The HHS proposal to totally exempt some “religious employers” (such as churches and seminaries) should be dropped because it unjustly denies contraceptive coverage to employees who may not subscribe to the religious beliefs of their employer, the coalition comments noted.  Moreover, such an exemption conflicts with Affordable Care Act provisions preventing discrimination on the basis of sex, since the exemption allows the denial of coverage for a health care service that only women use.  

If HHS decides that it must allow religious employers to refuse to provide contraceptive coverage, the exemption should be replaced with the “accommodation” HHS proposed for a second group of employers who have affiliations to religious entities, we suggested. Under the accommodation plan, the employer does not have to pay for or provide birth control coverage, but the employees still gain this coverage through an insurance company or third-party health plan administrator.

However, our comments also stressed that an employer’s use of an accommodation should not create any barriers or roadblocks for its employees to gaining access to contraceptive coverage without a co-pay.  So, we urged that HHS require employers claiming an accommodation to submit verification to HHS of why they qualify (instead of just self-certifying that they do, as HHS had proposed).  Moreover, we urged HHS to actively monitor what happens when employers claim an accommodation, such as by making sure affected employees are notified that they will be getting this coverage through a third party and following up to make sure they actually have received the coverage.  Want to learn more? Read the coalition comments here.

The Ryan budget would eliminate the ban on discrimination against those with preexisting conditions, including breast cancer, Cesarean sections, rape, and health needs related to domestic violence; provisions that allow young women to stay on their parents health insurance plans until age 26; premium tax credits that help individuals and small businesses purchase health insurance; Obamacare’s expansion of Medicaid; and a slew of other benefits that the law provides for women’s health.

Ryan’s hypocrisy about the health care law is on full display in this budget proposal.  While he would eliminate the benefits of the new health law, he is only able to make the numbers add up by retaining some of its tax increases and $716 billion in Medicare savings that the law put in place.  Among the changes Ryan’s budget would make to Medicare in the name of savings is a partial privatization of the program.  This would leave seniors to pay more for less coverage.  Keep in mind that women on Medicare already pay more out-of-pocket, so the Ryan budget’s Medicare cuts would be an added threat to the financial well-being of senior women.

Although the Supreme Court upheld the Affordable Care Act and its implementation is well underway, this attempt to defund the law and with it the promise of better health it brings for millions of women across the country, demonstrate that we can’t take this progress for granted.  It’s critical that women continue to voice our support for the law so that political leaders hear clearly that we won’t stand for proposals like Ryan’s budget and other extreme cuts to the new health care law.

This blog is part of the #HERvotes blog carnival” and then also link the hashtag #HERvotes to http://twitter.com/#!/search/realtime/%23hervotes so that people can find the HERvotes Twitter account and a link to the hashtag #StandUpForWomen.

The fight over the health care law’s guarantee that women will have insurance coverage for contraceptive care, regardless of the views of their employers, is wending its way through the circuits of the judicial system and working itself out in the weeds of federal regulations.  It’s also coming back to the circus known today as the U.S. Congress.

Why is this issue back in Congress?

As Congress moves from the failure of the sequester to its next budget battle -- the debate over the continuing resolution (CR) that is needed to keep the government running – opponents of reproductive health care are trying to muddy the waters of the budget debate by adding contraceptive coverage into the mix.  They’re following a well-trodden, though much criticized path, using the crisis of what’s known to Washington insiders as must-pass legislation, to press their own agenda.
 
The current Congressional appropriation to fund government operations will expire on March 27.  Without passage of a CR, all parts of the federal government – except those like prisons and air traffic management that provide essential services – must cease operations immediately.  As Congress learned in the mid-1990s, the pain caused by government shut-downs is felt very widely around the country, and members of Congress will be under great pressure to pass a CR.
 
Frequently, when Congress is under great pressure to pass a particular piece of legislation, people take advantage of the situation to advance their particular causes by attaching language, known as a rider.  This time is no exception.  Last month, a group of anti-abortion rights groups called on Congress to add a religious refusal rider to the CR so that any employer who has a religious or moral objection to providing employees with insurance that covers contraception would be allowed to omit that coverage.  Currently, churches and houses of worship are exempt, and the Obama administration has proposed an accommodation to respond to the objections of certain non-profit religious entities that object to providing the coverage.
 
