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Watch out for sneaky ACA repeal in GOP tax bill!

13 million would lose coverage and premiums would rise!
The subtext for Republican efforts to rewrite the tax code has always been tax cuts for the wealthy paid for by health care cuts for the middle and working class. This week the subtext became text, literally, when the Senate Finance Committee released its tax bill. The proposal pairs deep cuts in the taxes paid by corporations and the wealthy with a repeal of the Affordable Care Act’s individual mandate.
Why is repeal of the insurance coverage mandate bad for women, LGBTQ people and our families? The Congressional Budget Office (CBO) estimates that eliminating the individual mandate will cause 13 million people to lose their health insurance. How would that happen? Some people—typically younger, healthier people—will decide to take the risk of skipping coverage if they no longer are penalized for going uninsured. But, millions of other people who want to keep their coverage will be driven out by rising premiums as the healthiest people leave the marketplace and the “risk pool” of insured people becomes too heavily weighted with sicker consumers.
The American Medical Association, the American Academy of Family Physicians and the American Hospital Association were unanimous in their opposition to this sneaky ACA repeal this weekwriting that "eliminating the individual mandate by itself likely will result in a significant increase in premiums, which would in turn substantially increase the number of uninsured Americans." Instead of helping low- and middle-income families afford coverage, the bill takes federal funds that would have been spent on subsidizing health coverage and spends them instead on big new tax cuts for the ultra-rich, like the elimination of the estate tax and the alternative minimum tax.
But that’s not the only way the tax bill goes after health care for middle and working class families. The House GOP tax plan also eliminates the medical expense deduction. Nearly 9 million people with high medical expenses—for example, seniors needing long-term care, people with chronic health conditions, and parents of children with disabilities—benefit from this deduction. Nearly 70% of people taking the medical expense deduction earn $75,000 or less.
This week, the CBO also released an analysis warning that by adding $1.5 trillion to the deficit, the GOP tax bill would trigger automatic cuts to mandatory spending under the 2010 pay-as-you-go law (PAYGO). That would mean $25 billion in cuts to Medicare in 2018 alone and additional cuts to the Affordable Care Act.
Once again, it’s critical to call your members of Congress. You can reach them through the congressional switchboard at 202-224-3121. Or you can use a toll-free call line that SEIU has set up at 866-426-2631.
Republicans want to once again use reconciliation to ram their bill through with just 20 hours of debate and the support of 50 senators and Vice President Mike Pence. But they can't waive PAYGO in a reconciliation bill without 60 votes. If they successfully pass their tax bill using reconciliation, it’s likely that enough Democrats would subsequently join them in a separate vote waiving PAYGO, possibly attached to must-pass legislation like a year-end spending deal, to protect seniors from these deep cuts.
But Republicans’ overarching goal of creating a big budget hole that must be filled through cuts to our safety net would remain. In fact, Speaker Paul Ryan (R-WI) has promised that he will push for “entitlement reform” (code for cuts to Medicaid, Medicare, and Social Security) to pay for the tax bill.
Right now, Republican leaders are trying to soften opposition from Senate moderates—particularly Senators Susan Collins, Lisa Murkowski, and John McCain who voted against “skinny repeal” of the ACA in July. GOP leaders are promising to simultaneously hold a vote on the bipartisan Alexander-Murray bill to fund cost-sharing reduction payments and open enrollment assistance for two years. But that bill’s namesake cosponsor, Senator Patty Murray (D-WA), notes that repealing the individual mandate will “really destabilize the marketplaces,” which is the exact opposite of what her bill is supposed to do. On Wednesday, Sen. Ron Johnson, R-WI, said he could not vote for the Senate tax cut bill in its current form for an entirely different reason, complaining that the tax cuts disproportionately benefit corporations at the expenses of other businesses. (However, we aren’t counting on his opposition to kill the bill.)

