But under Obama-era regulations, they are limited to just three months. They also never satisfied the individual mandate requirements. Under the Trump proposal, these short-term “junk” plans could last 364 days, and of course, the individual mandate has been repealed starting 2019.
Much like the Trumpcare proposals pushed by the GOP Congress last year, these plans would not be required to cover the EHBs. They could discriminate against people with pre-existing conditions, charge limitless out-of-pocket expenses and reinstate annual and lifetime coverage caps. Unlike ACA-compliant policies, these “junk” plans would also not be subject to the MLR provision and so not required to spend a minimum percentage of our premiums on actually providing health care.
Because these “junk” plans cover so little, they’d cost very little too, appealing to younger, healthier people who don’t expect to get sick, have an accident, or need much insurance throughout the year. That would make the market for comprehensive coverage older and sicker, driving up premiums for everyone who needs the quality coverage of ACA-compliant plans.
You can make your voice heard by commenting on the proposed short-term ruleHERE before 5:00 EST on Monday, April 23, and tweeting at the administration using the hashtags #junkplans #trumpcare.
Some states moving to protect health consumers from Trump sabotage
Our Newark-based regional coordinator, New Jersey Citizen Action (NJCA), has been working to help insulate New Jersey’s insurance market and consumers from GOP attempts to undermine the ACA. Last Thursday, the New Jersey legislature passed two bills that would help preserve access to affordable health insurance for New Jerseyans. These bills now await Governor Phil Murphy’s signature.
One of the bills, S1877, would establish a state-level individual health insurance mandate in New Jersey. The federal individual mandate, which was repealed as part of the GOP tax plan, was put in place to make sure younger and healthier people were part of the insurance risk pool. Health insurance only works when both healthy people and sick people pay health insurance premiums. Having people who need less health care in the risk pool helps to cover the cost of care for sicker people. This keeps premiums down for everyone and keeps the market stable. A state-level individual mandate would ensure that both healthy and sick people can get affordable health coverage in New Jersey.
The second bill, S1878, would allow for the creation of a reinsurance program in New Jersey. In a previous newsletter, we described our Maryland regional coordinator’s work successfully advocating for a similar bill, which has subsequently been signed by Maryland Governor Larry Hogan. Reinsurance programs are designed to help insurance companies offset the costs of more expensive medical claims, without resorting to raising premiums on everyone.
NJCA is encouraging New Jerseyans to urge Governor Murphy to sign these bills without delay to help shield New Jersey from unaffordable health care premium increases. 
This week is a good time to realize what the tax bill  is doing
As they’re working to protect the ACA at the state level, NJCA is also raising awareness throughout the state about the terrible impact the GOP tax law will have on the health and economic security of New Jersey women and families. They’re reminding New Jerseyans that in addition to repealing the individual mandate – which the CBO estimated will lead to 13 million more uninsured Americans and premium increases of about 10% – the tax bill passed by Congressional Republicans in December gives huge tax cuts to the wealthy and large corporations, and increases the national debt by trillions of dollars. Now, Republicans are looking to pay for those tax cuts with deep cuts to Medicare, Medicaid, Social Security, and other programs women and families depend on.
On tax day, NJCA rallied outside the district office of Congressman Tom MacArthur (R-NJ 3) – the only New Jersey Congressman to vote yes on the GOP’s tax bill – to demand that he work to #RepealTheTrumpTax.
Speaking at the rally, NJCA Health Care Program Director Maura Collinsgru told the crowd: “They revoked and are not enforcing the requirement that people who can afford insurance, maintain it, and because of that, there is an estimate that more than 300,000 New Jerseyans will not have coverage by 2025 unless the state of New Jersey acts. As our uninsured increase, so too will the premiums for every family in New Jersey, whether they get their coverage through an employer or they pay themselves. After we have cut our uninsured rate in half and slowed the growth of health care cost in the last five year to record lows, Tom MacArthur’s yes vote has meant we are reversing all the progress [we have made].”



Help raise awareness about Black maternal mortality!

