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We’re working in the states to protect our health care!

There’s a lot to do at the state and local levels!

With Congress on recess following the passage of an omnibus spending package (which we reported on last week), we’re turning our attention to what’s been happening in the states. Our regional coordinators across the country have been busy engaging in state and local advocacy/policy work to protect the health care of women and LGBTQ people. Here’s some of what they’ve been up to!

Massachusetts protects patient confidentiality

Earlier this week, staffers and members of NARAL Massachusetts, our Boston-based regional coordinator, celebrated their third legislative win of the session with the approval of the Protect Access to Confidential Healthcare (PATCH) Act.

Currently, insurers automatically send Explanation of Benefits (EOB) forms listing the provision of potentially sensitive health care services, such as reproductive health care, to the primary subscriber on a health insurance plan. This process compromises the privacy of Massachusetts residents receiving health insurance as dependents on the plan of a parent or spouse. It particularly affects young women, members of the LGBTQ community, domestic violence survivors and people with substance abuse or mental health issues.

 H.2960S.2296 addresses this problem by ensuring that EOBs are sent directly to each patient and that each patient can choose to receive her EOB at an alternate address or electronically. It requires that EOBs include only generic information when sensitive care is received, and guarantees that EOBs are not sent for preventive health services with no cost sharing (such as an STI test or a domestic violence counseling session).

SisterReach raises health issues during Black Folks Day on the Hill

SisterReach, our Tennessee-based regional coordinator, and their new policy initiative, the Deep South Regional Roundtable, held their 2nd annual Black Folks Day on the Hill. Deep South partners, community members and allies statewide went to their state capitols in Tennessee and Mississippi, speaking with key legislators about issues, including health, which affect Black community members in both states.

Some of those issues include proposals to introduce harmful work requirements for Medicaid enrollees, abortion rights and the rights of pregnant women. During the TN hill visit, participants made a presentation to the Shelby County (Memphis) delegation about the issues Memphians face and offered the coalition as a resource to legislators. Black Folks Day on the Hill 2018 was a success, and the partnership looks forward to bigger and better hill actions to come!  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 in TN.

Making health care more affordable in Maryland

With only a few days left in their state legislative session, members of Consumer Health First, our Maryland-based regional coordinator, are celebrating the passage of a proposed policy that will help protect access to coverage and care for Marylanders. HB1795, which is awaiting Governor Larry Hogan’s signature, will help stabilize Maryland’s individual insurance market by allowing the state to take steps to create what’s called a “reinsurance program.”

Reinsurance programs -- which are almost like insurance for insurance companies – are designed to offset the costs that health plans can incur if they enroll individuals who use a lot of expensive medical care. Without the reinsurance payments, health plans would raise their premiums for all enrollees to cover medical expenses for the higher-cost people.  With the reinsurance payments, health plans would stay affordable for Marylanders who are purchasing them through the individual market.

Where would the money for the reinsurance program come from? HB1795 would allow the state to apply for what’s called a 1332 waiver to take advantage of federal dollars and state funding in 2019. See Consumer Health First’s testimony in support of the proposal here. Consumer Health First is closely watching HB1792/SB387, which would establish the state funding sources for a reinsurance program. That bill also charges the Maryland Health Insurance Coverage Protection Commission with studying a number of critical areas that can affect the cost of health insurance. These include: creating a state-level individual mandate to have health insurance (to replace the federal mandate that Congress and the President eliminated in the tax bill); merging the small group and individual health insurance markets; the use of subsidies to lower costs and a Medicaid buy-in option.

"We've worked tirelessly since the passage of the Affordable Care Act to bring the voice of the over 200,000 individuals who depend on the individual market for their health care coverage to the Insurance Commissioner during the rate review process," said Beth Sammis, President, Consumer Health First. "The Maryland Insurance Administration staff during a legislative hearing acknowledged we hold their feet to the fire. We will continue our advocacy to hold all policymakers’ feet to the fire until the individual market is stabilized and coverage affordable."

Illinois health care advocates say: Do No Harm!