On Tuesday, 14 members of the House of Representatives wrote to House Speaker John Boehner asking that he add a religious refusal rider to the CR.  The current exemption and accommodation are not enough, they wrote, asserting that “Nothing short of a full exemption for both nonprofit and for-profit entities” would be adequate.  (You can read the letter here to see whether your own Representative signed.)

What are we doing about it?

Raising Women’s Voices joined with more than 40 groups writing to leaders of the House and Senate Appropriations Committees stating that “Including language in a continuing resolution or omnibus appropriations measure to restrict women’s access to birth control would be bad policy and is contrary to our shared goals of improving women’s health.”  The letter went on to ask Congressional appropriators to stand strong against all such efforts to undermine the no co-pay contraceptive coverage established by the health care law.  “We respectfully urge you to reject efforts to politicize the appropriations process for the remainder of fiscal year 2013 and oppose riders that are harmful to women’s health.”
 
You can read the full letter from defenders of the Affordable Care Act and contraceptive coverage here. 

Starting in October 2013, uninsured individuals and families will be able to buy health care plans through an “exchange,” or insurance marketplace, in their own states. Certain states have chosen not to lead these efforts, and will instead have the federal government take some or complete control over their exchange.

Raising Women’s Voices has been working to make sure  the process of applying for health insurance through these marketplaces  will be consumer-friendly. Last week, RWV submitted comments to the federal government on its proposed single, streamlined application form that people will use to apply for health care and for federal subsidies (tax credits) to help pay for these plans.  

Our comments were written from the perspective of the diverse women and families whose experiences with the health system are so important to our work, and whose views we strive to represent. Here are a few of our comments:

---  We noticed that the proposed form asks female applicants if they are pregnant.  We commented that unless the reason for asking this question is clearly explained in “help text,” women may find this question very intrusive and might discontinue filling out the application. Applicants should be informed that pregnancy may make them eligible for free or low cost health care plans.

--- We also strongly recommended that once a woman answers the question about pregnancy,   health exchanges should ensure that her pregnancy status stays private. Some women may not wish to continue their pregnancies or may not want to share this information with other members of her household. This is especially true for women in abusive relationships, since domestic violence has been shown to increase during pregnancy.

--- We noted that the application includes a question asking if any household members are currently in prison. This question should also include clear help text explaining that people who are currently in prison are not eligible to obtain health insurance through state exchanges. Without any explanation, this question may cause some people to not answer honestly for fear of discrimination.

--- We recommended that the application ask about an enrollee’s legal sex, with help text clarifying that this should match the sex on an applicant’s social security card. For many transgender individuals, changing the sex designation on driver’s licenses, passports, birth certificates and Social Security cards is a long, complicated process. The sex designation may therefore be different on the various forms.

--- We recommended that applications recognize same-sex partners and spouses, and allow them to apply for family coverage. Many of the states that will be using this application allow same-sex marriages, civil unions or domestic partnerships. We want to make sure this application is inclusive of non-traditional families and does not discriminate on sexual orientation.

To read the rest of our comments, click here. Liked our comments or noticed we missed something? E-mail us at info[at]raisingwomensvoices[dot]net

Over the last seven months, as women began to try to use the new no-copay coverage required by the Women’s Preventive Services rules, problems have surfaced. Insurance companies took advantage of the lack of detail in the rules and put limits on the coverage that undermined the intent of the law:

• Some companies were arbitrarily limiting the types of contraceptive methods they would cover without co-pays.
• Women with IUDs, who were told by their doctors that they needed follow-up visits or tests to ensure the method was working, were being charged co-pays for those visits and tests.
• Nursing mothers who needed breast pumps and counseling were not able to get the equipment and support they needed to be able to nurse their babies successfully.

Hearing about these problems from women, Raising Women’s Voices and our allies in women’s health advocacy asked HHS to provide further clarification about the scope of the preventive health care coverage required by the law.  Last week, HHS responded, releasing a document answering frequently asked questions (FAQs) about coverage of preventive services that provided much needed clarity about this part of the law.  In several instances, HHS set the record straight, explaining that insurers will have to cover these services in a more comprehensive way than some have been doing:

1. Insurance companies must cover the full range of contraceptive methods approved by the Food and Drug Administration.  They cannot limit contraceptive coverage to oral contraceptives, and coverage must include a range of pills, the ring, the patch, the shot, implants, hormonal intrauterine devices (IUDs), non-hormonal IUDs, barrier methods and sterilization procedures.
2. Not only should women get their contraceptive method without a co-pay, but we should not be charged a co-pay for services related to follow-up, management of side effects, counseling for continued use or for removal of a contraceptive device such as an IUD or implant.
3. Although insurance companies are allowed to use some cost-saving techniques -- like charging a co-pay for a brand name drug if there is a generic equivalent available -- if a generic version of a drug does not exist, then the insurer must cover the branded version without a co-payment charge.  
4. If a woman needs preventive health care that is not available from any provider in her insurance plan network, her insurer must cover services provided by an out-of-network provider without charging her co-pay.  
5. Insurers must cover lactation support, counseling and equipment rental without co-payment for these as long as the woman is breastfeeding.

These are important clarifications and should help ensure that more women are able to get the preventive health care they need.  However, we did not get everything we asked for – and some of the clarifications HHS provided are not consistent with our understanding of what the law was intended to do.  The FAQ documents says, for example, that women who use contraceptive methods that are available over-the-counter, such as the sponge and female condoms, can only get insurance coverage if a clinician writes a prescription for her.  We were also disappointed that the FAQ states that contraception for men is not eligible for this coverage, even though use of such methods has a preventive health effect for women.

Despite the pieces still missing, RWV is pleased that we’ve been able to get clarifications about this important preventive health coverage for women. We believe the new HHS action will help many more women get the coverage the law promised.

It’s Wednesday, bright and early! The birds are chirping and the coffee is brewing. As I walk briskly into the health center there is a change in the air. Young women are leaving their appointments with birth control and are NOT paying any additional costs! Thanks to the Affordable Care Act, women like me can get the contraception we need without copays.

Before the new health care law, the biggest obstacle surrounding birth control for thousands of young women was cost. Many couldn’t afford the monthly copays on their student budgets. Now, young women are stoked about not having another necessity to pay for and stress about. For most students, college isn’t the time when we want to become parents. So this provision, which helps us plan our future, is a really exciting development.

I have personally seen the benefits of birth control without copays.  In the last two years, five of my friends have had unintended pregnancies, and none of them was using birth control at the time. When I asked why they hadn’t used contraception, the overarching answer was the cost of the pill, and the difficulty of trying to obtain it. Now these five friends are using contraception and they couldn’t be happier.

I’ve seen the stress my friends deal with being a mother, a student and an employee all at the same time, and I know that’s not for me. Don’t get me wrong – I love being an aunt, a godmother and a pseudo mom, but babies are simply not on my immediate horizon. I’m staying healthy by making sure that I stay on the pill until I’m ready to start a family.

I know that many young women, especially those in my school’s health center, share my opinion too, especially since some of us are still in school or getting ready to start our careers. I’m sure they’d also agree with me when I say that this Valentine’s Day, I’m in love with something new. I’m in love with the health care law for providing coverage of the birth control I need without copays. 

Samantha Daley is a senior at the University of Central Florida majoring in Health Sciences with a concentration in Pre-Clinical Sciences and minoring in Women Studies. She is a chapter leader and Student Correspondent for Choice USA, a youth focused and youth directed organization centered on reproductive justice. You can read more from Samantha at ChoiceWords.

RWV’s New York intern, Nina Nnamani, shares what she learned about how the Affordable Care Act (ACA) has improved her health insurance coverage.

As a woman in her early 20s, I am among those who benefit most from the health care law. I am in my first year of graduate school and have a lot of things on my “worry list” – assignments that must be turned in, rent that is due, loans that must be paid back and more. However, thanks to the new health care law, affording co-pays for key preventive care isn’t one of my worries.

Under the law, all new insurance plans must cover key preventive care for women without copays. This means that care like birth control or screenings for sexually transmitted infections are provided at no extra cost.

I knew this provision applied to plans starting after August 2012, and that many women would see the changes go into effect in January 2013 (when many new plan years start). But, I didn’t know whether my plan was complying and whether I’d begin seeing coverage without co-pays too.

Well, I checked, and it does! This is the first year that I will be able to get this key preventive care without paying for extra costs. This helps me stay healthy while on a student budget, and allows me to cross one more thing off of my “worry list.”

This provision of the health care law applies to all new plans starting on or after August 2012. Check to see if you are covered too! Ask these questions to find out whether your plan is complying.