The House is set to vote on its bill today (Thursday). The Senate is expected to take up its bill immediately after Thanksgiving. Though congressional leaders had initially planned to go to conference to reconcile different versions passed by the House and Senate, new intelligence suggests that the Senate could adopt a last-minute amendment during vote-a-rama to satisfy House conservatives. Under that scenario, the House would then promptly pass the Senate bill without amendment, sending it to the president’s desk.
RWV Regional Coordinator New Jersey Citizen Action (NJCA) has been working to raise awareness about the harmful impact the Republican House tax bill would have on New Jerseyans. The GOP tax plan would cost New Jersey residents billions in deductions. Under the House plan, the wealthiest 5% of New Jerseyans—those with annual incomes over $440,000—would get two thirds (67%) of the tax cut coming to the state by 2027. And, programs like Medicaid, Medicare and the ACA would be on the chopping block in 2018 as Congress tries to make up for trillions in lost revenue as a result of these tax cuts.  
On Monday, NJCA and New Jersey Organizing Project rallied outside Representative Tom MacArthur's (R-NJ 3) invitation only forum, where he defended tax cuts for the rich. Every one of New Jersey's congressional delegation, both Democrats and Republicans, oppose this plan, except Representatives MacArthur and Frelinghuysen (R-NJ 11). They are also the same two New Jersey Representatives who voted to take health care away from 32 million Americans. Maura Collinsgru, NJCA Health Care Program Director, pictured above, held a sign that reads “Health Care Not Tax Cuts”
NJCA is also hosting a “Stop Tax Cuts Day of Action,” during which New Jerseyans can drop in at one of the GOP district office locations to deliver a phony check made out to the 1% from New Jersey's low and middle-income families. In addition, NJCA and NJ Organizing Project are holding vigils in Freehold, Toms River, Marlton, and May’s Landing to oppose this harmful tax plan.



We’re on a roll! Let’s keep it up!

What a week for health care!

We’ve had double helpings of good health care news this week. First, we learned that enrollment in Affordable Care Act health insurance plans is surging! More than 200,000 people chose a health plan on November 1, the first day of open enrollment. That’s more than double the number who signed up on the first day of open enrollment last year. Then, on Tuesday, voters in Maine made that the first state to approve Medicaid expansion by popular referendum.

Help us keep the enrollment momentum going! Raising Women’s Voices is producing a series of colorful social media badges and flyers to get the word out about the short six-week open enrollment period for most of the country this year. They feature images of our targeted audiences: African-American, Latinx, LGBTQ, immigrant and low-income individuals and families. We’re working with our regional coordinators and with national partner organizations to distribute these materials on line and at in-person outreach and enrollment events.

This week has been declared Latino Week of Action!  Latinx people (we use this more inclusive term) have made record gains in coverage since the passage of the Affordable Care Act. However, the Latinx community is still one of the largest uninsured populations in the country, with uninsured rates far above the national average. We joined our partners, Salud America! and Young Invincibles, in a #SaludTues Twitter chat this week and encourage all of you to help us spread the word.  Check out all of our materials in English and Spanish, including the social media badges shown here, on Community Catalyst’s Google Drive. Make sure your Latinx friends and family know Open Enrollment is happening now through December 15 in most of the country.

How about that vote in Maine?  By an overwhelming 18-point margin, Mainers voted on Tuesday to extend coverage to 80,000 people who are currently in Maine’s coverage gap because they are ineligible for traditional Medicaid, but don’t earn enough to afford the private marketplace health plans offered through Maine Governor Paul LePage, a conservative Republican, has vetoed bipartisan Medicaid expansion bills passed by the state legislature five times, and he campaigned hard against the referendum.

LePage, who is term-limited in 2018, has made clear that he will try to block the expansion, even if it means violating Maine’s constitution and the will of the people. But Maine's House Speaker Sara Gideon (D) responded that “any attempts to illegally delay or subvert this law will not be tolerated and will be fought with every recourse at our disposal. Mainers demanded affordable access to healthcare yesterday, and that is exactly what we intend to deliver.”