Black Maternal Health Week starts tomorrow
Black women in the United States have among the highest rates of maternal mortality in the developed world.  Black women are three to four times more likely to die from pregnancy or childbirth-related causes than are white women. This week, we are joining the Black Mamas Matter Alliance in a campaign to raise awareness about this crisis and help support the development of solutions through community-driven policy advocacy and health systems change.

There are many ways that you can get involved! Join the Black Mamas Matter Alliance on social media with the official hastags #BMHW2018 #BlackMaternalHealthWeek. See their social media toolkit here.
Today (Tuesday) at 3PM EST there will be a pre-launch tweet chat with leading reproductive justice organizations to advocate for maternal rights and birth justice for Black women.
There will also be several information webinars that will amplify the issues:
  • Wednesday, April 11th at 12PM EST: Black Maternal Health Week launch webinar. Register here.
  • Thursday, April 12th at 12PM EST: "Best Practices in Black Mama Care Work” webinar. Register here.
  • Monday, April 16th at 12PM EST: BMHW Webinar highlighting African Immigrant women's advocacy in maternity care. Register here.
If you live in California, Florida, Georgia, Maryland, Massachusetts, New Jersey, Ohio, or Texas you can also go here to find local events in your area where you can get involved. The week will wrap up on Tuesday, April 17th at 3PM EST with the BMHW finale tweet chat. 
Feminist Women’s Health Center, RWV’s regional coordinator in Atlanta,  will be tabling with the Black Mamas Matter Alliance, Center for Black Women’s Wellness and other Black woman-led organizations, maternal justice advocates, and birth workers for a Film Screening and Community Discussion: Raising Awareness to Advance Black Maternal Health, Rights, and Justice on Thursday, April 12, 2018 at 6pm at the Auburn Avenue Research Library (101 Auburn Avenue NE, Atlanta, GA 30303). There will be a community conversation and advocacy connection as they showcase Death By Delivery, a documentary about the staggering rate of maternal mortality for black women.
FWHC is also partnering with SPARK Reproductive Justice NOW!, the National Institute for Reproductive Health and the State Innovation Exchange to develop a multi-year proactive policy strategy, grounded in the reproductive justice framework, to demonstrate the connections between the harms inflicted on women by abortion restrictions and  the deceptive practices of crisis pregnancy centers, and the high rates of maternal mortality and morbidity in Georgia.
Racial disparities in maternal mortality and morbidity persist among women of all income and educational levels.  Many Black women report chronic stress associated with the constant discrimination and obstacles they have faced because of being both Black and a woman in America. Studies have shown that Black college-educated mothers are more likely to suffer severe complications of pregnancy or childbirth than white women with less than a full high school education.
Even highly-paid celebrities and athletes with good health insurance can be affected. Tennis star Serena Williams suffered a pulmonary embolism that nearly killed her a day after giving birth last September. She told a Vogue magazine interviewer that she had to fight to get the emergency care she needed from health providers who doubted what she was telling them about her symptoms, including shortness of breath. Williams said she persisted because she knew that she had a history of such embolisms.
“Racism is creating these inequities,” explained Dr. Joia Crear-Perry, an obstetrician-gynecologist who is a member of the steering committee of the Black Mamas Matter Alliance and Community Catalyst board member.  Speaking at the New York Maternal Mortality Summit, she said that “When you see inequities in health, don’t think about individuals. Think about systems, because systems create inequities.”  She is founder of the National Birth Equity Collaborative.
The Black Mamas Matter Alliance grew out of a collaboration between the Center for Reproductive Rights and the SisterSong Women of Color Reproductive Justice Collective. The Alliance is now led by a steering committee that includes Kwajelyn Jackson of the Feminist Women’s Health Center, RWV’s regional coordinator in Atlanta.
Another of Raising Women’s Voices’ regional coordinators -- The Afiya Center in Dallas, TX -- is active in the Black Mamas Matter Alliance. The Afiya Center joined allies to successfully advocate for intensive review of all maternal deaths in Texas by a state board. “It’s systemic,” Afiya Center Executive Director Marsha Jones said of the maternal mortality crisis at last month’s Time to Show up for Black Women summit, according to KUT Austin. “It’s not going to be fixed black woman to black women or black man to black man. It’s not going to be fixed that way. We have to literally deconstruct the system that’s been put up.”
The Afiya Center recently released a call to action in order to accurately represent how Black women in Texas are affected during pregnancy. They are gathering stories from Texas women who have been pregnant and had any health issues during their pregnancy. Some of the health issues include preeclampsia, fibroids, preterm birth, heart disease, mental illness, postpartum hemorrhaging, and a host of others. Speaking at the Time to Show up for Black Women Summit, Dr. Joia Crear-Perry encouraged other local communities in Texas to mobilize around these issues. “You have motivated individuals and motivated systems here who want to see improvement and want to see work happen,” she said to the Austin audience. “So it’s now just building on that momentum and getting it going,” KUT Austin reported. For more information on the Afiya Center’s work in Texas, please email
What can be done to help address this health disparity? The Black Mamas Matter Alliance has prioritized driving research, advocacy, clinical improvements, empowerment of Black women, and cultural change: “We envision a world where Black mamas have the rights, respect and resources to thrive before, during and after pregnancy.”
Let’s support the Black Mamas Matter Alliance in bringing national attention to this pervasive health crisis so that more mamas can get the care they need to make it home safely with their babies!

