Recent Articles
This area does not yet contain any content.
The journal that this archive was targeting has been deleted. Please update your configuration.
Navigation

RWVoices

Tuesday
Dec112018

It’s the last week to enroll in ACA health coverage!

 It’s Women’s Week of Action for Open Enrollment!



It’s the last week of Open Enrollment! In most states (see below for a few exceptions), the last day to sign up for 2019 health coverage is this Saturday, December 15
. Still uninsured? Go to healthcare.gov to start shopping for a plan today, or go to localhelp.healthcare.gov to find free enrollment assistance.

So far, enrollment numbers are lower than what we have seen at this time in previous years. That’s largely due to Trump administration’s policies that slashed advertising for healthcare.gov, decreased funding to navigators that do outreach and enrollment work, and shortened the enrollment period to just six weeks. The start of open enrollment on November 1 was also overshadowed by the mid-term elections the following week.  

As a result of all these factors, a recent Kaiser Family Foundation tracking poll found that 3 out of 4 people who are uninsured or buy their own insurance don’t know the deadline to enroll in Marketplace insurance is December 15. Less than a third (31 percent) say they have heard or seen any information about how to get health insurance under the Affordable Care Act (ACA).

That’s why Raising Women’s Voices is leading a Women’s Week of Action, starting today, to spread the word about the deadline for enrollment.  Today, (Tuesday, December 11) we will be hosting a Twitter Chat at 3 pm ET/2 pm CT/1 pm MT/12 pm PT.  We will be joined by our partners at In Our Own Voice, National Institute for Reproductive Health (NIRH), Planned Parenthood, Community Catalyst, New Jersey Citizen Action, Power to Decide, Feeding America, Feminist Majority, American Association on Health and Disability, National Partnership for Women and Families, Black Women’s Health Imperative, NFPRHA and Young Invincibles. We’ll be discuss the importance of health coverage for women and our families,  how good coverage can help reduce health disparities and how to avoid those “junk” health plans that are cheaper, but don’t cover maternity care or pre-existing conditions.  Join us and include the hashtags #HerHealth, #GetCovered, and #EnrollByDec15 in your answers!

For this final week, we’ve created social media badges that you can use to remind people to sign up for health coverage while they still can! We have badges emphasizing the upcoming deadline (pictured), which you can find here. We also have that badges that count down the final days of Open Enrollment, which you can find in both English and Spanish.

There are a few exceptions to the December 15 deadline. It’s important to note that in a few states  and the District of Columbia that operate their own ACA health insurance marketplaces,  the deadline for Open Enrollment has been extended beyond Dec. 15:

  • Minnesota – January 13, 2019
  • California  and Colorado – January 15, 2019
  • Massachusetts – January 23, 2019
  • D.C., New York and Rhode Island – January 31, 2019

Let’s give these states a round of applause for doing the right thing, and giving busy people more time to enroll!

Tuesday
Nov202018

What are we thankful for this year?

We’re thankful for the ACA, and your work defending it!

The Affordable Care Act (ACA) is still the law of the land, and is likely to remain so with the balance of political power in the House of Representatives shifting to pro-ACA forces for 2019.  Since the passage of the ACA in 2010, the number of uninsured people in our country has dropped by more than 20 million. We are so grateful to all of you who have helped defend this law, which has been game changing for women, LGBTQ people and our families!

For the sixth year, Open Enrollment through healthcare.gov and state marketplaces is in full swing. This week, Raising Women’s Voices and many of our Regional Coordinators are getting the word out to those people most likely to be still uninsured -- members of the African-American, Latinx, LGBTQ and immigrant communities, who remain more likely to lack coverage. We’ll be using seasonally relevant social media messages like the one shown above.

We know many people will be spending time with their families during the Thanksgiving holiday. It’s a great opportunity to remind them that getting covered can help you stay healthy for the ones you love. It can also help you avoid bringing financial stress on the whole family if the unexpected happens.
In addition to spending time with our nearest and dearest humans, many of us will be spending time with our nearest and dearest screens! We’ll be posting graphics like those shown below starting the day after Thanksgiving to remind people to visit healthcare.gov and cuidadodesalud.gov for the best deals on health insurance.  Please follow RWV on FaceBook, Twitter and Instagram and help spread the word!

