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« ACA health care coverage gains chip away at racial, ethnic disparities | Main | Ryan’s ACA replacement plan? We’re not impressed! »

Women’s health victories in DC and the states!

We can’t stop smiling about the 5-3 decision by the U.S. Supreme Court on Monday that overturned provisions of a Texas law that had left many women without convenient access to an abortion provider. The law, H.B. 2, had required abortion clinics to meet the same building standards as ambulatory surgery centers, an expensive and unnecessary undertaking. It had also required abortion providers to have admitting privileges at hospitals within 30 miles, another daunting challenge given the refusal of many hospitals (especially the growing number of Catholic facilities) to grant such privileges to abortion providers. Admitting privileges are not required for outpatient provision of other health services, such as colonoscopies.
The court found that such requirements do not benefit women, as Texas legislators had claimed, and instead present serious obstacles to women trying to exercise their rights to obtain an abortion. The number of abortion clinics in Texas had dropped dramatically once H.B. 2 took effect, causing women to have to travel long distances to obtain abortion care.

Marsha Jones, Executive Director of the Afiya Center in Dallas, and an RWV regional coordinator, called the decision “a huge win for women’s reproductive freedom in Texas, nationally and around the world.” The Afiya Center and its reproductive justice allies in Texas “have expended valuable time, energy and resources to combat the reproductive oppression brought on by HB2,” she said. “While we won this one, the fight is far from over. We are still fighting for access to women’s reproductive choices that are safe, affordable and accessible. Furthermore, we seek to end the shame and stigma that has historically been attached to black women’s reproductive choices.”
There was another Supreme Court decision in favor of women’s health this week that got much less media attention. On Tuesday, the Court refused to consider an appeal from a drug store owner and two pharmacists in the state of Washington who objected to a state requirement that all pharmacies must stock and dispense time-sensitive medications, including emergency contraception.
The pharmacy owner cited religious objections to EC, and won at a lower court level. That decision was overturned by an appellate court, which said that "rules are rationally related to Washington's legitimate interest in ensuring that its citizens have safe and timely access to their lawful and lawfully prescribed medications." That decision is now final, since there were not four U.S. Supreme Court justices wiling to hear the pharmacy’s appeal.
More victories out in the states
Another overlooked story is the progress that some states have made in significantly expanding women’s access to reproductive health care, even while other states have enacted new abortion restrictions this year.
Last month, Maryland enacted the most comprehensive contraceptive coverage act in the nation, building on the groundwork laid by the Affordable Care Act (ACA). RWV’s own regional coordinator, Consumer Health First (formerly known as the Maryland Women’s Coalition for Health Reform), played a key role in the fight. Starting in January 2018, women with Maryland-regulated insurance plans, both public and private, will be able to access their preferred FDA-approved contraceptive drugs, procedures, and devices without co-payment—even if those methods would otherwise be charged a co-pay under the ACA. They will be able to pick up six months of contraception at a time, obtain long-acting contraception without pre-authorization requirements, and even use their insurance to cover FDA-approved over-the-counter (OTC) contraceptive medications without co-pays.
In Maryland and seven other states, women already had the right to use their Medicaid coverage to purchase OTC drugs, but the benefit is little known or used. With that benefit now extending to private insurance plans as well, advocates hope to spread the word to let Marylanders (and pharmacies) know they’ll be able to pick up a qualifying product like emergency contraception off the shelf, take it to the pharmacy counter (not the retail counter) along with their insurance card, and walk out without having to pay a co-pay. Popular OTC emergency contraceptive methods like Plan B can now cost $50 or more, making it prohibitively expensive when women need it, so the new no-copay provisions will make a big difference for women!
Maryland will also begin requiring insurance coverage for vasectomies without co-pay, bringing vasectomy coverage in line with the ACA-mandated coverage for tubal ligations. Because the ACA has only required coverage of permanent birth control methods for women, couples can feel forced into choosing tubal ligation, with greater risk and longer recovery times, when a vasectomy might be a better option.

In Illinois, RWV regional coordinator EverThrive Illinois was at the forefront in pushing the state legislature to pass equally comprehensive legislation. It would eliminate most co-pays for contraception, allow for OTC coverage, cover vasectomies, and would require insurance companies to allow women to pick up 12 months of contraception at a time, which studies have shown can be critical to allowing women to retain access to their preferred method. The bill currently awaits the governor’s signature, and advocates are optimistic he will sign in the next few weeks.
In Vermont, the governor signed legislation into law last month that, like Illinois and Maryland, would expand the ACA’s contraceptive coverage by requiring insurers to cover all FDA-approved methods without co-pays or delays, provide for vasectomy coverage, and cover a 12-month supply of contraception at one time. However, the Vermont law does not cover over-the-counter products.
These exciting steps forward for women’s health demonstrate the power of local advocates in proactively changing state policies and provide a template for action at the federal level. Have information about steps being taken in your state? Let us know!


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