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This week’s view from Washington, D.C

This week’s newsletter will be shorter than usual as we get ready for our annual convening in Washington, D.C. this week, when Raising Women’s Voices regional coordinators from around the country gather to discuss the months and year ahead. We’re excited to bring together so many different voices and perspectives at a time when the challenges facing us are so many!

But first, a quick update on what is happening in Washington, where conservatives still hope to beat the odds and push through a Trumpcare bill before the clock runs out on September 30 --  even as a bipartisan group of senators is working on a bill to stabilize health insurance markets upended by Trump’s sabotage.

Watching Graham-Cassidy bill as a “sleeper” threat

We wrote last week about the Graham-Cassidy bill, which is the last standing threat to repeal of the Affordable Care Act (ACA). The bill would turn the ACA and Medicaid’s guarantee of coverage into state-based block grants that cover millions fewer people, and would eliminate altogether both the Medicaid expansion and the ACA’s subsidies for private insurance after 10 years. The bill is expected to be released later this week after its initial introduction date of Monday was delayed. It is being backed by the White House and the House Freedom Caucus, but faces opposition from at least one Senate conservative after Senator Rand Paul (R-KY) announced this week that it doesn’t go far enough for him.

It’s clear that the bill doesn’t yet have the votes, and a number of Republicans are eager to set aside health care and move onto tax reform. But we will be monitoring it as a sleeper issue right up until 12:01 am October 1, when the current reconciliation process (allowing passage with only 51 votes, instead of the usual 60-vote requirement) loses its privilege on the Senate floor.
Work continues on bipartisan health coverage stabilization package

Meanwhile, there’s quiet optimism about the bipartisan package being crafted by the chairman and ranking member—Senators Lamar Alexander (R-TN) and Patty Murray (D-WA), respectively—of the Senate Health, Education, Labor & Pensions (HELP) Committee, even as a number of sticky issues remain. 

In August, CBO concluded that failure to fund the cost-sharing reduction (CSR) payments that lower out-of-pocket costs for low-income consumers payments “would increase the federal deficit, on net, by $194 billion from 2017 through 2026,” by driving up premiums and automatically increasing federal premium subsidies. A number of insurance companies have warned that they won’t participate in the health care marketplaces at all without a guarantee that the payments will be made. Most importantly, Republican leadership in Congress appears to have accepted that the payments must be made in order to stave off voter outrage.

In the ongoing negotiations, Republicans want to provide only a single year of CSR funding while Democrats argue that true stability demands a multi-year investment. At the same time, Republicans want Democrats to support unwinding key consumer protections in exchange for CSR money.
Senator Murray has been adamant that Democrats “will reject any effort to use this process as a back door to pass parts of Trumpcare that would erode protections for people with preexisting conditions — for example, women seeking maternity care or those with mental illness or substance-use disorders.” It’s likely that Democrats have the upper hand in negotiations. With a sizable block of Republicans in both chambers likely to oppose a deal no matter what, Republican leaders will have to depend on Democratic votes for passage, which should give Democrats significant leverage over the final deal.

Some of our regional coordinators will also be paying visits to their members of Congress while they are in DC this week for the RWV annual convening. We will be eager to hear what they learn.
Watch for next week’s newsletter, which will give highlights of our convening!





Trump is back, and we’re fighting back!

Just back in Washington from his summer vacation, Donald Trump is already busy using the power of the presidency in ways that will harm marginalized people – young immigrants who dream of citizenship and uninsured people who desperately need affordable health coverage.
This week, Trump announced that over the next six months, he will end the Deferred Action for Childhood Arrivals (DACA) program initiated by President Obama. DACA has allowed hundreds of thousands of young immigrants brought to the U.S. as children (often referred to as “Dreamers” for the DREAM Act, which would provide them with a pathway to citizenship) to gain work permits and live their lives free from the threat of deportation.
Unless Congress takes action, the DACA announcement will not only be a looming humanitarian crisis, it will also be a health crisis. Over 90 percent of the Dreamers surveyed in a recent study are currently employed, and hundreds of thousands of them get their health insurance through their employer. So, loss of their work permits will mean loss of their health care.

We express our solidarity with the thousands of activists throughout the country who have mobilized to defend the Dreamers and all of the undocumented people who face harassment and deportation. Raising Women’s Voices staff joined a protest march to Trump Tower in New York City last week, in anticipation of his action on DACA. Some of our signs are shown above. Our resolve for action was perfectly captured by two of our regional coordinators.