 

 

Get the facts about immigrants enrolling in health coverage

The Trump administration’s proposed changes to the “public charge” rule have frightened some immigrants out of applying for health insurance -- or even using the health coverage they already have. With Open Enrollment Period 6 now well underway, Raising Women’s Voices has created new fact sheets in English and Spanish that give concerned immigrants the information they need to decide whether to apply for health coverage.

Here are some of the important facts immigrants need to know:

1. If you are already a naturalized citizen, or have your green card, you do not have to worry about any risk from enrolling in health insurance.The same is true for immigrants who have protected status, such as refugees, asylees and people who have survived domestic abuse and other serious crimes.

2. Even if you are not in one of the categories described above, you can still apply now for any health insurance for which you may be eligible. Getting health insurance now for you or your family members can help you stay healthy. The proposed change in immigration rules is not in effect now, and it cannot even become policy until many months from now. The rule will not be retroactive to now, so it is ok for you to apply for coverage now if you are eligible. 

3. Only two types of health insurance coverage would be affected, if and when the rule goes into effect next year: regular (non-emergency) Medicaid and low-income subsidies for Medicare Part D coverage. That means you can receive federal subsidies for purchase of a marketplace health plan through healthcare.gov without worrying. Emergency Medicaid, which pays for medical costs if you have a sudden, life-threatening emergency, and Children’s Health Insurance, known as CHIP, are NOT included in the proposed rule.

4. If you are considering applying for regular (non-Emergency) Medicaid coverage, be aware that the proposed rule would only consider Medicaid received for more than 12 months in a three year period in a public charge determination. So, even if the rule does go into effect, receiving Medicaid for less than 12 months in a three year period will NOT count against you.

What is “public charge”? The term “public charge” is used by U.S. immigration officials to describe anyone who relies on the government for subsistence. If someone is determined to be a public charge, they can be denied a visa or a green card. Presently, the only two categories of benefits that are considered in determining whether someone is a public charge are cash assistance (e.g., SSI or TANF) or government-funded long-term institutional care.

The Trump administration’s proposed changes, released on October 10, would significantly expand the types of government benefits that could be considered in a public charge determination, including two forms of health insurance: regular Medicaid and low-income subsidies for Medicare Part D. Also included would be SNAP (food stamps) and housing assistance.  

The new rule is clearly designed to open doors for more highly educated immigrants and shut out those seeking opportunity. It would give preference to those who speak English and earn more money and penalize those with disabilities or lower income. If you would like to submit a public comment on the proposed rule, please start here. You have until December 10.

Wednesday
Nov142018

Election results looking even better!

More Dems win, but racist remarks unacceptable

One week after the election, the political landscape looks even better for supporters of women’s health and the Affordable Care Act than it did just a few days ago. In the U.S. House of Representatives, ACA supporters have gained additional seats in late-breaking West Coast races, while the election of two Democratic women to Senate seats previously held by Republican men in Nevada and Arizona has shrunk Mitch McConnell’s majority for 2019. Now Senate Republicans can—at most—only net a gain of 2 seats, and only if they win both outstanding races.

In Florida, a recount is underway. In Mississippi, incumbent Republican Cindy Hyde-Smith (appointed to Thad Cochran’sseat in April) is locked in a special election run-off with former Congressman Mike Espy (D-MS) scheduled November 27. This week, Hyde-Smith, a white woman running against a Black man, was videotaped joking about lynching. Our regional coordinator in Mississippi, the Mississippi Black Women’s Roundtable, issued this statement:

"In a state well known for its shameful history related to the lynching of African Americans, Hyde-Smith has not only shown a repulsive spirit of divisiveness and extremely poor judgment, but she has also shown she is unfit to represent the people of Mississippi. Cindy Hyde-Smith must be held accountable for using words that have cut deep within the African-American community and stirred up an unyielding pain. Therefore, we call for her resignation. Our network of black women needs a leader that will stand up for their families and communities regardless of their skin color. We condemn her unacceptable language and encourage others to speak out as well.”