As part of their advocacy work in opposition to state-based work requirements for Medicaid, RWV regional coordinator EverThrive Illinois and Protect Our Care Illinois, along with 100 partner organizations, sent a letter to Governor Bruce Rauner, a Republican, urging him to oppose adding work requirements to Illinois’ Medicaid program. They outlined the ways in which work requirements would create barriers to health care for Illinois residents, strip people of health benefits, and cost the State of Illinois billions of federal dollars with no benefit for the state. Read the letter in full here.

Meanwhile, EverThrive Illinois and their Protect Our Care Illinois colleagues have been building support for the “Do No Harm Healthcare Act.” This proposed policy, which has been approved in committee, would require the legislature to approve any requests by the Governor to the federal government for waivers that would reduce or restrict health insurance coverage under the Affordable Care Act (ACA) plans, State Employee Group Health Insurance or Medicaid.

This provision would apply, for example, to harmful Medicaid waivers proposals, like those recently approved by the federal government for Kentucky and Indiana, which would impose work requirements on Medicaid recipients. The proposed policy would help ensure that any attempt to restrict access to health care is transparent and open to public debate. For more details on HB 4165 HA1, see Protect Our Care Illinois’ fact sheet.

Trans- and queer-led Brown and Black coalition launches LGBTQ+ Justice Week
Trans Queer Pueblo, our Phoenix-based regional coordinator, and other community groups are taking to the streets with rituals, drag performance, celebration and protests for LGBTQ+ Justice Week.  LGBTQ+ communities of color will bring the Pride celebration to the institutions that detain, incarcerate, deport and kill LGBTQ+ people of color.
At Monday’s Vigil for Liberation event, community members built an altar and performed drag in protest (pictured left) at Eloy Detention Center, the nation’s deadliest detention facility. The protest lifted up deaths in detention due to bad or no medical care and the trauma of trans detainees, such as being caged with people of the wrong gender and being subject to constant harassment, abuse and often rape.  
At a Drag Town Hall, community members invited Phoenix mayoral candidates to participate in an open forum about how to make Phoenix safe for LGBTQ people of color. Community groups discussed the need to fund trans-inclusive women's health clinics and rape crisis centers. The conversation continued with dialogue on economic opportunity as a health issue and the lack of job opportunities for LGBTQ+ people of color due to document status, poverty, racism and transphobia.
WV FREE celebrates ACA anniversary

WV FREE, our Charleston-based regional coordinator, participated in a press event at the state Capitol to celebrate the ACA’s 8thanniversary. At the event, health care advocates highlighted the positive impact the ACA has had on West Virginians, including its role in reducing the uninsured rate among adults from 29 percent to 9 percent. These powerful statistics were complemented by the stories that individual consumers shared about the real life impact the ACA has had on their families. For example, Parkersburg resident Janice Hill talked about her daughter’s struggle with cancer and the life-saving coverage the ACA has provided for her.



Why were we glad to be left out?