We’re working in the states to protect our health care!

There’s a lot to do at the state and local levels!

With Congress on recess following the passage of an omnibus spending package (which we reported on last week), we’re turning our attention to what’s been happening in the states. Our regional coordinators across the country have been busy engaging in state and local advocacy/policy work to protect the health care of women and LGBTQ people. Here’s some of what they’ve been up to!

Massachusetts protects patient confidentiality

Earlier this week, staffers and members of NARAL Massachusetts, our Boston-based regional coordinator, celebrated their third legislative win of the session with the approval of the Protect Access to Confidential Healthcare (PATCH) Act.

Currently, insurers automatically send Explanation of Benefits (EOB) forms listing the provision of potentially sensitive health care services, such as reproductive health care, to the primary subscriber on a health insurance plan. This process compromises the privacy of Massachusetts residents receiving health insurance as dependents on the plan of a parent or spouse. It particularly affects young women, members of the LGBTQ community, domestic violence survivors and people with substance abuse or mental health issues.

 H.2960S.2296 addresses this problem by ensuring that EOBs are sent directly to each patient and that each patient can choose to receive her EOB at an alternate address or electronically. It requires that EOBs include only generic information when sensitive care is received, and guarantees that EOBs are not sent for preventive health services with no cost sharing (such as an STI test or a domestic violence counseling session).

SisterReach raises health issues during Black Folks Day on the Hill

SisterReach, our Tennessee-based regional coordinator, and their new policy initiative, the Deep South Regional Roundtable, held their 2nd annual Black Folks Day on the Hill. Deep South partners, community members and allies statewide went to their state capitols in Tennessee and Mississippi, speaking with key legislators about issues, including health, which affect Black community members in both states.

Some of those issues include proposals to introduce harmful work requirements for Medicaid enrollees, abortion rights and the rights of pregnant women. During the TN hill visit, participants made a presentation to the Shelby County (Memphis) delegation about the issues Memphians face and offered the coalition as a resource to legislators. Black Folks Day on the Hill 2018 was a success, and the partnership looks forward to bigger and better hill actions to come!  The photo shows SisterReach CEO & Founder Cherisse Scott, staff and volunteers posing with State Representative G.A. Hardaway Sr. during Black Folks on the Hill Day in TN.

Making health care more affordable in Maryland

With only a few days left in their state legislative session, members of Consumer Health First, our Maryland-based regional coordinator, are celebrating the passage of a proposed policy that will help protect access to coverage and care for Marylanders. HB1795, which is awaiting Governor Larry Hogan’s signature, will help stabilize Maryland’s individual insurance market by allowing the state to take steps to create what’s called a “reinsurance program.”

