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Trump rule a #LicensetoDiscriminate

Raising Women’s Voices calls on HHS to #PutPatientsFirst

Today, the Trump administration proposed a sweeping new rule designed to ensure that health care providers – hospitals, insurance plans, doctors, nurses, technicians and even volunteers at hospitals – can refuse to provide medical care to which they have religious or moral objections.  We fear the result could be the enshrining of discrimination against women and LGBTQ people, denying them not only needed care, but also the information they need to make informed health care decisions and find alternative medical providers when they are refused care.

Nowhere in the 216-page proposed rule is there an explanation of how the Department will ensure that patients can get the medical care they need, when their health providers refuse.  In fact, the proposed rule specifies that an objecting health provider cannot be required to even provide patients with a written notice about where else they can go to obtain needed care. There is no explanation of what a hospital should be expected to do when a patient desperately needs emergency care, such as treatment of a miscarriage or ectopic pregnancy, but the facility objects on religious grounds. 

The rule was issued on the same day that a new study reported that women of color in 19 states are disproportionately affected by Catholic hospital restrictions on reproductive health care. Among the pregnant women who have been harmed by such refusals is Tamesha Means, pictured, who was turned away from the emergency department at a Catholic hospital in Michigan, after presenting with premature rupture of membranes. Only when she returned to the ER for the third time did she finally receive needed care, but she suffered an unnecessary infection as a result of the delay.

In contrast to the lack of protections for patients, the proposed HHS rule would requirehealth care institutions to prominently post government-specified notices about the rights of employees to refuse to deliver medical care they find objectionable. Institutions would face the potential loss of federal funding for non-compliance.

Existing federal laws already allow individual clinicians and health care institutions to refuse to provide such services as abortions and sterilizations, based on religious beliefs. So, is unclear why HHS needs to take these additional steps, especially when the Department itself estimates it will cost affected entities (such as health providers, insurers and state governments) $312.3 million to implement in the first year and $125.5 million annually after that.  HHS could better spend such funds enforcing, rather than undermining, section 1557 of the Affordable Care Act, which prohibits discrimination against women and LGBTQ people in the provision of health care.

The religious objections of a health care provider cannot be allowed to leave a patient without access to timely medical information and care. In health care, the patient’s rights and needs must come first!



Trump wants health providers to get #RXtoDiscriminate

New HHS Effort to Protect Religious Health Provider Refusals

While most of Washington was busy trying to prevent the federal government from running out of money, reauthorize the Children’s Health Insurance Program (CHIP) and reach agreement on saving the Dreamers, the Department of Health and Human Services (HHS) had a different priority in mind. In a press release and special event this morning, HHS announced the creation of a new Conscience and Religious Freedom Division dedicating to protecting health providers that want to deny medical care because of religious or moral objections.

In other words, Trump wants to give religiously-motivated medical providers an #RXtoDiscriminate against women and LGBTQ patients!

Acting HHS Secretary Eric Hargan claimed that “For too long, too many of these health practitioners have been bullied and discriminated against because of their religious beliefs and moral convictions.”

The truth is very different: Women have suffered denials of needed care by individual clinicians and by hospitals claiming religious or moral objections.Pharmacists have refused to fill prescriptions for birth control. Pregnant women experiencing miscarriages have been turned away by hospital emergency departments. Women giving birth have been denied post-partum tubal ligations. In some states, women of color have been disproportionately affected by Catholic hospital refusals, according to a new study being released Friday by the Public Rights/Private Conscience Project at Columbia University Law School.

LGBTQ people have also been harmed. Lesbian couples have been denied infertility services by doctors who object to same-sex couples and families. Patients needing gender transition services, such as hormones or surgery, have been turned away.

HHS should be protecting patients’ ability to obtain health care and providers’ ability to provide that health care, rather than devoting unnecessary increased resources to a new office focused only on protecting those who would deny patients care. In particular, HHS needs to do more to enforce, rather than attempt to undermine, Section 1557 of the Affordable Care Act, which has provided important new non-discrimination protections to women and transgender individuals in this country. We need HHS to #PutPatientsFirst, not give health providers a #LicensetoDiscriminate! 
Raising Women’s Voices will close monitor what the new HHS office does. We are awaiting issuance of a new rule that reportedly will expand on existing provider refusal rights, and will be submitting comments on how that would affect women and LGBTQ people.