New federal spending bill mostly omits anti-women provisions
After six months of stop-gap spending bills and two government shutdowns, Congress passed an omnibus spending package late last week to fund the government through the rest of the 2018 fiscal year. Despite a last minute Fox News-inspired veto threat, Donald Trump signed the package into law five hours later, averting a third shutdown just hours before the deadline.
The bill was perhaps most notable for what it did notinclude on women’s health and other progressive priorities, with some of our biggest victories coming from blocking GOP attempts to add dangerous new anti-women policy language.
As we noted earlier this month, conservatives were pushing hard for language in the omnibus to make up for their defeats last year on Planned Parenthood. The omnibus is likely one of the last big, must-pass bills Congress will take up before the election, and opponents of abortion access saw it as their last chance to “defund” Planned Parenthood by blocking the popular health provider from receiving any federal funding, whether through reimbursement for serving patients insured through Medicaid or through Title X federal family planning grants. In the end, the bill didn’t include any attacks on Planned Parenthood or other abortion providers.
Similarly, Republicans had sought to codify into law the Trump administration’s proposed regulatory attacks on reproductive and LGBTQ health care. As we noted last week, the Trump administration has proposed a rule that would make it easier for doctors, nurses, pharmacists, hospitals, clinics and insurance companies to deny us care, based on their religious, moral or personal beliefs.  (See more on this topic below.)  An attempt to include religious refusal language similar to the proposed Trump rule into the omnibus bill provision was dropped, as was a proposed ban on fetal tissue research. 
Likewise, the bill maintained level funding  for the Title X family planning program and for the Teen Pregnancy Prevention program, but didn’t make any policy changes -- neither codifying into law the Trump administration’s proposed attacks on the two programs,nor protecting the programs from those attacks.
This still leaves these priorities at the mercy of a hostile anti-science, anti-woman, and anti-LGBTQ administration, but without the same force of law and without setting dangerous new precedents. History has shown that once these kinds of policy riders are added to spending bills, they are notoriously difficult to remove—as evidenced by the four decade-long fight to strip out Hyde amendment language blocking low-income women’s access to abortion care, if federal funds are used.
Finally, the bill did not include any funding to shore up Affordable Care Act (ACA) health insurance  marketplaces that have been rocked by GOP sabotageWe opposed several provisions in the Republican-only package released by Senators Lamar Alexander (TN) and Susan Collins (ME) that would have increased costs for moderate-income enrollees and created a de facto ban on private insurance coverage of abortion under the ACA.
What did the spending bill include?
 The bill included critical increases in funding for the Department of Health and Human Services (HHS)—$10 billion over last year—with new funding for substance use disorders and mental health. The National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and community health centers also won increases, as did a number of other intersectional priorities related to women’s health, such as low-income housing.
Unfortunately, the bill also includes more funding for several of Mike Pence’s pet projects at HHS, including abstinence-only education under the rebranded title of “Sexual Risk Avoidance Education.”
The package also modestly improves the ability of the CDC to conduct research related to gun violence—long blocked by Republicans—by clarifying through accompanying report language that nothing in the bill prohibits the CDC from doing so. Without dedicated funding for gun research, it’s unclear how much of a difference the bill will make. But symbolically, it’s the first small step toward recognizing gun violence as a public health issue that Congress has made in a generation, with ramifications for women’s health. On average, a woman in the U.S .is fatally shot by her current or former intimate partner every 16 hours. The bill also includes language improving the National Instant Criminal Background Check System (NICS) but does not include language gutting state regulation of concealed carry permits. For years, gun hardliners had been refusing to pass the bipartisan Fix NICS legislation unless it was paired with pro-gun legislation; their failure in the omnibus suggests that the tide may be turning on Congress’s ability to take up sensible gun reforms.
On lingering questions around immigration, public health and the Dreamers, the bill represented a stalemate. Democrats had hoped to enact a permanent pathway to citizenship for those immigrants brought to the US as children but the White House offered only a temporary reprieve, no better than what several federal courts have already granted the Dreamers through litigation. Congressional negotiators rejected Trump administration requests for detention beds, an attack on “sanctuary cities” and border wall funding—providing instead a much smaller pot of money to repair and replace existing fencing and explicitly prohibiting the use of funds for concrete structures.
We raised our voices to oppose the Trump religious refusal rule!
On Tuesday, Raising Women’s Voices submitted comments calling for the Trump administration to withdraw its proposed rule to expand the ability of health providers to deny care based on religious, moral or personal objections. We pointed out the harm the rule would cause for groups that already face obstacles in obtaining care – women and LGBTQ people, especially those of us who are low-income, immigrants, people of color, people with disabilities, and transgender or gender non-conforming people.  You can find our comments here.
We helped generate additional organizational and individual comments on the proposed rule through a social media campaign, #DontDenyUsCare, that cited actual instances in which women and LGBTQ people have already suffered care denials, even without the rule.  On Monday, we co-hosted with Community Catalyst a Twitter storm in which more than 30 organizations participated, including Lambda Legal, the National Women’s Law Center, the National Family Planning and Reproductive Health Association (NFPHRA), the National Center for Lesbian Rights, Moms Rising, SisterSong and the National Asian Pacific American Women’s Forum. 
Eighteen of our RWV regional coordinators participated in the Twitter storm and/or submitted written comments to HHS: The Afiya Center, California Latinas for Reproductive Justice (CLRJ), COLOR, EverThrive Illinois, Indiana Religious Coalition for Reproductive Justice, Kentucky Health Justice Network, Lesbian Health Initiative, Maine Consumers for Affordable Health Care, Montana Women Vote, NARAL Minnesota, New Mexico Religious Coalition for Reproductive Choice, New Voices Pittsburgh, Northwest Health Law Advocates, Planned Parenthood of Southern New England, Oregon Foundation for Reproductive Health, SisterReach, Wisconsin Alliance for Women’s Health, and WV Free. 