“We will continue to speak out and to organize and to fight any policy or any decision that will undermine our health, dignity and rights,” said Cristina Aguilar, Executive Director of the Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR). “Immigrants are here to stay. A strong, vocal, organized Latinx community is here to stay in this fight. We are not going anywhere.”
California Latinas for Reproductive Justice (CLRJ) released this statement: “Today CLRJ continues to stand strong and follow the lead of immigrant youth, who consistently put their lives on the line, to fight for all immigrants - queer, black, trans, low-income, and other immigrants who are deemed “unworthy” by U.S. immigration policies. Let us be clear, a person’s worth is not determined by their economic contribution, their age at entry, or any other category that defines their status. We will fight for immigration reform that fulfills our dream to be with our families, for the 800,000 DACA recipients and for ALL 11 million undocumented people. We will accept nothing less.”

 Meanwhile, Trump is sabotaging our health coverage
As part of its wholesale attempt at sabotage of the ACA, Trump’s Department of Health and Human Services (HHS) announced late last week that it would only spend $10 million on nationwide advertising of the 2018 open enrollment period—down from $100 million the year before. In addition, HHS would cut the amount spent on in-person outreach through the federal navigator program by 41 percent. As Vox reported, “Those in-person outreach efforts also ensure that vulnerable populations, like those that don’t speak English or lack internet access, can still enroll. Instead of making Obamacare more robust and inclusive, they’re setting the law up to fail.”
Trump’s demand that Senate Republicans hold another Trumpcare vote was given extra urgency after the Senate parliamentarian ruled on Friday that the special expedited process (known as budget reconciliation) that Senate Republicans had hoped to use to repeal the ACA with just 51 votes would die with the end of the current fiscal year on September 30. Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) have been pushing a radical proposal that would turn the ACA and Medicaid’s guarantee of coverage into state-based block grants providing less than two-thirds of the current federal commitment to health care funding. The bill would completely eliminate both the Medicaid expansion and the ACA subsidies for private insurance after ten years.
While the crowded Senate to-do list makes action before September 30 difficult, a short-term deal announced on Tuesday between the White House and congressional Democrats to raise the debt limit and make a down payment on disaster relief funding could open the door for Republicans to make one last Trumpcare push. This time, they have locked up the vote of Graham friend Senator John McCain (R-AZ), who told reporters this week that despite his impassioned pleas for a return to “regular order” process of bipartisan committee hearings and careful deliberation, he would still vote for the proposal, even if leadership rushed it through.

Should Republicans secure 51 votes on Graham-Cassidy or any other Trumpcare proposal, they will be able to pick up from where they left off in July, with all debate time expired and the rapid-fire vote-a-rama on amendments under way. In other words, some of the most consequential legislation in our nation’s history could get a vote with no committee consideration and only 5 minutes of debate on the Senate floor.
Fortunately, there was also a hint of positive news this week as the Senate Health, Education, Labor & Pensions (HELP) Committee began its first round of bipartisan hearings over the next ten days to help craft a bipartisan deal to stabilize health insurance marketplaces before September 27, when insurance companies must sign final contracts. Republicans had hoped to avoid giving insurance experts a chance to publicly unwind their most dishonest talking points by ramming a Trumpcare package through Congress without hearings, but this week state insurance commissioners were finally given the chance to knock down falsehoods and to urge Congress to fund the cost-sharing reduction (CSR) payments that Trump has repeatedly threatened to withhold. For example, Theresa Miller, Pennsylvania’s insurance commissioner, testified that “the narrative that Obamacare is imploding is just false,” while Mike Kreidler, Washington State’s commissioner, compared not permanently funding CSR payments to yelling ‘fire’ in a crowded theater.

We’ve been keeping the pressure on Congress
While members of Congress were in their home districts for the recess, some of our regional coordinators and national allies participated in visibility events and district meetings to send a message that our health coverage must be preserved.

The Save My Care Drive for Our Lives bus hit the road again, touring the country to highlight the stories of people whose lives on are the line if the ACA is repealed. Among some of its final stops were in Charleston, West Virginia, and in West Orange, New Jersey. RWV regional coordinators WV FREE and New Jersey Citizen Action (NJCA) both showed up to welcome the bus to their state, and to highlight the impact ACA repeal would have on local women and families. 