The GOP’s Cynical Bargaining CHIP

Meanwhile, Republicans in Congress have put forward a bill this week that funds the government for an additional four weeks—the fourth such stop-gap funding bill since the start of the 2018 fiscal year in October—and reauthorizes the Children’s Health Insurance Program (CHIP) for six years.
Unfortunately, the package is as notable for what it doesn’t do as what it does. The bill fails to fund community health centers or other key health priorities which expired at the end of September, fails to fund disaster relief for Puerto Rico or the US Virgin Islands months after the islands were devastated by Hurricane Maria, and leaves 800,000 Dreamers without legal protections. Republicans crafted their package without Democratic input in the hopes that Democrats would balk at voting against CHIP, a program they’ve long championed.

As of this writing, it’s unclear whether Republicans have the votes to pass their package and avoid a government shutdown on Saturday. If the House passes its package on Thursday, the path through the Senate is even trickier, where two Republicans have already announced their opposition to the bill on the grounds that it doesn’t provide enough funding for the military.

As we noted last week, the Centers for Medicare & Medicaid Services (CMS) has warned that some states will run out of CHIP funding by January 19 (tomorrow!). But if the package fails, Republicans can still bring up CHIP as stand-alone legislation at any time—as they could have done at any point thus far. Regardless of what happens this week, we will be pushing Congress to fund CHIP for at least six years (if not longer) and fulfill its responsibilities to the Dreamers and the U.S. citizens of Puerto Rico and the U.S. Virgin Islands, thousands of whom are still without power.



Top of Our "To Do" List: Reauthorize CHIP!

First On Our “Must Do” List for Congress: Reauthorize CHIP!
For the first time since they left Washington, D.C., for the holidays, both chambers of Congress are back this week with a full slate of must-pass legislation left over from last year.
Top of the “must-do” list for us is a long-term reauthorization of the Children’s Health Insurance Program (CHIP), which expired in September. CHIP funds health insurance for nine million kids, including two million children with serious chronic conditions. Without guaranteed long-term federal support, states are spending down reserves and moving to cut off new enrollments as a first step to shutting down their CHIP programs altogether.
In December, Republicans chose to prioritize passing deficit-busting tax cuts for billionaires over reauthorizing health care for kids. Instead, Congress passed a short-term funding patch that was intended to keep the program afloat through the end of March. But, the Centers for Medicare & Medicaid Services (CMS) has warned that some states will run out of money by January 19.
While there is strong bipartisan support for CHIP, the parties have split over how to pay for the program, with Republicans insisting on deep cuts to other critical health programs to offset CHIP’s costs. In a plot twist this week, the prospects of a deal became stronger when the price tag for a 5-year reauthorization of CHIP fell from $8 billion to under $1 billion. 
Why the change? By repealing the Affordable Care Act’s individual mandate, the Republican-passed tax bill is projected to drive up ACA premiums in 2019, because fewer healthy people will buy coverage. The result will be that ACA coverage will be more expensive for the government to subsidize than it would otherwise have been. If CHIP were to lapse, budget scorekeepers predict that some of the children currently insured through CHIP would move to the now-more-expensive ACA plans. If CHIP were to be reauthorized, however, the government’s “new” spending on CHIP would only be $800 million over current law.
It’s an only-in-Washington solution: Republicans made their CHIP spending problem magically disappear by raising the government’s other costs. In fact, a 10-year reauthorization of CHIP--  instead of 5-year deal -- would now save the government $6 billion, leading Democrats to call for a longer-term or even permanent renewal. With funding for the overall government also set to expire on January 19, there is a chance that CHIP could be added to another short-term funding bill—if Congress feels pressure to act.
At the same time, Congress is struggling to come together on a host of other must-pass deals with big implications for women, people of color, immigrants and the LGBTQ community.
Following a televised negotiation at the White House in which Donald Trump both agreed to and rejected passing a clean DACA deal to help Dreamers brought to the U.S. as children, it’s unclear what will happen next. Anti-immigrant Republicans in Congress and the administration are pushing a wasteful $18 billion border wall as their price for restoring basic employment and health care rights to the Dreamers. A  court decision this week temporarily reinstating DACA nationwide, while positive, could take the pressure off of Republican moderates to find a legislative fix.
Meanwhile, the two parties still haven’t reached a deal to waive “sequestration” (the automatic spending cuts mandated by the 2011 Budget Control Act) for Fiscal Years 2018 and 2019, even though we’re four months into FY18. If these cuts were to take effect, both defense and non-defense funding would be slashed, including a host of health-related programs ranging family planning through Title X to HIV/AIDS medical care through the Ryan White program.
The other big news this week was an announcement by the Trump administration that states will now be allowed to include work requirements in their Medicaid expansion proposals. The Obama administration had long resisted approving work requirements, arguing that they violate long-standing Medicaid law. Under the law, state proposals must “assist in promoting the objectives of [Medicaid]” to expand medical care to the needy. At best, work requirements do nothing to expand access to care and at worst, lead to denials of care, with major consequences for women and people of color.
In our 2016 report on state Medicaid proposals, we noted that 60 percent of the then-nearly 3 million adults in the Medicaid coverage gap were already working. Among those not working, the vast majority are students, care-takers, those too ill to work and those already actively looking for work.
From a public health perspective, it makes little sense to deny coverage that helps prevent the spread of disease, allows the mentally ill to access care, and ensures that family members are able to care for individuals who might otherwise require more costly services like nursing homes.
The consequences for women and people of color would be particularly severe.While women and men have had roughly equivalent unemployment rates post-recession, women are far more likely to work part-time, making them vulnerable to the kinds of hourly requirements legislators have proposed. In 2014, for example, women accounted for 66 percent of the part-time work force and only 41 percent of the full-time workforce. Likewise, since the 1940s, the unemployment rate among African Americans has been consistently double that of white Americans.