Also on Tuesday, National Women’s Health Network Health Policy Intern Maddy McKeague (to the right of the speaker in the photo) represented Raising Women’s Voices at a press conference outside HHS headquarters, during which a coalition of women’s health and LGBTQ health organizations announced they had gathered and were about to submit 200,000 comments in opposition to the rule. 



Trump rule would make it easier for providers to deny us care!

Here’s your chance to speak out against the harmful Trump rule!

The Trump administration wants to make it easier for doctors, nurses, pharmacists, hospitals, clinics and insurance companies to deny us care, based on their religious, moral or personal beliefs. We must speak out against this proposed rule that would especially harm women and LGBTQ people.

What can you do? Go here for suggested talking points and a direct link to the Health and Human Services Department page where you can submit your personal or organizational comments opposing this destructive rule. The deadline to submit comments is Tuesday, March 27, so we all must act quickly!

You can also join a #DontDenyUsCare Twitter storm on Monday, March 26, from 1 to 2 p.m. Eastern that will be co-sponsored by Raising Women’s Voices and Community Catalyst to coincide with the start of LGBTQ Health Awareness Week. The goal will be to let more LGBTQ people know about the threat posed by this proposed rule and encourage more people to submit personal comments opposing it. Go here for social media “badges” we have created and suggested posting text you can use.

How do we know what the consequences of the proposed rule would be? Sadly, too many women and LGBTQ people have already suffered the kinds of health care denials that would get worse under Trump’s rule. We know a lesbian couple in California were denied infertility services by a fundamentalist Christian physician who didn’t approve of same-sex couples having children.  We also know that a transgender teen in Georgia was denied medically-prescribed testosterone injections by an objecting clinic provider who commented, “What kind of a doctor would do this to a girl? And we know a transgender man was denied a hysterectomy for gender transition purposes by a hospital in New Jersey.

How would Trump’s proposed rule make things worse? Existing harmful religious refusal policies apply primarily to abortion and sterilization services.The proposed rule would allow health providers to refuse to provide “any lawful health service or activity based on religious beliefs or moral convictions.” This expansive interpretation could lead to provider denials based on personal beliefs that are biased and discriminatory, such as objections to providing care to people who are transgender or in same-sex relationships, or are not based in scientific evidence, such as refusals to provide emergency contraception out of the unfounded belief that it can cause abortion.

The rule would protect refusals by anyone who would be “assisting in the performance of” a health care service to which they object, not just clinicians. An expansive interpretation of “assist in the performance of” thus could conceivably allow an ambulance driver to refuse to transport a patient to the hospital for care he/she finds objectionable. It could mean a hospital admissions clerk could refuse to check a patient in for treatment the clerk finds objectionable or a technician could refuse to prepare surgical instruments for use in a service.

On an institutional level, the right to refuse to “assist in the performance of” a service could mean religiously-affiliated hospital or clinic could deny care, and then also refuse to provide a patient with a referral or transfer to a willing provider of the needed service. Indeed, the proposed rule’s definition of “referral” goes beyond any common understanding of the term, allowing refusals to provide any information, including location of an alternative provider, that could help people get care they need.