Reinsurance programs -- which are almost like insurance for insurance companies – are designed to offset the costs that health plans can incur if they enroll individuals who use a lot of expensive medical care. Without the reinsurance payments, health plans would raise their premiums for all enrollees to cover medical expenses for the higher-cost people.  With the reinsurance payments, health plans would stay affordable for Marylanders who are purchasing them through the individual market.

Where would the money for the reinsurance program come from? HB1795 would allow the state to apply for what’s called a 1332 waiver to take advantage of federal dollars and state funding in 2019. See Consumer Health First’s testimony in support of the proposal here. Consumer Health First is closely watching HB1792/SB387, which would establish the state funding sources for a reinsurance program. That bill also charges the Maryland Health Insurance Coverage Protection Commission with studying a number of critical areas that can affect the cost of health insurance. These include: creating a state-level individual mandate to have health insurance (to replace the federal mandate that Congress and the President eliminated in the tax bill); merging the small group and individual health insurance markets; the use of subsidies to lower costs and a Medicaid buy-in option.

"We've worked tirelessly since the passage of the Affordable Care Act to bring the voice of the over 200,000 individuals who depend on the individual market for their health care coverage to the Insurance Commissioner during the rate review process," said Beth Sammis, President, Consumer Health First. "The Maryland Insurance Administration staff during a legislative hearing acknowledged we hold their feet to the fire. We will continue our advocacy to hold all policymakers’ feet to the fire until the individual market is stabilized and coverage affordable."

Illinois health care advocates say: Do No Harm!

As part of their advocacy work in opposition to state-based work requirements for Medicaid, RWV regional coordinator EverThrive Illinois and Protect Our Care Illinois, along with 100 partner organizations, sent a letter to Governor Bruce Rauner, a Republican, urging him to oppose adding work requirements to Illinois’ Medicaid program. They outlined the ways in which work requirements would create barriers to health care for Illinois residents, strip people of health benefits, and cost the State of Illinois billions of federal dollars with no benefit for the state. Read the letter in full here.

Meanwhile, EverThrive Illinois and their Protect Our Care Illinois colleagues have been building support for the “Do No Harm Healthcare Act.” This proposed policy, which has been approved in committee, would require the legislature to approve any requests by the Governor to the federal government for waivers that would reduce or restrict health insurance coverage under the Affordable Care Act (ACA) plans, State Employee Group Health Insurance or Medicaid.

This provision would apply, for example, to harmful Medicaid waivers proposals, like those recently approved by the federal government for Kentucky and Indiana, which would impose work requirements on Medicaid recipients. The proposed policy would help ensure that any attempt to restrict access to health care is transparent and open to public debate. For more details on HB 4165 HA1, see Protect Our Care Illinois’ fact sheet.

Trans- and queer-led Brown and Black coalition launches LGBTQ+ Justice Week
Trans Queer Pueblo, our Phoenix-based regional coordinator, and other community groups are taking to the streets with rituals, drag performance, celebration and protests for LGBTQ+ Justice Week.  LGBTQ+ communities of color will bring the Pride celebration to the institutions that detain, incarcerate, deport and kill LGBTQ+ people of color.
At Monday’s Vigil for Liberation event, community members built an altar and performed drag in protest (pictured left) at Eloy Detention Center, the nation’s deadliest detention facility. The protest lifted up deaths in detention due to bad or no medical care and the trauma of trans detainees, such as being caged with people of the wrong gender and being subject to constant harassment, abuse and often rape.  
At a Drag Town Hall, community members invited Phoenix mayoral candidates to participate in an open forum about how to make Phoenix safe for LGBTQ people of color. Community groups discussed the need to fund trans-inclusive women's health clinics and rape crisis centers. The conversation continued with dialogue on economic opportunity as a health issue and the lack of job opportunities for LGBTQ+ people of color due to document status, poverty, racism and transphobia.
WV FREE celebrates ACA anniversary

WV FREE, our Charleston-based regional coordinator, participated in a press event at the state Capitol to celebrate the ACA’s 8thanniversary. At the event, health care advocates highlighted the positive impact the ACA has had on West Virginians, including its role in reducing the uninsured rate among adults from 29 percent to 9 percent. These powerful statistics were complemented by the stories that individual consumers shared about the real life impact the ACA has had on their families. For example, Parkersburg resident Janice Hill talked about her daughter’s struggle with cancer and the life-saving coverage the ACA has provided for her.