Instead of apologizing for her remarks, the Mississippi GOP doubled down. In his defense of Hyde-Smith, Governor Phil Bryant (R-MS) attacked Black women, labeling legal abortion a form of “genocide.” Mississippi Reproductive Freedom Fund Executive Director Laurie Bertram-Roberts noted the grotesqueness of his charge: “It is absurd that a governor in a state that has one of the worst maternal and infant mortality rates in the country, where it is one of the most dangerous places for women to give birth—black women to give birth, specifically—would talk about abortion being black genocide.”

RWV at the APHA Conference

 
This week, some of the Raising Women’s Voices staff and a few of our RWV regional coordinators are in San Diego attending the 2018 American Public Health Association Annual Meeting and Expo, “Creating the Healthiest Nation: Health Equity Now.”
 
Two of RWV’s cofounders, Byllye Avery and Cindy Pearson, were joined by RWV Progressive States Advocacy and Policy Manager, Ann Danforth, and Ena Suseth Valladares, Research Director for RWV’s Los Angeles-based RC, California Latinas for Reproductive Justice, for RWV’s panel entitled “2019 and Beyond: Opportunities and Challenges for Women’s Health.” RWV’s presentation explored the substantial – though incomplete – progress we’ve made advancing women’s health under the ACA, and looked at the threats, setbacks, and barriers we withstood in 2017 and 2018, as well as the challenges and opportunities ahead, with a particular focus on women of color.

RWV cofounder Cindy Pearson began by discussing the current state of Medicaid expansion under the ACA. She explained the significance of Medicaid expansion, particularly in undoing the legacy of institutionalized racism associated with original Medicaid. When it was created in 1965, the Medicaid program, unlike Medicare, allowed states to set their own eligibility limits, a power that was used by certain states to reinforce Jim Crow era policies. By expanding Medicaid, the ACA sought to expand coverage to individuals who had previously been excluded from coverage. Even though a Supreme Court decision made the ACA’s Medicaid expansion optional, a number of states adopted Medicaid expansion, and even more continue to do so thanks in large part to the hard work of grassroots activists like our RCs in states including LA, and ME.  
 
Ann Danforth, RWV Progressive States Advocacy and Policy Manager, discussed the state-level opportunities to protect advances for women’s health and LGBTQ health, given ongoing federal threats. She discussed the work being done by RWV RCs to establish state-level reproductive health protections, prohibitions against gender rating and discriminating against women with pre-existing conditions, marketplace stabilization measures, protections for women against “junk” insurance plans that don’t cover important services like maternity care, and protections for transgender people in health care.
 
Ena Suseth Valladares, Research Director for RWV’s Los Angeles-based RC, California Latinas for Reproductive Justice, spoke about the barriers that exist for California Latinas in achieving true economic and reproductive justice. Despite significant strides in a numbers of social indicators – including better access to health care services and better health outcomes – Latinas as a group continue to have high uninsured rates; in large part because their jobs do not offer health insurance, they do not qualify for the benefits offered, or they cannot afford the plans that are offered. As part of their work to achieve reproductive and economic justice for Claifornia Latinas, CLRJ and their colleagues have pushed for a number of anti-poverty measures within the past couple of years, including the Earned Income Tax Credit and Paid Family Leave. Despite the legislative progress, there is much more that can be done for Latinas at the state level, such as expanding existing housing vouchers, and creating rent control policies and tenant protections. The recent public charge rule provides an additional barrier to California Latinas seeking health care services.
 
RWV’s cofounder Byllye Avery closed out the panel by discussing how we can make progress in a divided nation by talking to people “on the other side,” who are opposed to health care coverage, reproductive justice, LGBTQ and immigrant rights. The most important thing to do, Byllye said, is to “just really listen to what they’re saying, and what they’re not saying.”  She highlighted the work of two RWV women of color-led RCs, SisterReach and the Afiya Center, talking to “the other side.” Both groups are connecting reproductive justice advocates with the African American reilgious community in Tennessee an Texas through summits, shared projects, and bible study.
 