The rule does not address how a patient’s needs would be met in an emergency situation. There have been reported instances in which pregnant women suffering medical emergencies – including premature rupture of membranes (PPROM) and ectopic pregnancies-- have gone to hospital emergency departments and been denied prompt, medically-indicated care because of institutional religious restrictions.  This lack of protections for patients is especially problematic in regions of the country, such as rural areas, where there may be no other nearby hospital to which a patient could easily go without assistance and careful medical monitoring enroute.

The proposed rule includes no exceptions for emergency situations and makes no reference to the Emergency Medical Treatment and Active Labor Act (“EMTALA”), which requires hospitals that have a Medicare provider agreement and an emergency department to provide to anyone requesting treatment an appropriate medical screening to determine whether an emergency medical condition exists, and to stabilize the condition or if medically warranted to transfer the person to another facility. Under EMTALA every hospital is required to comply – even those that are religiously affiliated. Because the proposed rule does not mention EMTALA or contain an explicit exception for emergencies, some institutions may believe they are not required to comply with EMTALA’s requirements. This could result in patients in emergency circumstances not receiving necessary care.

Health care institutions would be required to notify employees that they have the right to refuse to provide care, but would not be required to notify patients about the types of care they will not be able to receive at that hospital, pharmacy, clinic or doctor’s office. The rule sets forth extensive requirements for health care institutions, such as hospitals, to notify employees about their refusal rights, including how to file a discrimination complaint with OCR. The rule requires posting of such notices on the employer’s website and in prescribed physical locations within the employer’s building.

By contrast, the rule contains no requirement that patients be notified of institutional restrictions on provision of certain types of care. Such notification is essential because research has found that patients often are unaware of service restrictions at religiously-sponsored health care institutions.

What should we say in our comments to Department of Health and Human Services (HHS)? You can find a template letter of comment here that you can tailor to your own organization. But here’s the bottom line: The proposed pule will allow religious beliefs to dictate patient care by unlawfully expanding already harmful refusals of care. The proposed rule is discriminatory, violates multiple federal statutes and the Constitution, fosters confusion and harms patients contrary to the Department’s stated mission.  For all of these reasons, we call on the Department to withdraw the proposed rule in its entirety.

Meanwhile, Congress set to vote on spending bill

Congress is set to vote this week (maybe even today!) on a 2,000+ page omnibus spending bill to fund the government. Current stopgap funding expires on Friday. Based on early reports of what made it into the bill (e.g. increases for health research and other key priorities) and what didn't (attacks on Planned Parenthood) we're cautiously supportive. But with the text released to the public only hours before Congress begins voting, we're still going through the bill to see what it will mean for all of our women's health priorities.

While it’s not included in the omnibus bill, the Senate could also take a vote tomorrow on package to stabilize ACA marketplaces. As we noted last week, the package is controversial because it could raise out-of-pocket costs for moderate-income enrollees andwould make it all but impossible to get abortion coverage through the individual market. Look for our recap of congressional action next week.



Reproductive health at risk in Congressional funding fights!

