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RWVoices

Tuesday
Apr182017

The fight to save our health care isn’t over yet!

With members of Congress back home in their districts for the April recess this week and last, the biggest news out of Washington has been the Trump Administration’s reckless game of chicken with the health insurance marketplaces created through the Affordable Care Act (ACA). Even as the Republican ACA repeal bill has entered a “zombie” phase—neither alive nor dead, but getting uglier by the day—Donald Trump has opened a new line of attack, threatening to take the health care of millions of Americans as his hostage. At stake is $7 billion in funding for “cost-sharing reductions”  -- essentially subsidies -- to keep co-pays and deductibles low for low-income households enrolled in marketplace plans.
 
This week, advocates are working to protect our health care from these latest threats. Below we will tell you how you can join in. But first, we want to bring you up to speed. 
 
In 2014, House Republicans sued the Obama Administration to stop the cost-sharing reduction subsidies,  arguing that they were never appropriated by Congress. The suit was expected to be dismissed—few legal experts thought the House had standing to sue—but a conservative lower court judge sided with Republicans. The payments were allowed to continue while the Obama Administration appealed. With the change in power, insurers hesitant about committing to the marketplaces for 2018 coverage have been watching to see what the Trump Administration will do.
 
Now that Republicans are increasingly likely to be blamed by the public for chaos in health insurance markets, most congressional Republicans would like to see the subsidies continue—but without their fingerprints. What was cynically tarred as a“taxpayer bailout for insurance companies” under President Obama is now being called a necessity for “marketplace stability.”
 
So, the New York Times reported last week that the U.S. Department of Health and Human Services (HHS) would continue to pay the subsidies while the lawsuit is pending, with the support of Speaker Paul Ryan (R-WI). But Trump himself reportedly angrily intervened and forced HHS to denounce the story, believing it lessened his negotiating position with Democrats. Trump gave several interviews where he said he wouldn't pay the subsidies in order to force Democrats to support the failed Trumpcare bill.

Congressional Democrats responded by suggesting that they are willing to let the government shutdown when current appropriations expire at the end of April unless Congress funds the subsidies directly. Since appropriations bills require 60 votes in the Senate, Republicans will need at least eight Democrats to pass a funding bill and prevent a shutdown. Meanwhile, all the uncertainty is driving insurers to leave marketplaces. And University of Michigan Law School professor Nicholas Bagley argues that resolving the subsidies through the lawsuit could be far trickier than most people realize.
 
Where does that leave us? We must demand that Congress fund the subsidies directly. Even as we fight continuing efforts to repeal the ACA, gut Medicaid and block women from accessing care at Planned Parenthood, we must press Congress to prevent the administration from sabotaging health care access from the inside. Insurers will not participate in the 2018 marketplaces unless they are assured that Republicans won’t pull a $7 billion rug out from under them. Only Congress can stabilize markets both near- and long-term.

 

What can you do?

The national Protect Our Care coalition, in which Raising Women’s Voices participates, is encouraging people to communicate with members of Congress while they are home in their districts during this Congressional recess. While the focus of much of this advocacy has been on persuading opponents of the ACA to stop trying to repeal it, we also need to remind supporters of the ACA that we appreciate their work! You can find out if there is a Congressional town hall meeting or another event near you by going to the website of Resistance Recess.

 
Planned Parenthood of Southern New England (PPSNE), our Raising Women’s Voices regional coordinator working in Connecticut and Rhode Island, hosted a Congressional recess “roundtable” discussion in Stamford, CT, on Friday. The event attracted more than 60 supporters of Planned Parenthood to hear directly from U.S. Senators Richard Blumenthal and Chris Murphy about their active support of PPSNE’s work, and the fight to preserve the Affordable Care Act (ACA). 
 
They warned of tough times still ahead, although both Senators are outspoken champions of protecting family planning programs and access to reproductive health care. The Senators discussed recent attacks on Planned Parenthood’s funding as well as the risks of newly appointed conservative Supreme Court Justice Neil Gorsuch.
 
There was time for audience participation, and multiple stories were readily shared about how Planned  Parenthood’s services were, in several cases, literally life-saving. Even Stamford Mayor David Martin told the story of someone very close to him who had sought Planned Parenthood’s services nearly 50 years ago, and how that health care changed her life…and his.
 
Last Wednesday, New Jersey Citizen Action rallied outside of Congressman Leonard Lance’s (R-NJ 7) Town Hall meeting to voice their opposition to the ACA repeal bill – the American Health Care Act or AHCA -- and to urge policymakers to save the health care of New Jersey residents. Lance voted for a version of the AHCA in committee but ultimately opposed the final bill under pressure from his constituents.  
 
On the same evening, NJ Citizen Action held a vigil outside of Congressman Tom MacArthur’s (R-NJ 3) office. MacArthur is the only New Jersey Member of Congress who supported the AHCA in its final form and continues to support efforts to take health care away from millions of Americans. 

What to say at a Congressiona Town Hall Meeting

If you go to a Congressional Town Hall meeting, what should you say?Here are some tips from the Protect Our Care coalition: Keep it simple. Our message is: Do not take away our care. Stop trying to repeal the Affordable Care Act. 