WV FREE staff Chela Barajas, Julie Warden and Amanda Schwartz (pictured above from left to right) were at the August 24 Drive for Our Lives bus tour stop in Charleston, WV
At the September 1 bus stop in West Orange, New Jersey, NJCA and partners Health Professionals & Allied Employees (HPAE), Blue WaveNJ, NJ Assemblywoman Mila Jasey (D Essex/Morris), local host Pastor Miquel Hernandez and 50 community members, pictured below, welcomed the tour’s crew and speaker Ilyse Hogue, President of NARAL. The rally called on Republicans to recognize health care as a human right.  NJCA Health Care Program Director Maura Collinsgru issued a call to action urging people to continue the fight to save the ACA and join with NJCA in promoting the upcoming open enrollment saying, “boosting enrollment is the best defense we have against repeal.”  See a video of the event, including Maura’s full speech here

Meanwhile, RWV’s Memphis-based regional coordinator,SisterReach, took advantage of the August recess by meeting with some of their members of Congress in-district. As part of their Reproductive Justice Week of Action (August 22-24), SisterReach hosted a legislative day of action where they met withCongressman David Kustoff’s (R-TN 8) staff about the importance of fixing, rather than dismantling the ACA. SisterReach also held a policy briefing -- Our Bodies, Our Lives, Our Voices: The State of Black Women and Reproductive Justice Policy -- with Congressman Steve Cohen (D-TN 9), where they applauded his efforts defending the ACA.  London Lamar, SisterReach’s Policy Associate, is shown on the right in the photo.



Advancing reproductive and racial justice in conservative states

See what RWV coordinators in conservative states have been doing!

With images of white supremacists marching in Charlottesville fresh in our minds, Raising Women’s Voices is more committed than ever to fighting for reproductive and racial justice. Our founding mission states that we want to raise the voices of those who are often marginalized and left out of health care policymaking, including women and LGBTQ people of color, immigrants and our families. One of the ways we are pursuing that mission is through funding and supporting groups in conservative states that are working for reproductive and racial justice. This week, we are proud to share some of what they have been doing this year!

The Afiya Center, the Raising Women’s Voices regional coordinator in Dallas, TX, has been working hard to promote reproductive justice in a state with a hostile political climate.

One of the legislative priorities championed by the Afiya Center took an important step forward late last month. On July 31, the Texas House of Representatives passed HB 11: The Texas Moms Matter Act, a piece of legislation to address the maternal mortality crisis in Texas. Afiya Center Executive Director Marsha Jones, third from left in photo, celebrated House passage of HB 11 with the bill's sponsor, Representative Shawn Thierry (D-Houston), second from right, and legislators and advocates.

The Texas Moms Matter Act will create a Maternal Mortality and Morbidity Task Force within the Department of State Health Services to review cases of pregnancy-related deaths and trends in severe maternal morbidity, which has disproportionately affected Black women. The Afiya Center hosted a press conference addressing the maternal mortality crisis in Texas, encouraged supporters to attend hearings and drove out calls to state representatives and senators demanding they support The Texas Moms Matter Act.

Earlier this year, the center hosted a #TXBlackWomenRiseUp Advocacy Weekend attended by women of color advocates and allies, as well as supportive state legislators. The weekend included a rally with abortion provider and activist Dr. Willie Parker and other reproductive justice leaders, a screening of the documentary film TRAPPED and an advocacy training before hill visits the next day to the state capitol building in Austin. Advocates distributed information on the ACA and Medicaid, and other laws that would impact Black women, maternal health, women with HIV and LGBTQ individuals.

With so much at stake for states, governors and state legislators have played an outsized role this year in the national fight over the future of the ACA and Medicaid. The Afiya Center also took their message directly to Congress, meeting with the offices of Representatives Eddie Bernice Johnson and Marc Veasey and Senators Ted Cruz and John Cornyn, and attending Representative Joe Barton’s town hall in Mansville, TX, speaking up in defense of the ACA and Medicaid. 

Meanwhile, SisterReach, the RWV regional coordinator in Memphis, TN, has laid the groundwork for a model of intersectional partnerships, taking a regional approach to building reproductive justice (RJ) power in the South. Earlier this year, they initiated a cross-state coalition, the Deep South Regional Round Table, to build RJ power across Tennessee, Mississippi, Arkansas, Kentucky and Alabama, with a focus on priorities such as opposing religious exemptions that allow health providers and employers to deny care and coverage, criminal justice, and reproductive and healthcare justice.