Congress threatening Planned Parenthood, abortion coverage
There’s only a week to go before the federal government will once again be on the brink of shutting down. Conservative Republicans are trying to use the crisis to block Planned Parenthood from receiving any federal funding. They’re also insisting that any effort to shore up health insurance markets contain a provision effectively banning private abortion coverage in Affordable Care Act (ACA) plans. 
Such an abortion ban would go well beyond the Nelson Amendment included in the ACA.  That provision prohibits the use of federal funding to pay for abortion coverage, but it allows marketplace plans to include abortion coverage as long as that portion of the premium is paid for by an individual’s private payments. In contrast, abortion opponents in Congress want to totally ban private abortion coverage if anyportion of the premium is paid for with federal funds, essentially imposing the Stupak Amendment that they tried and failed to add to the ACA.
Planned Parenthood threatened in “omnibus” funding bill
The action by conservative Republicans is taking place as Congress is negotiating the last pieces of an “omnibus” spending package to fund the government through the end of the fiscal year. Current stopgap funding expires on March 23. Originally slated for a House vote this week, the timeline has been pushed to early next week. While most of the spending decisions have been finalized, big questions remain over more than a hundred controversial policy changes that Republicans hope to tie the bill. The package is likely one of the last big, must-pass bills Congress will take up before the election, making it the last chance for members of Congress to win legislative victories that they can take home.
Anti-abortion conservatives, in particular, are clamoring for a win now that Republicans have given up on attempting a third reconciliation package, which would have let them once again try to force through attacks on Planned Parenthood and other abortion providers with just 50 senators. The omnibus bill will require 60 votes to overcome a filibuster in the Senate, but hardliners hope that Democrats don’t have the appetite for another shutdown. They want the GOP to use the omnibus to block Planned Parenthood from accessing all federal funding, whether through reimbursement for serving patients with Medicaid insurance or through Title X federal family planning grants.
In 2015, Republicans came close to shutting down the government over Planned Parenthood funding, but ultimately backed off. It’s unclear whether cooler heads will once again prevail, whether we’re headed for a third shutdown this year, or whether this is simply a cynical gambit to win concessions from Democrats in other areas like financial reform or environmental regulations. As congressional leadership is fond of saying, nothing is decided until everything is decided. Other proposed “poison pill” provisions relevant to women’s health include codifying Trump’s plan to eliminate the Teen Pregnancy Prevention (TPP) Program and funding his anti-immigrant deportation force.
Abortion coverage ban not the only problem with market stabilization proposals
Congress is also negotiating a market stabilization package to shore up ACA insurance markets rocked by GOP sabotage. At stake are cost-sharing reduction (CSR) payments to insurance companies and federal funding for state-based reinsurance programs.
As we’ve noted previously, insurance companies are required by law to keep cost-sharing (e.g. co-pays, deductions, and co-insurance) artificially low for low-income enrollees in the ACA marketplaces. So, for example, someone with an income of 150% of the federal poverty level who signs up for a plan that would normally carry a $2,000 deductible might end up having no deductible at all. Then, the federal government is supposed to reimburse insurers through CSR payments.
An immediate cut-off in those payments could have been disastrous, with insurance companies abruptly raising premiums across the board or leaving ACA markets altogether. But because Trump spent months teasing whether or not he would block the payments, insurance markets had time to prepare in clever ways.
In 36 states (representing 85% of ACA enrollees), insurance companies working with state insurance regulators carefully increased premiums in such a way that actually lowered out-of-pocket costs for low- and moderate-income enrollees. That’s because financial assistance from the federal government is pegged to the cost of an area’s second lowest cost silver plan—even if the enrollee chooses a less comprehensive bronze  plan or a more comprehensive gold plan. When the Trump administration cut off CSR reimbursements, insurers were forced to raise premiums to compensate. But few raised premiums on all plans. Instead, many insurers increased premiums only on silver plans, while keeping premiums stable in bronze and gold plans—a practice known as “silver loading.”
With the government paying more for premium assistance, many enrollees found themselves with free or close-to-free bronze plans or with gold plans that were actually cheaper than silver plans. This is one reason why, despite the administration’s brazen attempts to sabotage the open enrollment period for 2018, enrollment stayed so high.
Reinstating CSR payments now that markets have adjusted to life without them would save the government money, because the CSR payments are lower than the cost of subsidizing higher premiums. But it would do soat the expense of low- and moderate-income enrollees who will see their out-of-pocket premium costs rise. With the repeal of the individual mandate in last year’s GOP tax bill and the Trump administration’s promotion of worthless “junk” health plans, consumers would face strong financial incentives to drop out of comprehensive ACA markets.
Republicans would like to use the savings from reinstating CSRs to fund state reinsurance programs. Reinsurance helps buffer insurance companies against very large losses—like those associated with an unusually sick and expensive pool of enrollees. Without reinsurance, a company has to price the risk of really sick enrollees into higher premiums for everyone. With reinsurance, a company can keep premiums lower and be compensated if claims rise above a certain level.
However, as the Center on Budget and Policy Priorities notes, the GOP proposal would mean taking financial help away from low-income enrollees to reduce premiums for middle-income enrollees. We can—and should!—fund reinsurance to lower costs for enrollees who don’t qualify for financial assistance, but we don’t need to pit low- and middle-income families against each other. We can make health insurance more affordable for everyone.