Why were we glad to be left out?

New federal spending bill mostly omits anti-women provisions
After six months of stop-gap spending bills and two government shutdowns, Congress passed an omnibus spending package late last week to fund the government through the rest of the 2018 fiscal year. Despite a last minute Fox News-inspired veto threat, Donald Trump signed the package into law five hours later, averting a third shutdown just hours before the deadline.
The bill was perhaps most notable for what it did notinclude on women’s health and other progressive priorities, with some of our biggest victories coming from blocking GOP attempts to add dangerous new anti-women policy language.
As we noted earlier this month, conservatives were pushing hard for language in the omnibus to make up for their defeats last year on Planned Parenthood. The omnibus is likely one of the last big, must-pass bills Congress will take up before the election, and opponents of abortion access saw it as their last chance to “defund” Planned Parenthood by blocking the popular health provider from receiving any federal funding, whether through reimbursement for serving patients insured through Medicaid or through Title X federal family planning grants. In the end, the bill didn’t include any attacks on Planned Parenthood or other abortion providers.
Similarly, Republicans had sought to codify into law the Trump administration’s proposed regulatory attacks on reproductive and LGBTQ health care. As we noted last week, the Trump administration has proposed a rule that would make it easier for doctors, nurses, pharmacists, hospitals, clinics and insurance companies to deny us care, based on their religious, moral or personal beliefs.  (See more on this topic below.)  An attempt to include religious refusal language similar to the proposed Trump rule into the omnibus bill provision was dropped, as was a proposed ban on fetal tissue research. 
Likewise, the bill maintained level funding  for the Title X family planning program and for the Teen Pregnancy Prevention program, but didn’t make any policy changes -- neither codifying into law the Trump administration’s proposed attacks on the two programs,nor protecting the programs from those attacks.
This still leaves these priorities at the mercy of a hostile anti-science, anti-woman, and anti-LGBTQ administration, but without the same force of law and without setting dangerous new precedents. History has shown that once these kinds of policy riders are added to spending bills, they are notoriously difficult to remove—as evidenced by the four decade-long fight to strip out Hyde amendment language blocking low-income women’s access to abortion care, if federal funds are used.
Finally, the bill did not include any funding to shore up Affordable Care Act (ACA) health insurance  marketplaces that have been rocked by GOP sabotageWe opposed several provisions in the Republican-only package released by Senators Lamar Alexander (TN) and Susan Collins (ME) that would have increased costs for moderate-income enrollees and created a de facto ban on private insurance coverage of abortion under the ACA.
What did the spending bill include?
 The bill included critical increases in funding for the Department of Health and Human Services (HHS)—$10 billion over last year—with new funding for substance use disorders and mental health. The National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and community health centers also won increases, as did a number of other intersectional priorities related to women’s health, such as low-income housing.
Unfortunately, the bill also includes more funding for several of Mike Pence’s pet projects at HHS, including abstinence-only education under the rebranded title of “Sexual Risk Avoidance Education.”
The package also modestly improves the ability of the CDC to conduct research related to gun violence—long blocked by Republicans—by clarifying through accompanying report language that nothing in the bill prohibits the CDC from doing so. Without dedicated funding for gun research, it’s unclear how much of a difference the bill will make. But symbolically, it’s the first small step toward recognizing gun violence as a public health issue that Congress has made in a generation, with ramifications for women’s health. On average, a woman in the U.S .is fatally shot by her current or former intimate partner every 16 hours. The bill also includes language improving the National Instant Criminal Background Check System (NICS) but does not include language gutting state regulation of concealed carry permits. For years, gun hardliners had been refusing to pass the bipartisan Fix NICS legislation unless it was paired with pro-gun legislation; their failure in the omnibus suggests that the tide may be turning on Congress’s ability to take up sensible gun reforms.
On lingering questions around immigration, public health and the Dreamers, the bill represented a stalemate. Democrats had hoped to enact a permanent pathway to citizenship for those immigrants brought to the US as children but the White House offered only a temporary reprieve, no better than what several federal courts have already granted the Dreamers through litigation. Congressional negotiators rejected Trump administration requests for detention beds, an attack on “sanctuary cities” and border wall funding—providing instead a much smaller pot of money to repair and replace existing fencing and explicitly prohibiting the use of funds for concrete structures.
We raised our voices to oppose the Trump religious refusal rule!
On Tuesday, Raising Women’s Voices submitted comments calling for the Trump administration to withdraw its proposed rule to expand the ability of health providers to deny care based on religious, moral or personal objections. We pointed out the harm the rule would cause for groups that already face obstacles in obtaining care – women and LGBTQ people, especially those of us who are low-income, immigrants, people of color, people with disabilities, and transgender or gender non-conforming people.  You can find our comments here.
We helped generate additional organizational and individual comments on the proposed rule through a social media campaign, #DontDenyUsCare, that cited actual instances in which women and LGBTQ people have already suffered care denials, even without the rule.  On Monday, we co-hosted with Community Catalyst a Twitter storm in which more than 30 organizations participated, including Lambda Legal, the National Women’s Law Center, the National Family Planning and Reproductive Health Association (NFPHRA), the National Center for Lesbian Rights, Moms Rising, SisterSong and the National Asian Pacific American Women’s Forum. 
Eighteen of our RWV regional coordinators participated in the Twitter storm and/or submitted written comments to HHS: The Afiya Center, California Latinas for Reproductive Justice (CLRJ), COLOR, EverThrive Illinois, Indiana Religious Coalition for Reproductive Justice, Kentucky Health Justice Network, Lesbian Health Initiative, Maine Consumers for Affordable Health Care, Montana Women Vote, NARAL Minnesota, New Mexico Religious Coalition for Reproductive Choice, New Voices Pittsburgh, Northwest Health Law Advocates, Planned Parenthood of Southern New England, Oregon Foundation for Reproductive Health, SisterReach, Wisconsin Alliance for Women’s Health, and WV Free. 