SisterReach was also active in the fight to save the ACA and Medicaid, co-leading the Save My Care Bus Tour’s Memphis stop, and hosting a “Black Folks on the Hill” day at the Tennessee state capitol in Nashville.  SisterReach provided training, exposure to legislative committee and caucus meetings, and helped their participants meet legislators and staff in six offices. The photo shows SisterReach CEO & Founder Cherisse Scott, staff and volunteers posing with State Representative G.A. Hardaway Sr. during Black Folks on the Hill Day.

In Louisiana, Women With A Vision, one of two RWV coordinators based in New Orleans, held RJ roundtables in New Orleans, Baton Rouge and Lafayette to discuss health issues important to Black women, including ACA and Medicaid expansion. Then they took those messages to the state capitol, bringing low income Black women and LGBTQ individuals from across the state to Baton Rouge for an advocacy day focused on Black women’s issues. “Our Voice Our Time:  Black Women’s Advocacy Day” was attended by over 50 women, who met with state legislators and their staff to discuss the impact of Medicaid expansion on women in Louisiana. WWAV trained the participants on how to advocate for health care, ACA and Medicaid, and provided swag bags with educational information related to policy advocacy as well as t-shirts, fans and pens. Shown below are “Our Voice Our Time” attendees posing in their pink WWAV shirts at the state capitol in Baton Rouge.

WWAV also participated in RWV’s #IfILoseCoverage social media campaign, asking women across the state to describe the effect ACA repeal would have on their lives. They gathered stories highlighting women’s fears about losing their choice of when to reproduce, not being able to receive their medication, decrease in standard of life, fear of losing preventive health services and not being able to manage chronic illnesses. 

On the other side of the country in Phoenix, AZ, RWV regional coordinator Trans Queer Pueblo convened an organizing institute in May, during which supporters, board members and staffers discussed “know your rights” training, health justice, and economic justice. A second convening is planned to train new members in leadership development and enhance their ability to activate communities. TQP uses promotora leaders, or community health educators, to speak with LGBTQ people and migrants about the importance of health care.  With the support of RWV, TQP brought on board three promotoras this year in time for TQP’s first organizing institute to learn effective organizing. 

The promotoras are tasked with outreach to the immigrant community to encourage use of the LGBT-friendly primary care clinic, Clínica Liberación, which Trans Queer Pueblo created.  Trans Queer Pueblo continues to grow support for their clinic and organization through hosting monthly activities like volleyball and sex-ed trivia with Planned Parenthood and healing circles.

This year, TQP also joined Joti-PolitcAZ, a coalition tracking state legislation affecting health and other issues impacting the LGBTQ community. TQP put together an advocacy workshop for their membership, hosted small community gatherings and fought back against Donald Trump’s tweets to block trans military servicemembers from serving. They made news in Phoenix during the annual Pride Parade when they temporarily shut down the parade to highlight the ways in which the movement has failed to ensure the rights of trans and queer migrants, bringing the issue national attention.  Shown in photo are Trans Queer Pueblo leaders Cyntia Domenzain Mejía and Karyna R Jaramillo protesting at the Phoenix Pride.


While fighting ACA repeal, we’ve been busy protecting our health in the states

For months, we’ve been highlighting Raising Women’s Voices work opposing efforts by Congress and the White House to repeal or replace the Affordable Care Act (ACA). Now that we have a brief pause in the action, after the Senate repeal/replace efforts failed spectacularly, we want to share with you some of the amazing work our Raising Women’s Voices regional coordinators have been doing to protect the health of diverse women, LGBTQ people and our families at the state level.

Oregon passes Reproductive Health Equity Act and Cover All Kids Act

Our Raising Women’s Voices regional coordinator based in Portland, OR, the Oregon Foundation for Reproductive Health, celebrated a major reproductive health win with the successful passage of the Reproductive Health Equity Act. This comprehensive piece of legislation will ensure access to reproductive health care for everyone in Oregon, regardless of income, type of insurance, citizenship status or gender identity. The bill will provide the full scope of reproductive health care, including contraception and abortion, with no cost-sharing. Notably, it will extend post-partum care to about 48,000 Oregonians of reproductive age, including undocumented immigrants, who have coverage for labor and delivery that drops immediately after birth.

The Reproductive Health Equity Act was part of a larger policy agenda of Fair Shot for All, an initiative with the goal of achieving greater health equity in Oregon. Just last week, the Cover All Kids act (SB 558), another Fair Shot legislative priority, was signed into law. With its passage, Oregon became the seventh state in the country to extend health coverage to all children, regardless of their immigration status. 