Moreover, under the GOP proposal, no plans accessing CSR support and no plans backstopped by reinsurance could cover abortion, no matter who pays for the actual premium costs associated with abortion care. The likely net effect would be to discourage private abortion coverage in any ACA plan. That would set a very dangerous precedent that is simply wrong for women’s health!



What’s at stake this International Women’s Day?

So many gains for women’s health, and so much at risk from new attacks!
Today, March 8th, marks International Women’s Day. We’re taking a moment to recognize all the once-in-a-generation advances we’ve seen for women’s health because of the Affordable Care Act (ACA). But, we’re also acutely aware that we need to keep up our vigorous resistance to the attacks on women’s health that are taking place practically every week in Washington, D.C., and in some of the states.
What are we celebrating today? The ACA has improved health coverage for millions of women. For example:
  • The uninsured rate for women has been cut nearly in half.
  • An estimated 53 million women now have contraceptive coverage without co-pays.
  • Insurance plans must cover maternity care without charging us extra.
  • Women can’t be charged more than men for the same health plan.
  • Women can’t be denied coverage or charged more because of “pre-existing conditions” such as having once been sexually assaulted, or having had a Cesarean section delivery.
But many of these hard-won gains have been under steady attack from the Trump administration and Congressional leaders for more than a year. Since taking office, Trump has tried to repeal or undermine the ACA, roll back contraceptive coverage requirements, prevent women from using their Medicaid coverage at Planned Parenthood and sabotage last fall’s ACA open enrollment period. So far this year, we’ve seen the Trump administration endorse cheap short-term “junk” health plans that offer inadequate coverage (such as no maternity care), propose “religious refusal” rules that would make it easier for health providers to deny care to women and LGBTQ people, and allow states to impose burdensome work requirements on Medicaid enrollees (which are likely to cause women to lose coverage).
This week, we learned that an advocate of “abstinence-only” sex education will be the final decision-maker on which clinics and agencies receive federal Title X family planning grants! Meanwhile, House Republicans are demanding the inclusion ofanti-reproductive health riders in the omnibus spending package needed to keep the federal government open.