During the discussion portion of the panel, panelists and the audience talked about the role stories play in changing the hearts and minds of people on “the other side,” including family members, but also policy makers. When asked how we can balance the inclusion of compelling stories with the data and research needed to back those stories up, Ena’s advice was to use stories as “the main course,” and use data as “the seasoning.”

One of RWV’s New Orleans-based regional coordinators, Women With a Vision, was also active at the Conference. Catherine Haywood, WWAV’s Community Health Promoter, presented to a packed room as part of a panel on promoting Community Health Workers as change agents in reducing health disparities or impacting social determinants of health. Catherine spoke about WWAV use of CHWs and community champions to promote the activities of and legitimize the message of Movin’ for LIFE (M4L) – a program to increase healthy living in two low-income, primarily Black neighborhoods in New Orleans, LA. Two part-time CHWs were trained in M4L activities and successfully recruited 88 champions, who extended the work of the CHWs by promoting M4L activities, including walking groups, exercise, dance and cooking classes. “CHWs are a great asset to any program because people who sit behind desks can’t truly know the communities in the way CHWs can,” Catherine told the audience.  
 
APHA’s closing general session: Dying too Soon: A Look at Women’s Health, will feature Linda Blount, President and CEO of the Black Women’s Health Imperative – one of RWV’s co-coordinating organizations. The panel will explore issues around premature death in women in America throughout the life span, including through cardiovascular disease, deaths during childbirth, and domestic violence. Linda’s portion of the presentation, entitled “Black is Not a Risk Factor: Racism and Gender Bias in Maternal Health,” will focus on how the disproportionately high rates of maternal morbidity and mortality among Black women result from implicit bias, structural racism, and a lack of understanding of the lived experiences of Black women. Linda will discuss how these factors lead to Black women receiving poorer quality maternal care, and being less likely to have their peri-partum complaints evaluated, and will also offer strategies to improve Black maternal outcomes.

Thursday
Nov082018

Health care was the winning issue!

Whew! ACA repeal off the table in Congress

Thanks to your efforts and those of activists all around the country, there were huge victories for high quality, affordable health care on Tuesday!

You marched, called, wrote, protested, canvassed and spoke out. And it worked! In exit polls nationwide, voters confirmed that health care was their top priority, and they punished those officials who had sought to take it away. Even in races where health care proponents ultimately lost, the margin of victory was often significantly closer than anyone would have predicted two years ago in states won handily by Donald Trump – thanks to health care voters. Strikingly, a number of the Affordable Care Act’s harshest foes were forced to lie about their opposition to the law’s consumer protections, in a sweeping reversal of health care politics from previous election cycles.
 
With Democrats taking control of the U.S. House of Representatives, the door has been firmly closed on further legislative attempts next year to repeal the ACA, gut Medicaid, block low-income patients from receiving care at Planned Parenthood or cut Medicare to pay for the GOP tax cuts. The change in power also has significant implications for the kinds of oversight that the House will conduct. House committees are now expected to investigate the administration’s efforts to sabotage the ACA and its refusal to defend the law in court. We may even get a full investigation of Brett Kavanaugh by the House Judiciary Committee next year – something the Senate Judiciary Committee refused to do this year.
 
The next two years could be particularly turbulent for House Republicans, two-thirds of whom have never served in the minority before. We can look to a recent analog in the 2006 wave elections, where a similarly long-standing Republican majority was handed defeat. Chafing in the minority and facing another tough re-election fight defined by an unpopular president, large numbers of Republicans who’d survived 2006 announced their retirement. How this could affect a smaller, Trumpier GOP conference’s approach to health care, we’ll have to wait and see.
 
In the Senate, where Democrats were defending 10 seats in states won by Trump, Republicans only increased their narrow majority by 2 to 4 seats. We may not know the outcome of races in Arizona and Florida until next week. The loss of the House neuters Senate Republicans’ ability to pass harmful legislation but the additional seats gives them a larger buffer to confirm extremist conservative judges. Senate Majority Leader Mitch McConnell is expected to spend the next two years aggressively attempting to remake the federal judiciary in Trump’s image. As disturbing a prospect as this is, however, it’s still a marked reversal in fortunes from the filibuster-proof majority that Republicans had once envisioned for 2019.
 