Our regional coordinator in Maine, Consumers for Affordable Health Care (CAHC), played an important role in building the massive public support for expansion. CAHC promised to keep up the fight: “This is a robust and clear message from voters across our state: it is long past time to provide a path to affordable coverage for all of Maine's people. We look forward to working hand-in-hand with consumers, our partners, the Legislature, and Governor LePage's administration to swiftly and faithfully uphold the will of the people and implement Medicaid expansion in Maine.”
This huge victory helps secure the ACA by sending an undeniable message to Congress. It also sets the stage for other states to move forward with expansion. Referenda on expansion have been proposed for 2018 in Utah and Idaho, and GOP-led state legislatures in Georgia, Kansas, and elsewhere have been flirting with expansion for several years, waiting for the threat of repeal to have passed. We’re feeling exuberant about this week’s victory and (cautiously) optimistic about the future.
RWV national coordinating team members were at the American Public Health Association conference in Atlanta this week. Our well-attended session, sponsored by the APHA Women’s Caucus, was entitled “If they come for one of us, they come for all of us!” It highlighted the need for cross-movement, intersectional work to defend our health care, our rights and our families at this perilous moment for our country.

RWV Co-founder Cindy Pearson kicked off the discussion by celebrating our victories so far in holding off repeal of the ACA and then warning of new challenges ahead. These include Trump administration encouragement of states to propose punitive requirements for Medicaid enrollees, as well as proposed GOP Congressional “tax reform” bills that would increase the federal deficit and pave the way for renewed attempts to slash Medicaid and undermine the ACA.
RWV Co-founder Lois Uttley and Regional Field Manager Kalena Murphy discussed some of the successful strategies, tactics and messaging we‘ve been using this year to defend the ACA and the gains for women’s health and LGBTQ health that have come from the ACA. These have included social media campaigns like our #IfILoseCoverage initiative that we kicked off just weeks after last year’s election, as well as rallies, vigils and participation in Congressional town hall meetings. Some of our Southern regional coordinators have had great success with Black Folks Day on the Hill-type events in their state capitols. RWV Co-founder Byllye Avery stressed the importance of working together in coalitions to fight the broad sweep of regressive policies coming out of Washington. She offered examples such as RWV-NY’s participation in New York City marches supporting immigrant rights.



Spread the word: Open enrollment starts today! 

We only have six weeks to enroll in most states. Don’t wait!
Today’s the day! It’s the start of the fifth Open Enrollment (OE5) period for and the state marketplaces. We’ve often felt like we were on a scary roller coaster ride this year, but we made it to OE5 with the Affordable Care Act (ACA) still the law. Now we need your help to get the word out!
In partnership with Community Catalyst, Raising Women’s Voices has been working to create an outreach and enrollment campaign designed to reach groups of people with the highest remaining uninsured rates: African-Americans, Latinx people, LGBTQ people and immigrants. Now, scores of colorful social media “badges” like the ones shown above are ready to go. They will be shared online by our RWV regional coordinators around the country, and by national partner groups such as Out2Enroll and Unidos US. Many are available in both English and Spanish.

Can you help spread the word? You can find all of these badges, as well as suggested posting text and other great resources (like flyers and fact sheets), on a google drivecreated by Community Catalyst. You can also share these badges by going to our Raising Women’s Voices Facebook page or following us on Twitter.  
We previously shared with you our campaign materials for the period leading up to today. The new social media badges and flyers we are releasing today are focused on three important topics:
  1. Awareness and urgency about OE 5. Most important, we want people to know that and the state marketplaces are truly open for business. Additionally, with a brief 6-week enrollment window in most states, it is critical that people who want to enroll or re-enroll do not procrastinate. Our communications hammer home urgency with the message “It’s time.”
  2. Emotionally compelling reasons to get health insurance. For example, we encourage people to protect their own health so they can be there for the people who depend on them, like spouses, children and elderly parents.  Our badges and flyers also stress the importance of protecting your family from unexpected medical bills and debt that can devastate family finances for years.
  3. Tips about how to choose the right health plan. We’ve created “Insider Tips” to help people find the best health plan for them. Some of the most important tips: Make sure your trusted doctors take the plan you choose! And, see if the prescriptions your family takes will be covered by the plan.
Our new animated video is ready, too! After interviewing RWV regional coordinators about their needs, RWV Outreach and Enrollment Project staffers Amy Zarin and Sarah Wulf-Riordan identified a “how-to enroll” video as a priority. Fortunately, Zarin (who has experience in advertising and marketing) connected with NeverTheLess, a group of women in advertising who donate their skills to progressive causes. Zarin and Wulf-Riordan donated their time to work with a creative team from NeverTheLess consisting of Copywriter Lauren Cooper, Art Director Erika Kohnen and Motion Designer Sarah Cortese. The end result is a one-minute video entitled “The 4 Steps to Affordable Health Insurance.”