Also on Tuesday, National Women’s Health Network Health Policy Intern Maddy McKeague (to the right of the speaker in the photo) represented Raising Women’s Voices at a press conference outside HHS headquarters, during which a coalition of women’s health and LGBTQ health organizations announced they had gathered and were about to submit 200,000 comments in opposition to the rule. 



Trump rule would make it easier for providers to deny us care!

Here’s your chance to speak out against the harmful Trump rule!

The Trump administration wants to make it easier for doctors, nurses, pharmacists, hospitals, clinics and insurance companies to deny us care, based on their religious, moral or personal beliefs. We must speak out against this proposed rule that would especially harm women and LGBTQ people.

What can you do? Go here for suggested talking points and a direct link to the Health and Human Services Department page where you can submit your personal or organizational comments opposing this destructive rule. The deadline to submit comments is Tuesday, March 27, so we all must act quickly!

You can also join a #DontDenyUsCare Twitter storm on Monday, March 26, from 1 to 2 p.m. Eastern that will be co-sponsored by Raising Women’s Voices and Community Catalyst to coincide with the start of LGBTQ Health Awareness Week. The goal will be to let more LGBTQ people know about the threat posed by this proposed rule and encourage more people to submit personal comments opposing it. Go here for social media “badges” we have created and suggested posting text you can use.

How do we know what the consequences of the proposed rule would be? Sadly, too many women and LGBTQ people have already suffered the kinds of health care denials that would get worse under Trump’s rule. We know a lesbian couple in California were denied infertility services by a fundamentalist Christian physician who didn’t approve of same-sex couples having children.  We also know that a transgender teen in Georgia was denied medically-prescribed testosterone injections by an objecting clinic provider who commented, “What kind of a doctor would do this to a girl? And we know a transgender man was denied a hysterectomy for gender transition purposes by a hospital in New Jersey.