But even as we celebrate our health care victories, we know our work is far from over. In Texas, one of the most openly partisan judges on the federal bench is set to rule very soon against the ACA's consumer protections, including those for people with pre-existing conditions. Top House Democrat Nancy Pelosi and Senate Democratic Leader Chuck Schumer both called on Republicans to prove their supposed support of coverage for people with pre-existing conditions and withdraw from the lawsuit. “We think as a sign of good faith and in keeping with what they’re saying on the campaign trial – prove it, withdraw the lawsuit. So that would be one place that we could start,” Pelosi said during a Wednesday press briefing. Meanwhile, two newly elected Democratic attorneys general in Wisconsin and Michigan could lead those states to withdraw from the lawsuit.

The Trump administration is also rushing full speed ahead to push "junk" plans on unsuspecting consumers and continue to sabotage ACA marketplaces.  On Wednesday, the administration released two final rules designed to make it easier for employers to cite religious or moral objections to birth control and gain exemptions from the contraceptive coverage requirements established through the ACA. The initial versions of these rules were blocked by courts, and the final rules should be, too!

The Trump administration also issued a proposed rule that would impose unnecessary and burdensome requirements on health insurance plans that cover abortion care, as well as the enrollees in these plans. This proposed rule would force such health plans to send separate monthly bills to enrollees for the abortion coverage, instead of one bill that itemizes the abortion coverage. Enrollees would have to send in two separate payments, one for abortion coverage and one for everything else. The ostensible purpose of this process is to ensure that no federal funds are used to pay for abortion coverage that is not allowed under the Hyde Amendment (which allows federal funding of abortion only for cases of rape, incest or threat to the woman’s life). But the true purpose of this rule is to discourage health plans from covering abortion because of the administrative hassles. There will be 60 days of public comment on this proposal, and we will be weighing in firmly in opposition.

State victories for Medicaid expansion

In Nebraska, Idaho and Utah, voters overwhelmingly passed Medicaid expansions by ballot initiative, closing the coverage gap for more than 300,000 people. Our early sense from all three states is that none of their Republican governors is likely to follow the lead of Maine’s departing Republican governor, Paul LePage, who has been illegally blocking a voter-approved expansion this year. 

In Kansas and Maine, voters elected pro-health care governors, easing the path for their states to expand Medicaid, which would cover an additional 200,000 people.Both states had previously passed Medicaid expansions through their Republican-controlled legislatures only to see extremist governors veto them. Pro-expansion gubernatorial candidates also won in states like Wisconsin (which has a partial expansion) and Michigan (which had sought to undermine its expansion through the waiver process). In Georgia, where Republicans engaged in blatantly illegal efforts to suppress the African American vote, pro-expansion candidate Stacey Abrams could be headed to a run-off election, depending on the outcome of a recount. 
 
In Nevada and New Mexico, newly-elected state leaders are considering Medicaid buy-in programs. These would allow residents with incomes above the threshold for Medicaid eligibility to use their ACA premium assistance dollars to purchase Medicaid coverage instead of a private plan. Nevada’s legislature passed Medicaid buy-in in 2017 but the program was vetoed by outgoing Republican Governor Brian Sandoval. By contrast, incoming Governor Steve Sisolak, a Democrat, is supportive.

Montana's I-185 initiative fails, but Medicaid expansion still possible

 
On Tuesday, 55% of Montanans voted against the I-185 Healthy Montana Initiative, an plan to raise taxes on all tobacco products and include e-cigarettes and vaping products. The proposal would have dedicated a percentage of these funds to ce
rtain health-related programs, including some of the costs for Montana’s ongoing Medicaid expansion program (covering nearly 100,000 Montanans) veterans’ services smoking prevention and cessation programs and long-term care services for seniors and people with disabilities.