As a former Marketplace Assister, Wulf-Riordan understands the steps consumers must take to complete a Marketplace application and find the best health plan available. “This year’s shorter enrollment period and cuts to outreach and enrollment funding mean we need to step up and help people learn about and enroll in health insurance,” she said. “We wanted to create something that can help motivate and prepare people to enroll in coverage by December 15.”
We invite you to view the animated video on RWV’s YouTube channel here, and share it through your social media. Be sure to turn the volume up when you watch it: the original score was donated by music house Heavy Duty Projects.
We’re doing on-the-ground outreach, too!
Social media campaigns can reach thousands of people quickly, but sometimes the personal, one-to-one touch is what is needed to really encourage someone to apply for coverage. That’s why you will see RWV staffers and our regional coordinators around the country doing tabling, canvassing and handing out flyers at events during OE5.
Over the weekend, RWV was there at the big Women’s Convention in Detroit!  Staffing our table were RWV national coordinating team members Rebecca Berry (at left in photo), a Law Students for Reproductive Justice Fellow at the Black Women’s Health Imperative, and Kalena Murphy (at right), RWV Regional Field Manager, who works for the National Women’s Health Network.
Together, they handed out 1,000 of our English-language OE5 flyers and 1,000 of the Spanish-language flyers. The also collected contact information from more than 200 women attending the Convention who were interested in receiving our materials and potentially helping spread the word in their home states. “Women were so excited to hear about RWV and how they can be involved in the effort,” Murphy explained.  She said they heard a lot of comments like "Thank you for fighting for us," and "I have ACA and wouldn't know where I would be without it," and "My daughters love their marketplace plans."

Can you help us spread the word in your community? Let us know by emailing



Help us get the word out about open enrollment!


Despite all the attempts by Congress and Donald Trump to repeal and replace the Affordable Care Act, the ACA remains the law of the land. The fifth ACA Open Enrollment period (OE5) will begin on November 1. But, sadly, many people are confused or think the ACA has been repealed.  After all, the Trump Administration cut the advertising budget for OE5 by a whopping 90% and has slashed funding for navigators who can help people enroll.
Raising Women’s Voices is working with Community Catalyst and other national non-profits to fight back and make sure people know OE5 is happening. Open enrollment starts Nov. 1 and, in most states, goes only until Dec. 15 this year. We need your help to get the word out!
This week, we are launching a campaign to let people know that they can still enroll this fall, or renew their coverage. We have prepared social media badges for use on Facebook and Twitter (like the one shown above) and flyers that can be printed out and distributed at outreach events. You can find all of our materials (and more created by Health Literacy Media) in a google drive established by Community Catalyst (click the button below):

We have four key messages for people who need health insurance:

1. Yes! You can sign up for health insurance this year.  But the open enrollment period is shorter than in previous years in most states, so don’t wait to sign up. We are encouraging uninsured people to go on the website right now to learn how to apply and be ready when Open Enrollment starts on Nov. 1. 
 2. Most people who apply for coverage through the marketplace will still get financial help.  Yes, some of the premiums for health plans are going to be higher this year, in part because of the Trump sabotage efforts. However, the amount of federal premium tax credit subsidies available through ACA marketplaces will rise along with the price of the plans. So, people who receive subsidies to help cover insurance costs may not have to pay more for premiums.