RWV coordinators push for contraceptive coverage protections, expansion

RWV Regional coordinators have been joining with allies in more progressive states to advocate for policies that would secure the ACA’s contraceptive coverage protections and even improve on them. Both Washington and Colorado approved legislation that will improve access to contraception by allowing for the dispensing of 12 months of contraception at one time. Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR), RWV’s Denver-based RC, and Northwest Health Law advocates (NoHLA), our Seattle-based regional coordinator, played critical roles in the successful passage of these bills. COLOR was present as Governor John Hickenlooper (shown at right) signed HB 1186 into law at the state Capitol.

Twelve-month dispensing policies align with recommendations from the Centers for Disease Control and Prevention, which state that providers can promote the consistent use of contraception by providing or prescribing multiple cycles of contraceptives at a time. A 2011 study found that dispensing a one-year supply of contraceptives (as opposed to a three- or one-month supply) is associated with a 30% reduction in the likelihood of an unplanned pregnancy.

RWV regional coordinators in a handful of states -- including CT, MA, MN, NM and NY -- worked to build support for contraceptive equity bills that would codify the ACA’s contraceptive coverage requirements into state law, thereby ensuring that women have access to the full range of FDA-approved contraceptive options with no cost sharing.  Bills to accomplish that goal were enacted last year in Illinois and Maryland with the support of our regional coordinators.  While none of the proposed bills in other states were enacted this year, our regional coordinators reported they made good progress in communicating the need for these policies and are looking forward to 2018 state legislative sessions to renew their efforts.

New York protects reproductive health coverage through regulatory action

In New York, the Cuomo Administration responded to requests from Raising Women’s Voices-NY and other  women’s advocacy groups for state-level action to protect New York’s women from attacks on reproductive health coverage by Congress and the Trump administration. The governor issued regulations to expand contraceptive coverage protections in the state. These regulations, which are less comprehensive than the proposed Comprehensive Contraceptive Coverage Act, which RWV-NY continues to support, were finalized in June. They require coverage without co-pays for one type of contraception in each of the 18 FDA-approved categories (the federal ACA standard), and allow for the dispensing of 12 months of contraception after an initial three-month allotment (June 28, 2017 Register: Page 13, Notice of Adoption).

In addition, the Cuomo Administration finalized another regulation that requires private insurance coverage for medically necessary abortions without cost sharing (June 21, 2017 Register: Page 18, Notice of Adoption). While the draft regulation included an overly broad religious exemption – which would have followed the disturbing national trend of allowing employers to use their personal religion to discriminate against employees – the finalized regulation includes a much narrower religious exemption. The change came in response to hundreds of comments that individuals and organizations like RWV-NY submitted in support of the proposed regulations, and urging the Administration to narrow the scope of the overly broad religious exemption.

More recently, the Cuomo Administration proposed a rule that would require insurance carriers offering health plans in New York’s individual and small group market to cover the ACA’s 10 Essential Health Benefits, which include vital services for women, such as maternity care. The emergency/proposed rule also includes a non-discrimination provision, which includes discrimination based on race, color, creed, national origin, sex (including sex stereotyping and gender identity), age, marital status, disability and preexisting conditions. RWV-NY has joined other members of the Health Care for All NY coalition in praising these proposed measures, but urging the addition of sexual orientation to the non-discrimination policy.

Preserving funding for Planned Parenthood at the state level

Since many of the GOP’s proposed ACA repeal bills included provisions that would defund Planned Parenthood, our coordinator in Maryland, Consumer Health First, worked to successfully advocate for the passage of HB 1083 – Family Planning Services – Continuity of Care. Maryland is the only state in the country to proactively address the threat to women’s health in the event that the federal government revokes funding under Title X, the national family planning program. The bill directs $2.7 million in state funding to establish a Family Planning Program at the Department of Health and Mental Hygiene. This ensures that patients can continue to access these providers, including Planned Parenthood.

RWV will continue to fight for our health at the state level!

Given the continued federal threats to our health, it is critical that states serve as leaders in ensuring access to reproductive health care. RWV and our regional coordinators will continue to work to protect women, LGBTQ people and our families from harmful federal policies that threaten our well-being.


What’s next for health care in Washington?  

Wondering what’s next after the Republican effort to repeal the Affordable Care Act (ACA) was dramatically stopped in its tracks last week? This week has brought a pause in action on the Senate floor to repeal the ACA, but also a new round of legislative threats. Moreover, we’ve seen another promise from a petulant president to actively sabotage the law at the expense of millions of Americans who rely on it for their care. On the positive side, there are signs of bipartisan efforts to save the cost-sharing reduction subsidies that lower co-pays and deductibles for low-to-moderate income people.