How would Trump’s proposed rule make things worse? Existing harmful religious refusal policies apply primarily to abortion and sterilization services.The proposed rule would allow health providers to refuse to provide “any lawful health service or activity based on religious beliefs or moral convictions.” This expansive interpretation could lead to provider denials based on personal beliefs that are biased and discriminatory, such as objections to providing care to people who are transgender or in same-sex relationships, or are not based in scientific evidence, such as refusals to provide emergency contraception out of the unfounded belief that it can cause abortion.

The rule would protect refusals by anyone who would be “assisting in the performance of” a health care service to which they object, not just clinicians. An expansive interpretation of “assist in the performance of” thus could conceivably allow an ambulance driver to refuse to transport a patient to the hospital for care he/she finds objectionable. It could mean a hospital admissions clerk could refuse to check a patient in for treatment the clerk finds objectionable or a technician could refuse to prepare surgical instruments for use in a service.

On an institutional level, the right to refuse to “assist in the performance of” a service could mean religiously-affiliated hospital or clinic could deny care, and then also refuse to provide a patient with a referral or transfer to a willing provider of the needed service. Indeed, the proposed rule’s definition of “referral” goes beyond any common understanding of the term, allowing refusals to provide any information, including location of an alternative provider, that could help people get care they need.

The rule does not address how a patient’s needs would be met in an emergency situation. There have been reported instances in which pregnant women suffering medical emergencies – including premature rupture of membranes (PPROM) and ectopic pregnancies-- have gone to hospital emergency departments and been denied prompt, medically-indicated care because of institutional religious restrictions.  This lack of protections for patients is especially problematic in regions of the country, such as rural areas, where there may be no other nearby hospital to which a patient could easily go without assistance and careful medical monitoring enroute.

The proposed rule includes no exceptions for emergency situations and makes no reference to the Emergency Medical Treatment and Active Labor Act (“EMTALA”), which requires hospitals that have a Medicare provider agreement and an emergency department to provide to anyone requesting treatment an appropriate medical screening to determine whether an emergency medical condition exists, and to stabilize the condition or if medically warranted to transfer the person to another facility. Under EMTALA every hospital is required to comply – even those that are religiously affiliated. Because the proposed rule does not mention EMTALA or contain an explicit exception for emergencies, some institutions may believe they are not required to comply with EMTALA’s requirements. This could result in patients in emergency circumstances not receiving necessary care.

Health care institutions would be required to notify employees that they have the right to refuse to provide care, but would not be required to notify patients about the types of care they will not be able to receive at that hospital, pharmacy, clinic or doctor’s office. The rule sets forth extensive requirements for health care institutions, such as hospitals, to notify employees about their refusal rights, including how to file a discrimination complaint with OCR. The rule requires posting of such notices on the employer’s website and in prescribed physical locations within the employer’s building.

By contrast, the rule contains no requirement that patients be notified of institutional restrictions on provision of certain types of care. Such notification is essential because research has found that patients often are unaware of service restrictions at religiously-sponsored health care institutions.

What should we say in our comments to Department of Health and Human Services (HHS)? You can find a template letter of comment here that you can tailor to your own organization. But here’s the bottom line: The proposed pule will allow religious beliefs to dictate patient care by unlawfully expanding already harmful refusals of care. The proposed rule is discriminatory, violates multiple federal statutes and the Constitution, fosters confusion and harms patients contrary to the Department’s stated mission.  For all of these reasons, we call on the Department to withdraw the proposed rule in its entirety.

Meanwhile, Congress set to vote on spending bill

Congress is set to vote this week (maybe even today!) on a 2,000+ page omnibus spending bill to fund the government. Current stopgap funding expires on Friday. Based on early reports of what made it into the bill (e.g. increases for health research and other key priorities) and what didn't (attacks on Planned Parenthood) we're cautiously supportive. But with the text released to the public only hours before Congress begins voting, we're still going through the bill to see what it will mean for all of our women's health priorities.

While it’s not included in the omnibus bill, the Senate could also take a vote tomorrow on package to stabilize ACA marketplaces. As we noted last week, the package is controversial because it could raise out-of-pocket costs for moderate-income enrollees andwould make it all but impossible to get abortion coverage through the individual market. Look for our recap of congressional action next week.