Members need to keep hearing from their constituents so they understand that it’s time to give up on repealing the health care law. Remember: Keep it personal. The best and most impactful questions are ones where someone shares their story about what the Affordable Care Act has meant to them or their family.
  1. Will you give up on repealing and replacing the law with anything that results in people losing their health coverage and increasing costs?
  2. Do you agree with the latest repeal efforts that include weakening protections for people with pre-existing conditions by allowing insurance companies to charge them as much as they want?
  3. Do you think the Trump Administration should be working to strengthen the individual market versus trying to sabotage it?
  4. Choose your own issue: It’s clear that people are against the American Health Care Act. Will you pledge to never vote for legislation that:
    1. Creates an age tax that makes health care more expensive for people between the ages of 50-64?
    2. Guts Medicaid by shifting costs to states through a block grant or per-capita cap and rationing the care of seniors, kids and people with disabilities?
    3. Allows insurance companies to stop covering basic services such as prescription drugs, maternity care, and cancer screenings?
    4. Stops women from getting their health care from a Planned Parenthood?
Wednesday
Apr052017

New GOP health care plan would hurt people who need health care most!


Republicans in the U.S. House of Representatives gave up on their first attempt to replace the Affordable Care Act (ACA). That was after the Congressional Budget Office (CBO) predicted it would cause 24 million people to lose their health insurance, in order to fund a massive tax cut for the very wealthy. Now they are back with the same basic repeal bill, but with the possible addition of two terrible ideas that would further undermine the ACA’s consumer protections, potentially stripping health insurance from millions more.
 
Under the new GOP plan, states would be allowed to drop two important provisions of the ACA: the requirement that insurance plans cover 10 Essential Health Benefits and provisions (known as “community rating”) to prevent insurance companies from discriminating against sick people.  There was also a report that Vice President Mike Pence had floated the idea of abandoning what is called “guaranteed issue” – essentially a requirement that insurance companies must offer you a health plan.

The people who would be hurt are those who need good health insurance the most—like pregnant women and people with pre-existing medical conditions! Insurance companies couldn’t refuse them coverage, but they could sell 
bare-bones plans that don’t cover the medical care that sick people need, or they could charge such expensive premiums that sick people couldn’t afford coverage.

 What are Essential Health Benefits and why do we need coverage for them?
 
One of the most important things the ACA did was require insurance companies to cover 10 important types  of health care called Essential Health Benefits. Examples include hospital stays, doctor visits, prescription drugs, maternity care and mental health services. Before the ACA, many insurance companies did not cover maternity care and mental health care and had skimpy coverage for other types of care.

If states are allowed to drop the Essential Health Benefits requirement, then insurance companies could sell plans that are 
cheaper but don’t cover very much. If we get sick or become pregnant, we would have to pay out of pocket for anything that isn’t covered—like cancer treatment or childbirth and newborn care. Comprehensive health plans would be significantly more expensive than they are now—or they might disappear altogether.

What is “community rating” and why do we need to keep it?

Under the ACA, insurance companies can't charge sick people more for the same coverage that they provide to healthy people in the same insurance market. This principle is known as “community rating” (versus “individual rating”) because insurance companies charge one premium based on the shared risk of the insurance pool instead of charging each person based on his or her individual health status. This keeps coverage affordable for the people who need it most and eliminates the extensive paperwork and reporting requirements of the pre-ACA days when insurance companies could discriminate based on health status.

If Republicans allow states to get rid of community rating, insurance companies will once again sort us based on how healthy or sick they think we are and charge millions of people substantially more for their insurance, pricing millions out of people out of coverage altogether. We will have to fill out lengthy questionnaires about whether health status 
and 
history and could once again have our policies canceled if we forget to list even mild pre-existing conditions like acne. These policy cancellations were common before the ACA.
 
What would happen to people with pre-existing conditions?

People with pre-existing conditions, such as women with breast cancer, would be left without any affordable health plans that actually cover the care they need. This is exactly what happened in many states before the ACA.
 
Republicans in Congress say they would take care of people with pre-existing conditions by helping states to create what are called “high-risk pools.” A 
high-risk pool is made up of people who have pre-existing conditions and can’t afford health insurance that covers the care they need.

When 
high-risk pools were tried in the past, people with pre-existing conditions often had long waits (six to 12 months) before they could qualify. They needed to show documentation that they had a health condition, which could be difficult to do without insurance coverage to pay for the necessary tests. Not only that, even when people do get insurance through a high-risk pool, it still might not cover all the care they need.

Republicans say they will subsidize the cost of health insurance for people in those pools with a “stabilization fund” of $115 billion over 10 years. But people who have studied this plan say that wouldn’t be nearly enough money. They estimate it will cost between $200 billion to $1 trillion, and that would only cover a small proportion of the uninsured people with pre-existing conditions.

 

Thursday
Mar302017

Celebrate our victory, but don’t take your eyes off Washington!