Let us know what you find out by joining our #ACAwomen Tweetchat on Monday January 28^th, at 2 pm ET. We will be talking about the preventive care services now covered without co-pays, and would love to hear what you think. Tweet us @RWV4healthcare or use the hashtag #ACAwomen to join the conversation! 

If you've been following our newsletter (sign up here), you may have read our earlier story on the battle over the federal budget, deficit reduction proposals and the so-called fiscal cliff, you know that some important women’s health programs are at risk – including parts of the Affordable Care Act health care law, as well as Medicare and Medicaid.  And if you’re reading news reports this week, you know that Boehner and his Republican colleagues in Congress have put forward a proposal that threatens Medicare in a very specific way – and it’s a way that makes no mathematical sense.

The proposal is to raise the age of eligibility for Medicare from 65 to 67, so you would have to wait two extra years before you would be able to get health care through Medicare.  This would save the federal government money because it would no longer have to pay for health care for people who are 65 and 66 years old.

But what supporters of the proposal don’t like to talk about is that those 65 and 66-year-old seniors will still have health care needs that will cost money and those health care dollars will still have to be paid by someone.  Turns out that someone is us!  This proposal isn’t actually about reducing health care spending; it’s just about shifting the costs for health care for those seniors from the federal government to seniors, employers and state health care programs.

What’s worse, the Kaiser Family Foundation did a study showing that raising the age of eligibility for Medicare would not only shift the costs – it would actually double them!  The federal government would save $5.7 billion, but everyone else would have to spend more than $11.4 billion to cover the health care costs of the seniors who got dropped from Medicare.

And worse still, this change would do disproportionate harm to seniors of color and people whose jobs require physical labor.  Seniors of color are more likely to have health problems at a younger age, so the delay in getting into Medicare could mean they suffer through extra years when their health care needs aren’t being met.  Native Americans and African Americans would be losing the most because they have shorter life expectancies, on average, meaning that the two year Medicare postponement cuts out a larger proportion of their time in the Medicare program even though they will have paid Medicare taxes through their whole working life, just like workers of other races.

People who do physical labor would also be hurt because they’re less likely to be able to keep working to maintain employer-based insurance for the extra years when the proposal would leave them without Medicare.  It’s one thing to continue working as a partner in a law firm or behind a CEO’s desk when you’re 65, and another thing to scrub floors or do construction work when you no longer have the physical stamina you did at 25.

Making people wait longer for Medicare will hurt seniors, cutting their benefits and leaving more of them without the health care they need.  It will also increase health care costs for businesses and states and push the price of health insurance premiums up for all of us.  That doesn’t sound like a conservative solution – in fact, it doesn’t sound like a solution at all.
Tell your member of Congress not to shift Medicare costs on to us!

RWV works to ensure that women’s voices are heard and concerns are addressed as health care reform is put into action.  As women, our voices are important and powerful because we are the experts on what health services we need to ensure the health of ourselves and our families.  The health care law is already helping women by eliminating long standing discriminatory practices by the insurance industry and making care more affordable so women and our families can stay healthy and be powerful.

Ivy Ngo and Keely Monroe outside of the US Supreme Court Women of color, in particular, stand to gain a lot from the law.  Communities of color have long suffered from lack of access to basic health services and this has resulted in dangerous and deadly health disparities.  African American women are nearly four times more likely to die during childbirth than White women, reflecting differences in access to prenatal and maternity care.  Vietnamese American women are five times more likely and Latinas twice as likely to develop cervical cancer as their white counterparts due to barriers to cancer screenings.  Latinos are also the most likely to be uninsured of any other racial or ethnic group and experience disproportionately high rates of unintended pregnancy, diabetes, asthma and sexually transmitted infections including HIV.  It’s time to bring an end to these shameful disparities and the health care law is helping us to do this.

The health care law includes some important provisions that help women of color get the health care services they need and RWV is sharing that important and empowering news, using our Countdown to Coverage campaign!  This campaign tells the real incredible story of how the new health care law is already helping millions of women, including women of color, by helping us to access important preventive care we need like mammograms and contraception without costly co-pays; by protecting us from discriminatory health insurer practices that have allowed them to deny care to those with pre-existing conditions; and by providing security in knowing that insurers can’t cancel our coverage when we get sick. 

Please take a moment today to learn about how the health care law is helping women of color get the health care they need and help us spread the word about these advances for women of color by sharing the links to our website and coverage checklists with a woman in your life.  Remember, we are powerful and when women and our families get the health services we need, we are healthy AND powerful.