3. You may qualify for free or low-cost health insurance.  Trump and Republicans in Congress failed to eliminate Medicaid expansion or traditional Medicaid coverage in their repeal and replace bills over the summer. So people who are worried they cannot afford health insurance may still qualify for Medicaid in their state.
4. Free local enrollment help is still available. While some federally-funded navigators have had their budgets slashed or eliminated, others have received enough funding to offer help. Moreover, certified application counselors (such as staff at hospitals and community health centers) have not relied on federal funding and so will continue to help people enroll. We are encouraging groups to list local enrollment assistors when posting this and similar badges on Facebook.
Because of our experience working with diverse women, LGBTQ people and families who are disproportionately affected by health care inequities, Raising Women’s Voices was asked by Community Catalyst to create materials for five specific audiences: African-Americans, LGBTQ people and our families, the Latinx community, immigrants and low-income people. We produced all of the badges for the Latinx community in both English and Spanish, with the aid of the Caracol Translation Cooperative. Health Literacy Media created similar materials for general audiences, young adults and Asian-Americans. The printable flyers are available in PowerPoint with space for local groups to add their contact information and logos. Funding for this work has been generously provided by the Robert Wood Johnson Foundation, through Community Catalyst. 
Six RWV Regional Coordinators in targeted outreach effort!
Raising Women’s Voices could not have created meaningful outreach and education materials for this initiative without the active participation of these six regional coordinators:
  • The Afiya Center, Dallas, TX
  • Feminist Women’s Health Center, Atlanta, GA
  • Lesbian Health Initiative/Montrose Center, Houston, TX
  • New Mexico Religious Coalition for Reproductive Choice, NM
  • Trans Queer Pueblo, Phoenix, AZ
  • Women with a Vision, New Orleans, LA
These regional coordinators were invited to participate in the OE5 Outreach and Education project because the states in which they are based have higher rates of un-insurance and lower rates of Medicaid enrollment. They serve on an advisory committee to Raising Women’s Voices, giving advice on our messaging. They are also committed to distributing the materials we created in the coming weeks through their social media platforms, at community events, and at gatherings they organize.

Take action! Help spread the word!
You can help!
Click the button above to choose the messages you want to share on your social media. Print out flyers and fact sheets and share them within your community. We need strong mobilization in every state this fall to overcome Trump’s sabotage of the ACA.



More ACA Sabotage From Trump

Executive order is latest attempt to undermine the ACA
Donald Trump issued an executive order today attacking some of the Affordable Care Act’s (ACA) key consumer protections for people buying health insurance on the small business and individual markets. While the executive order itself doesn’t do much, it directs federal agencies to implement disruptive changes to the ACA designed to push younger, healthier people into unregulated “junk” insurance. The order is part of a much bigger push by Trump to sow chaos in ACA markets and build momentum for full repeal.

This is just the latest step in a long line of steps to sabotage the ACA and drive up the costs of insurance for women, families, and anyone with a pre-existing condition. The Protect Our Care coalition, of which Raising Women’s Voices is a member, released this video earlier today explaining how Trump is actively working to sabotage our health care and fulfill his promise to let the ACA “be a disaster.”
Trump’s Department of Health and Human Services (HHS) is cutting nationwide advertising for the 2018 open enrollment period by 90 percent. In addition, HHS announced it was cutting the amount spent on in-person outreach through the federal navigator program by 41 percent—and abruptly stopped funding navigators altogether for 30 days—saving some of the deepest cuts for the most successful navigators.
For example, one of our RWV regional coordinators, Enroll Michigan, was deeply cut despite praise from federal officials for “years of outstanding work as a navigator grantee and leader of your community.” Executive Director Dizzy L. Warren (pictured at left) was quoted in the New York Timeshighlighting the scope of the problem: “Our funds were drastically reduced, but the government did not reduce our responsibilities.” And “we have not received an explanation of why our funds were cut,” she said.
RWV Regional coordinator Planned Parenthood of the Heartland, the largest navigator group in Iowa, was also quoted in the Times after after their grant was cut by 85 percent: “The government claims this funding is tied to performance measures,” said President Suzanna de Baca. “But we met or exceeded nearly all our goals, so a cut of more than 80 percent appears to be completely arbitrary.”
Trump order allows “junk” insurance 