Our Montana-based regional coordinator, Montana Women Vote, worked extremely hard this year, prioritizing participation in theHealthy Montana Coalition. Dedicated volunteers from across the state worked hard to gather 40,000 signatures for the I-185 initiative to be on the 2018 election ballot. Unfortunately, the tobacco industry wages a fierce and expensive campaign against the initiative.  Now the legislature will determine the fate of the expansion, eliminating it completely or finding a new way to fund the program. Montanans value health coverage for their families and are dedicated to saving their state expansion, Medicaid saves lives in Montana.

Mixed results on abortion policy at the state level
 

On Tuesday, voters in three states – Alabama, Oregon, and West Virginia – voted on ballot measures affecting abortion rights and access in their state. While we saw a pro-choice victory in Oregon, we were disappointed by the outcomes in West Virginia and Alabama, where pro-choice advocates engaged in hard fought campaigns pushing back against harmful anti-choice ballot measures, which unfortunately  passed.

In Oregon, NARAL Pro-Choice Oregon, our Portland-based RC, helped successfully defeat Measure 106, a proposed constitutional amendment that would have prohibited public state funds from paying for abortion. Oregonians showed up at the polls in full force to defeat this backdoor ban on abortion. With the resounding rejection of Measure 106, Oregon remains the most pro-choice state in the nation, and the only state with no additional barriers to accessing abortion care.

Despite tireless efforts by our Charleston-based RC, WV FREE, West Virginia voters approved Amendment 1, which will add language to the West Virginia Constitution stating "nothing in this Constitution secures or protects a right to abortion or requires the funding of abortion. The amendment negates a 1993 state Supreme Court decision that affirmed a right to abortion care and state Medicaid funding for abortion in the state. Although the West Virginia amendment "won't have an immediate impact," Julie Warden, WV FREE Communications Director told CNN, "it is ominous for low-income women who already face insurmountable barriers to healthcare.” With so many restrictions already in place, if the state takes away Medicaid coverage for abortion, it will disproportionately impact women already struggling to make ends meet, and will be devastating for women and families.

As part of their campaign, WV FREE and their coalition partners called nearly 200,000 unique voters across West Virginia, ran television ads in three major West Virginia markets, reached nearly 150,000 voters via mail and communicated with over 200,000 West Virginia voters through digital advertising. Their hard work made a difference. The narrow margin of victory for the opposition (52%-48%), made it clear that Amendment 1 was not a mandate. WV FREE will continue to make sure West Virginians can navigate their way through the restrictive healthcare landscape created by politicians.

In Alabama, voters approved a ballot measure known as Amendment 2, which gives fetuses
the same rights as people by adding personhood language to the state constitution. The amendment also adds that the state constitution “does not protect the right to abortion or require the funding of abortion.” Amendments like those passed in West Virginia and Alabama are particularly concerning at a time when the fate of Roe could lie in the hands of the Supreme Court, with newly appointed anti-choice Justice, Brett Kavanaugh. Since West Virginia and Alabama both have pre-Roe abortion bans, the new amendments could be used to restrict abortion in the state outright if Roe falls.

Beyond ballot initiatives, Tuesday’s elections had additional state-level implications for reproductive health, rights and justice, as a number of state legislatures flipped to a pro-choice majority. For example, New York will now have a Democratically-controlled state Senate, which will likely move quickly to pass the Reproductive Health Act. The Reproductive Health Act, which continues to pass in the Assembly, but until now, has stalled in the Senate, would move abortion from the criminal code into the health code, and bring New York State law in line with Roe v. Wade. The Reproductive Health Act would serve to back up abortion rights in New York State should the Supreme Court undermine or overturn Roe.

Thursday
Nov012018

ACA enrollment starts today; sabotage continues

Open Enrollment starts TODAY!

Today, November 1, is the first day of 2018 Open Enrollment season! Despite repeated attempts by Trump and the GOP to undermine or repeal the ACA, including a 90% cut to open enrollment advertising, Open Enrollment begins with great news for consumers. Premiums are stabilizing or even dropping, and most people have more options than before.
 