Three GOP senators promote extreme bill masquerading as moderate

This week, Senators Lindsey Graham (R-SC), pictured on the right, Bill Cassidy (R-LA), pictured on the left, and Dean Heller (R-NV) announced that they are working on yet another extreme GOP-only bill with the House Freedom Caucus to gut the ACA. The bill would repeal the ACA’s Medicaid expansion and its financial assistance to help low-to-moderate income households purchase private insurance. In their place, the bill would give states a block grant worth less than what the federal government would contribute under current law. The states that expanded Medicaid would receive deep cuts in their funding, while the 19 states that have so far refused to expand would be rewarded with a windfall. The block grant would be worth less and less each year, until ending abruptly in 2026.
The bill is being mistakenly cast as a moderate alternative because it keeps a portion of the ACA’s revenue. But as Vox correctly noted, “In many ways, it’s the most radical one yet.” In addition to cutting the federal investment by over one-third, the bill would destabilize private insurance markets by requiring insurance companies to accept sick patients but eliminating both the carrot of subsidies and stick of an individual mandate to encourage healthy people to sign up.

In a sign of likely conservative support, Scott Walker, Wisconsin’s far-right governor, has already endorsed the proposal. Graham and Cassidy have reportedly been pitching their plan to a White House eager to sign anything that they can cast as tarnishing President Obama’s legacy.

 But, if this happens, we will be ready to resume our resistance! Standing by are RWV regional coordinators such as New Jersey Citizen Action, which was in D.C. last week for the Senate vote. NJCA’s Maura Collingsgru (front right in photo) reported: “What a successful trip! Repeal and delay failed in the Senate. We met with one New Jersey Senator and two Congressmen. We delivered thousands of petitions and spoke with staff members of four Congressmen to urge them to vote against any bill that increases costs and decreases coverage. We visited the Senate gallery to watch debate on repeal and rallied with Planned Parenthood. We brought New Jersey's fight to save our care to D.C. and we're back on the bus to keep the fight going back home.”

But wait, isn’t the repeal effort dead in the Senate?

From a procedural perspective, the repeal effort is not dead in the Senate but rather undead, and could potentially stay that way until the end of this Congress on January 3, 2019. We defeated multiple amendments last week, but Senate Republican Leader Mitch McConnell (KY) pulled the underlying bill (the House-passed Trumpcare bill, also known AHCA) before a vote on final passage, sending it to a kind of procedural limbo on the Senate floor calendar.
If Republicans can win 50 votes for a deal, they will simply re-start the debate on the reconciliation bill where they left off, offering their new plan as another amendment. Remember that the Senate already used up most of the 20 hours allowed for that debate during last week’s floor action, so there would be little left for debate of any new bill!

Cost-sharing reduction subsidies threatened

Threats from Congress are not the only ones we’re watching closely. Over the weekend, Donald Trump unleashed an angry tweetstorm directed at the Americans whose health insurance he’d hoped to take away and the members of Congress who had defied him.  Trump falsely called  cost-sharing reduction (CSR) payments a “bailout” for insurance companies and threatened to stop making these payments, which keep deductibles and copayments low for low-to-moderate income families on the individual market. 
Under the ACA, insurance companies are required to keep cost-sharing artificially low for low-to-moderate income patients and the federal government is required to make up the difference in payments to insurers. If Trump cuts off those payments, insurance companies could abruptly withdraw from individual markets or they could hike their premiums to make up for their costs. Rates must be set by mid-August, leaving insurers just two weeks to cope with the uncertainty caused by the White House. 
But nothing in yesterday’s court’s ruling requires the Trump administration to keep making the payments, and Trump could still proactively stop paying  for CSRs by re-writing the Obama-era regulation that authorized them.
The prospect that the Trump administration could cut off the payments has encouraged some fledgling bipartisan efforts in Congress. Lamar Alexander (R-TN), who is chair of the Senate health committee, urged Trump to continue the CSR payments and said he'd seek bipartisan legislation extending the payments for one year.  He promised hearings in September on legislation to “stabilize and strengthen the individual insurance market” for 2018. Senator Patty Murray (D-WA), the senior Democrat on the health committee, said she welcomed Alexander’s statement.
So, stayed tuned! We will to monitor developments in Congress. Next week, we will report on what RWV regional coordinators have been doing on the state and local level, while the federal work to defend the ACA and Medicaid has been raging.