Got health insurance? Start using it!

We’ve Got Coverage. Let’s Get Health Care!
We fought hard in 2017 to keep the Affordable Care Act and help millions of women, LGBTQ people and families learn they could still enroll in good, affordable coverage for 2018. Our New Year’s resolution is to get people started using that coverage!
We’ll be devoting the first two months of the year to promoting health insurance literacy and motivating people to use their health insurance. Raising Women’s Voices has lots of experience doing this from our successful My Health, My Voice campaign that has provided thousands of health insurance user guides and personal health journals to women across the country. 
Experience has taught us that the best way to engage newly-insured people is to tell them about the free preventive services that come with their health insurance. Our new social media campaign, targeted to women of color, Latinx people, LGBTQ people, immigrants and low-income families, does just that.
As we did for our Open Enrollment campaign, we developed our new campaign’s social media materials by listening to our RWV Regional Coordinators from Arizona, Georgia, Louisiana, New Mexico and Texas, who helped us select photos that feature people who reflect the diverse people they serve.
Each of the social media badges, like the one shown above, will be posted with text that includes a link to a relevant flyer or fact sheet like this one, which you can find here to download and use in your community. The flyer lists some of the most popular preventive services, like check-ups and flu shots, that are available at no charge to anyone with health insurance. (By the way, that includes people with employer-based health plans!) But we caution that you must use a provider who is in your health plan’s network.

For many of the women RWV serves, free access to birth control can be life-changing. But, we are worried that some women may believe the ACA’s contraceptive coverage without co-pays benefit has been repealed by the Trump administration. In fact, the Trump birth control rules have been blocked by two federal courts. So, we will be using social media badges like this one to get the word out that birth control is still a free women’s preventive services benefit for 2018.
Another of the free preventive services we will be highlighting in our campaign is testing for HIV and Sexually Transmitted Infections (STIs). This message is especially important for those in our communities who are at higher risk and could go undiagnosed. Some of our regional coordinators, such as the Afiya Center in Dallas and Women with a Vision in New Orleans, work directly with women, LGBTQ people and families with HIV.
We are also communicating the importance of establishing a relationship with a primary care provider (PCP) who can oversee your health care. For many people, finding a doctor they are comfortable with can be a challenge. This can be especially true for LGBTQ people and for immigrants whose first language is not English. The posting text for these graphics will lead people to a fact sheet with tips on finding a primary care provider who not only takes their insurance, but is a good fit for them personally. The fact sheet is written to empower people and lets them know they deserve to be treated with respect by their providers. You can download it here.
We also created an LGBTQ specific social media graphic for this topic and will link the post to GLMA’s (previously known as the Gay & Lesbian Medical Association) Provider Directory. We hope to connect LGBTQ people across the country to vetted providers they can trust.
Getting health insurance is just the first step in taking charge of your health.Knowing how to use your insurance in our health care system is yet another challenge. We’re proud to be working with Community Catalyst on this new effort that we hope will make a difference in the lives of many newly insured people in 2018.



Five key lessons from 2017 will power our 2018 advocacy!

Lessons learned in 2017 have prepared us for 2018

With the New Year approaching, Raising Women’s Voices and our 30 regional coordinators around the country have been reflecting on our experiences this year on the front lines of advocacy to protect women’s health and LGBTQ health. What have we learned in 2017 that will power our work in 2018?