Open Enrollment only lasts 6 weeks in most states, so don’t wait to sign up! You can go to healthcare.gov to explore your options, and find free enrollment assistance near you at localhelp.healthcare.gov. If you would like to help us spread the word about Open Enrollment and help more people get covered, you can learn more about our outreach resources here
 
 

Another attempt to sabotage the ACA

In the closing weeks before the election, the Trump administration has done everything it can to change the message away from the GOP’s disastrous health care proposals. The president casually floated the idea of overturning the 14th amendment by executive order—he can’t. And GOP candidates around the nation have been trying to convince voters that they don’t support repealing protections for pre-existing conditions—they do.
 
Citing a number of Republican House members who’ve made false claims about their support for health care using an unrelated Washington Post fact-check, the Post wrote: “These lawmakers have been put on notice that they are peddling a falsehood—and politicians who care about their reputation should acknowledge they made a mistake and offer an apology. Instead, they apparently believe it is politically advantageous to continue to deceive the voters in their districts.”
 
But while the public’s attention has been on the election, the administration has been diligently working to gut those same protections through executive action. Last week, the administration issued new guidelines that will allow states to effectively eliminate the Affordable Care Act’s consumer protections through the 1332 waiver process.
 
Under section 1332 of the ACA, states may apply to waive some of the law’s requirements in order to explore innovative alternatives for providing the same level of coverage. The law establishes certain guardrails to ensure that a comparable number of people are covered with the same quality of care at no additional cost to the federal government. Guidance issued by the Obama administration emphasized coverage for low-income and vulnerable populations.
 
Most of the waivers granted since 2015 have established state reinsurance programs. For example, Consumer Health First—Raising Women’s Voices Regional Coordinator in Maryland—helped successfully shepherd that state’s 1332 waiver for reinsurance. More radical proposals have been rejected.
 
But the guidance issued by the Trump administration is specifically intended to push states into promoting non-ACA compliant plans like Association Health Plans and short-term“junk” plans, driving up costs for those who remain in comprehensive ACA marketplaces. Using the same semantic sleight of hand that Republican leaders used for their repeal efforts last year, the new guidance emphasizes “access” to coverage over actual coverage.
 
Last year we warned you about the real-world impact of the Cruz amendment to undermine protections for pre-existing conditions: “the choice Cruz is offering is between insurance you don't want (the skimpy plans) and insurance you won’t be able to afford (the comprehensive plans, which will cost much more than they do now). … Even the insurance companies think the Cruz amendment is a bad idea! AHIP, an insurance industry trade group, says it would ‘de-stabilize the individual market and increase costs for those with pre-existing conditions.’”
 
Now, writing in the Commonwealth Fund, Timothy Jost warns that the new guidance is worse: “With its 1332 waiver guidance, the Trump administration is attempting to accomplish through administrative fiat changes in the ACA that Republicans repeatedly tried and failed to bring about through legislation in 2017. The waiver guidance, for example, resembles but goes even further than the Cruz Amendment to the Senate’s Better Care Reconciliation Act or the Graham-Cassidy-Heller-Johnson bill, which would have allowed coverage that is not legal under the ACA and funneled money directly to the states to spend on their own health coverage priorities. Like those bills, the 1332 guidance promises to further exacerbate differences in coverage between red and blue states.” It’s clear that in states that take up Trump’s offer now, those with pre-existing conditions could find themselves quickly priced out of the coverage they need.
 
Furthermore, despite touting increased “flexibility” for states, that flexibility only runs in one direction. The guidance makes it more difficult for states to use 1332 waivers to create a public option or pursue a Medicaid buy-in program to allow residents with incomes above the threshold for Medicaid eligibility to use their ACA assistance to purchase Medicaid coverage instead of a private plan.
 
Unlike a proposed regulation, the guidance went into effect immediately upon being issued on October 22 and will be used to evaluate all new 1332 waiver requests. Outside of a legal challenge, there’s no way to stop the guidance from moving forward. But activists can and should share concerns with state officials about the ways in which these Trump waivers will result in worse coverage, higher costs, and harm to people with pre-existing conditions.