What is “junk” insurance and why is it bad for us? 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, they are limited to three months and they don’t satisfy the ACA’s individual mandate to have health insurance coverage.  By contrast, Trump’s order directs the federal government to re-write the rules to allow year-long “junk” insurance policies to satisfy the mandate.
Much like proposals pushed bycongressional conservatives this summer, these plans would not be required to cover essential health benefits like maternity or mental health care. They could discriminate against people with pre-existing conditions, charge limitless out-of-pocket expenses and reinstate annual and lifetime coverage caps. The ”junk” plans would not be required to spend a minimum percentage of our premiums on actually providing health care, instead of CEO salaries or advertising.
With lower monthly premiums, “junk” plans would appeal to younger, healthier people who don’t expect to get sick, have an accident, or need much insurance throughout the year. Referencing an earlier, similar proposal, insurance companies warned, “This would allow the new plans to ‘cherry pick’ only healthy people from the existing market, making coverage unaffordable for the millions of people who need or want comprehensive coverage, including, for example, coverage for prescription drugs and mental health services. … In fact, it creates two systems of insurance for healthy and sick people.
What else would the Trump order do to disrupt the ACA marketplaces?

In a second part of the executive order, Trump directs federal agencies to dramatically expand association health plans with similarly disruptive results. Pre-ACA, national trade associations like the Farm Bureau or the US Chamber of Commerce could pick a state with the worst coverage and use those rules to offer insurance nationwide. So, for example,they could offer coverage that complies with Mississippi’s consumer protections to small businesses in Massachusettsregardless of Massachusetts state law. Under current rules, small businesses can still band together to form association health plans for their members, but they have operate within states (not across state lines). Mostly importantly, they have to abide by ACA coverage requirements for small businesses. For example, they have to cover essential health benefits like maternity care.  
Under the changes Trump is proposing, association health plans would be exempt from a host of ACA consumer protections and would once again be able to operate under the rules of any state they choose – most likely one with the least coverage protections. The small businesses with the youngest, healthiest people would face strong incentives to exit the ACA’s small business marketplaces and buy a cheaper, skimpier association plan, raising prices for all of the small businesses that remained. 

One under-discussed impact of the pre-ACA small business insurance market was how it depressed employment opportunities for women. A small business looking at a highly qualified female candidate and a less qualified male candidate would face a strong financial incentive to pick the male candidate simply because it would mean lower insurance premiums. In industries dominated by women—like home health care—small businesses simply provided no insurance at all. There is every reason to think that the Trump proposal would reinstate barriers to hiring women, particularly older women or those with pre-existing conditions.
But even for women who end up being covered by an association plan, there’s no guarantee that they’ll actually be covered as promised. As the Washington Post notes, “25 years ago, federal watchdogs concluded that [similar] plans ripped off hundreds of thousands of Americans by refusing to pay their medical claims while violating state insurance laws and even criminal statutes.”
If fully implemented the way the Trump order envisions, these two changes (individually and combined) could destabilize ACA marketplaces by setting up a “death spiral” in comprehensive coverage. Some younger and healthier people would opt for cheaper, junk plans (or have their employer choose it for them) making the market for comprehensive coverage slightly older and sicker. That would drive up premiums which would price out the next tier of healthy people, including those who wanted comprehensive coverage but could no longer afford it. And that, in turn, would leave ACA markets as a de facto high risk pool with only the very sickest still trying to afford comprehensive coverage.


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