Lesson 1: Take to the streets! RWV and our regional coordinators kicked off the year by participating in the January 21,  2017,  Women’s March on Washington, as well as sister marches in 10 states (CA, CO, GA, MA, MI, NY, OR, TX, WA, WV) to raise awareness about the importance of women’s health within the larger context of women’s rights. We distributed RWV-branded “We march for women’s health” stickers to be handed out during marches across the country. Coordinators in five states (CA, CO, MI, OR, WV) had speaking roles at their local marches.

During 2017, RWV and our regional coordinators participated in more than 141 visibility actions, conveying pro-ACA messages through street actions like holding up signs at busy intersections, organizing prayer vigils and participating in rallies to defend the coverage gains and protections provided by the ACA.

We’ll be marching again on January 20, 2018, in the second round of Women’s Marches taking place in many cities across the country! Please join us. 

Take a moment now to make a year-end charitable donation to help support the work of Raising Women’s Voices in 2018. Your donation is more tax deductible now than it will be in 2018, because of Trump’s tax bill. You can make a donation online through the Network for Good page of Community Catalyst, a fiscal sponsor for RWV. Earmark your gift for RWV.

Lesson 2: Make it personal. We started by asking women to answer this question for themselves and their families: “What if I lose coverage?” We did this through a national #IfILoseCoverage social media campaign we launched, in collaborationwith the Ms. Foundation for Women. We provided a handy sign template women could print out and fill in with their answer to the question. Then they could take a photo and post it online. RWV regional coordinators gathered more than 125 stories that they were able to use in their state-based advocacy. We used stories to develop social media badges and materials highlighting the potential impact of ACA repeal on women and their families.

Lesson 3: Keep it simple! RWV’s national coordinating team realized we had to figure out how to take wonky federal-level policy discussions and turn them into information that our regional coordinators and their grassroots constituencies would relate to personally and which would spur them to take action in defense of the ACA. We joined national coalitions to help track developments and strategy at a high level. Then, we worked hard with our regional coordinators to develop messaging and campaigns that would reach and mobilize the grassroots. One of our most successful tactics was use of simple cartoon-like graphics like the one shown here to help build understanding. RWV supported 11 regional coordinators in 10 states (CA, CO, GA, IL, KY, LA, MA, NY, OR, TX) to hold 69 informational sessions to help women understand what would be at stake if the ACA were repealed. RWV’s regional coordinators also submitted more than 52 letters to the editor/op-eds and had over 120 press hits during the year.

Lesson 4: Bring it home! In anticipation of Trump administration efforts to roll back the ACA’s contraceptive coverage requirements, six RWV regional coordinators helped win contraceptive coverage protections in their home states (CO, MA, ME, NY, OR, WA).  The Oregon Foundation for Reproductive Health (OFRH) celebrated adoption of the most far-reaching of these policies, the Reproductive Health Equity Act, which requires coverage of the full range of reproductive health related services with no cost-sharing. The new policy covers contraceptives, abortion, screenings for cancer and sexually transmitted infections and prenatal and postpartum care.

During RWV’s annual convening in September, Maria Ignacia of the Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR), pictured at right, described COLOR’s efforts successfully advocating for the adoption of a state level policy that allows women to pick up a year’s supply of birth control at one time. COLOR helped drum up support for this bipartisan bill through their Latina/o Advocacy Day. Leni Preston of Consumer Health First, RWV’s Maryland-based RC, spoke about their work building momentum for the passage of the Family Planning Services – Continuity of Care Act, the only policy in the country to proactively address the threat to women’s health if the federal government revokes funding under Title X, the national family planning program. Under the new law, $2.7 million in state funding would be put towards establishing a Family Planning Program at the Department of Health and Mental Hygiene if federal support for Planned Parenthood is withdrawn.

Coordinators in ME and MA helped win adoption of contraceptive equity policies that codify and extend the ACA’s birth control benefit. RWV-NY helped win a rule that would require insurance carriers offering health plans in New York’s individual and small group market to cover the ACA’s 10 essential health benefits (EHBs), which include vital services for women, such as maternity care, even if the ACA is repealed or the EHB requirement dropped.  

Regional coordinators in states with hostile political climates and conservative representatives in Washington had to work especially hard to make progress for women in 2017. Marsha Jones (third from left in photo) of the Afiya Center (the RWV coordinator in Dallas) celebrated passage of HB 11: The Texas Moms Matter Act, a piece of legislation to address the maternal mortality crisis in Texas. It will create a Maternal Mortality and Morbidity Task Force within the Department of State Health Services to review cases of pregnancy-related deaths and trends in severe maternal morbidity, which has disproportionately affected Black women.Kwajelyn Jackson, Community Education & Advocacy Manager at Feminist Women’s Health Center (GA), shown at left, highlighted and lifted up the work being done on Black maternal health disparities by the Black Mamas Matter Alliance, as well as the importance of recognizing the racial, gender, environmental and economic factors  that influence maternal health outcomes.

