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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.

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