That’s why it is important that women all across the country stand up and speak out against these attacks on our health. Make your voices heard! You can call the congressional switchboard at (202) 224-3121 to urge your members of Congress to protect the gains for women’s health care we are celebrating today.
Reproductive Parity Act passes in Washington State!
Our Seattle-based regional coordinator, Northwest Health Law Advocates (NoHLA),has had a major win with the passage of the Reproductive Parity Act. The bill requires Washington health plans issued on or after January 1, 2019, to cover all FDA-approved contraceptive methods and voluntary sterilization with no cost-sharing, as well as all FDA approved over-the-counter contraceptives without a prescription. In addition, it requires coverage of abortion services in a substantially equivalent manner as maternity care and services, and subject to the same cost-sharing as maternity coverage. Not all plans, however, are subject to the Reproductive Parity Act, such as self-insured health plans, which are regulated at the federal level.
“This bill ensures Washingtonians have access to all FDA approved contraceptives, products, and devices free of cost-sharing barriers and prescription requirements for over-the counter contraceptives and products, and protects the right of women to access abortion services. We are thankful to our partners and legislators for working diligently to safeguard the right to reproductive health care and services,” said NoHLA Staff Attorney Huma Zarif.
Constitutional Amendment Restricting Abortion Goes to the Ballot in WV
Meanwhile, in West Virginia, our Charleston-based regional coordinatorWV FREE is leading the charge against a harmful proposed state constitutional amendment that would take away the constitutional right to abortion in that state. On Monday, West Virginia lawmakers passed Senate Joint Resolution 12, the “no constitutional right to abortion” measure, which will now go to the ballot for a public vote during the general election this November.
WV Free and its coalition partners are fighting back against this egregious attack on women’s health. On Saturday, WV FREE and partners held a rally at the West Virginia State Capitol, where West Virginians from all over the state joined together to tell politicians not to play politics with women’s health care (#HealthNotPolitics). WV FREE Executive Director Margaret Chapman Pomponio (second to left) is shown with WV advocates Bradley Milam, Jen Wagner, and Kate Chilko pictured above (left to right) at the Enough! Rally for Women’s Lives.
What’s behind this attack? In 1993, the Supreme Court of West Virginia ruled that the state constitution protects women’s health care, and that if the state Medicaid program funds pregnancy care, it must include all pregnancy related medical services, including abortion. Now, with Senate Joint Resolution 12, the West Virginia legislature is trying to overturn that decision.
While the amendment is being explained as an effort to take away Medicaid funding for abortion, WV FREE and other women’s health advocates point out that the bill’s very short text makes it clear that the bill’s aim is even broader. Crafters of the resolution have said they hope that Roe v. Wade will eventually be overturned and that the state constitution will then enable antiquated language to criminalize abortion altogether.
To make matters worse, WV legislators rejected a motion to add to the constitutional amendment exceptions for rape, incest or where the woman’s life is at risk. At the same time, Republicans in the state legislature are pushing a bill that would ban nearly all Medicaid-funded abortions in the state, with no exceptions for rape or incest (only an exception to save the life of the pregnant woman). HB4012 is still making its way through House.
WV Free will continue to do outreach and education around the state to encourage West Virginians to oppose this harmful measure that would not only take away Medicaid coverage of abortion for low-income women, but could pave the way to criminalizing abortion. WV FREE’s Executive Director Margaret Chapman Pomponio, shown speaking at Saturday’s rallysaid of the amendment: “The legislature abandoned women and families by passing SJR12... WV Free has already snapped into action to defeat this nasty amendment at the ballot box in November. This amendment is extreme to the core to say the least and it’s a bridge too far. It is out of step with what West Virginians want.”
A January Hart Research Poll revealed that two-thirds of West Virginia state residents do not support legislation to ban Medicaid-funded abortions. And 62 percent said they do not believe that government should have a say in abortion decisions. Instead, West Virginians want good jobs and healthy families - not politically motivated attacks on health care.
Had a life change? You may be able to sign up for health insurance!
If you recently experienced a life change, you may be able to sign up for health insurance at by qualifying for a Special Enrollment Period (SEP). A Special Enrollment Period is a time, other than during annual Open Enrollment, when you can sign up for health insurance. If you qualify for an SEP, you have to act fast! You only get 60 days after a life change to enroll in a health plan.
Which life changes qualify?  Some of the most common qualifying life changes include:
  • Losing your health insurance, such as through a layoff.
  • Moving to a new zip code or county.
  • Getting married or divorced.
  • Having a baby, adopting or becoming a foster parent.
  • Having a change in immigration status.
  • Turning 26 and aging off your parents’ health insurance.
Survivors of domestic violence can also qualify for an SEP and apply for their own health plans. Survivors can qualify whether or not they are married. Additionally, a survivor’s dependents can also be added to a new health plan.

Survivors who want to apply for their own health plan should call at 1-800-318-2596. Those who qualify will then have 60 days to enroll in a Marketplace plan.

Help us spread the word!  Because there is only a 60-day window to apply for health insurance after a life change, it is important that people know about SEPs.  Raising Women’s Voices is especially concerned about reaching groups of people with the highest remaining uninsured rates: African-Americans, Latinx people, LGBTQ people and immigrants. We have produced a set of new Special Enrollment Period badges like the ones shown here. These badges will be shared online by our RWV regional coordinators around the country and by national partner groups such as Out2Enroll and Unidos US.  Please help us share them! You can find all of our SEP badges, as well as suggested posting text and other great resources (like flyers and fact sheets), on a Google Drive created by Community Catalyst. You can also share these badges by going to Raising Women’s Voices’ Facebook and Twitter page.
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