SisterReach, the RWV regional coordinator in Memphis, TN, was active in the fight to save the ACA and Medicaid, co-leading the Save My Care Bus Tour’s Memphis stop, and hosting a “Black Folks on the Hill” day at the Tennessee state capitol in Nashville.   SisterReach provided training, exposure to legislative committee and caucus meetings, and helped their participants meet legislators and staff in six offices. 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.

Women With A Vision, an RWV coordinator in Louisiana, held RJ roundtables in New Orleans, Baton Rouge and Lafayette to discuss health issues important to Black women, including the ACA and Medicaid expansion. Then they took those messages to the state capitol, bringing low income Black women and LGBTQ individuals from across the state to Baton Rouge for an advocacy day focused on Black women’s issues. “Our Voice Our Time:  Black Women’s Advocacy Day” was attended by over 50 women, who met with state legislators and their staff to discuss the impact of Medicaid expansion on women in Louisiana.

On November 7, Maine became the first state in the country to pass Medicaid expansion by referendum. Our regional coordinator, Maine Consumers for Affordable Health Care (CAHC), played an important role in building the massive public support for Medicaid expansion throughout the fall. While not every state allows referenda, RWV will use Maine as a model of policymaker education, advocacy and use of personal stories for achieving these gains in states that have not yet expanded Medicaid.

Lesson 5: Tell the truth. Loudly!  After a tumultuous first nine months of 2017, during which we helped stave off repeal of the ACA and drastic cuts to Medicaid, Raising Women’s Voices and our regional coordinators faced a new challenge as Open Enrollment Period 5 approached.  We realized that many of the women, LGBTQ people and families we serve were confused about whether they would still be able to sign up for health insurance for 2018, and whether there would be any affordable health plans available in their regions of the country.  We knew we had to get the truth out, and do it in a big way! That’s why we launched our truth-telling social media campaign.

RWV developed 111 original OE5 badges to be used on social media to let women know the ACA marketplaces were open – but for only six weeks this year -- that health plans were available and that many people would qualify for free or low-cost health insurance.  During the Open Enrollment Women’s Week of Action, RWV hosted a Twitter chat focused on women’s health, using the hashtag #GetWomenCovered, that had about two million impressions.

Key to the success of our campaign was our active engagement of six of our regional coordinators from southern and southwestern states that were targeted for intensive outreach because of higher-than-average rates of un-insurance: the Feminist Women’s Health Center in Atlanta, the Afiya Center in Dallas, the Lesbian Health initiative/Montrose Center in HoustonWomen with a Vision in New Orleans, Trans Queer Pueblo in Phoenix and the Religious Coalition for Reproductive Choice in New Mexico. These regional coordinators helped us design materials that effectively targeted African-American, Latinx, immigrant, LGBTQ and low-income women and their families.

 “The fliers and badges were very inclusive and intersectional - in terms of including larger bodied women, diverse populations, interracial couples, queer couples of all ages and different religious expressions,” explained Naushaba Patel,pictured at right, who is Women’s Health Education and Outreach Specialist for theLesbian Health Initiative/Montrose Center in Houston. “Being fully inclusive of all people requires work and trust in others' stories, and I saw that reflected in the RWV staff and I'm grateful for that.”

“I feel great about our results,” said Kwajelyn Jackson from the Feminist Women’s Health Center in Atlanta said. “We really pushed hard in the last two weeks to make a strong showing,” she said, noting that enrollments in Georgia surged in the final two weeks of Open Enrollment, nearly doubling the previous four weeks.  “I’d like to think that our efforts helped make that happen.”

Nationwide, nearly nine million people signed up for 2018 health insurance coverage through the marketplace, almost as many as last year, but with an open enrollment period that was only half as long, and despite the Trump administration’s cuts to marketplace advertising and funding of navigator agencies. We count that as an especially sweet victory from 2017!

Raising Women’s Voices wishes you and your family a very Happy New Year! Stay tuned to learn about some new directions we will be taking in 2018.

Don’t forget to make a year-end charitable donation to support our work through the Network for Good page of Community Catalyst, a fiscal sponsor. Many thanks for your support!