 

We have a lot to celebrate in our come-from-behind victory over the proposed American Health Care Act (AHCA) last week, so here’s a toast to all our hard work! Together, we made the case that women, LGBTQ people, and our families would be hard hit by a bill that would have caused 24 million people to lose their health insurance, gutted Medicaid, blocked Planned Parenthood from accepting Medicaid and given almost a trillion dollars in tax cuts to major corporations and the very wealthy. Many thanks to all of our Raising Women’s Voices regional coordinators and all of you who raised your voices in defense of women’s health care.
 
But don’t take your eyes off Washington yet! Today, the Senate is taking a vote on a resolution that would allow states to deny Title X family planning funds to Planned Parenthood and other abortion providers. That’s even though Title X funds don’t pay for abortion services. Title X is an extremely important source of funding for the family planning services that low-income women, including many uninsured immigrant women, desperately need. Today’s vote would override a rule the Obama administration had issued blocking discrimination against Planned Parenthood in the Title X program.
 
Meanwhile, Republicans in the House of Representatives – smarting from a weekend of humiliating news coverage -- are talking about bringing the AHCA back to the House floor, possibly as soon as next week. We don’t know how seriously to take this talk, but we know hard-right Republicans are desperate to give Donald Trump a win and we know the entire conference is eager to pass
a round of massive tax cuts for the wealthy through ACA repeal (paid for by deep cuts to Medicaid!) before they officially start working on a tax package.
 
How did the AHCA fail last week?
 
Last Friday, House Republicans had to pull their bill from consideration when it became clear that they didn’t have votes to pass it on the House floor. In a desperate bid to shore up their right flank, leaders negotiated massive changes to the insurance markets in the dark of night, including stripping essential health benefit protections such as maternity and newborn care, prescription drugs, mental health care, and more from millions of women.
 
No one knows exactly how such a massive disruption to insurance regulations would have affected markets, because Republicans didn’t bother to consult Congress’s official scorekeeper, the Congressional Budget Office (CBO), before throwing the provision into the bill. But experts predict that it would have led to even worse coverage than before enactment of the ACA. With insurers still required to accept sick people, but no longer required to cover the medications, hospital visits, or other care those sick people require, insurers would race to design the skimpiest possible plans to lure in the healthiest possible enrollees. They’d also design plans just cheap enough that people could use their $2,000 tax credit, leading to the rise of, say, aromatherapy-only plans that bilk the government while providing no real benefit to taxpayers.
 
While much of the press coverage has focused on the extreme right wing group known as the House Freedom Caucus, it is clear that a number of those members were ready to cave right before the bill was pulled. So we must continue to take our fight to the “moderate” wing of the party, to any member sitting in a swing district, to any member whose state expanded Medicaid, and so on. Whether there’s a vote on this bill next week, a vote in May, or an attempt to pass parts of this legislation through must-pass bills later this year, our message must be clear: If you come for our care, we will come for you!
 
What are they likely to do next?
 
Even if this particular bad bill never again sees the light of day, we know they are far from done attacking women’s health. In Congress, members will have multiple opportunities for mischief. They hope to take on tax reform and may once again look to Medicaid as a piggybank. They need to fund the government for the remainder of the current fiscal year on April 28. They need to negotiate a budget that sets total appropriations for the next fiscal year. They need to prevent a debt default. They need to reauthorize the Children’s Health Insurance Program (CHIP), which forms a key backstop to the ACA.
 
Over in the executive branch, there’s considerable harm they could do even without congressional action. They could move to strip contraceptive coverage requirements or issue an executive order on “religious freedom” so broad that it nullifies most women’s health protections. In the aftermath of the House GOP’s failure last week, Trump repeatedly tweeted his seeming intent to sabotage the ACA and force it to “explode” in the hopes that voters blame his political opponents.
 
While numerous experts—including the CBO—believe that most ACA marketplaces are stable, the Trump administration could take actions to actively destabilize them. For example, the IRS could announce it was no longer enforcing the individual mandate, prompting the healthiest people to drop coverage and making premiums more expensive for everyone else.
 
What the IRS has actually done thus far represents the bare minimum of it complying with Trump’s inauguration day executive order. That order urged federal agencies to waive wherever possible “any provision or requirement” of the ACA that would impose any kind of “cost, fee, tax, penalty, or regulatory burden.” This year was the first year that the IRS was supposed to start turning away tax returns that didn't include self-reported health insurance information.
Instead, they very quietly let tax preparers know that they would continue to accept those returns as they always have. In short, the Trump administration could gut the individual mandate, but they haven't yet.
 
Equally disruptive, the Trump administration could stop fighting a lawsuit filed against the Obama administration by House Republicans in 2014 over subsidies paid to insurance companies to keep copays and deductibles low for low-income marketplace enrollees. Under the law, the insurance companies are required to provide the benefit, but without subsidies from the federal government, they would be forced to raise premiums or withdraw from markets. In an effort to keep markets stable, House Republicans and the Trump Department of Justice jointly agreed to delay the suit until May. Some Republican members of Congress have begun talking about formally appropriating these funds. But if they want to destroy the ACA from within, they’ll almost certainly start here.
 
Our job in all of these cases will be to remind Republicans that the politics of ACA sabotage have changed. Slowly degrading how Americans interact with the health system was great politics for Republicans under President Obama, when they could rightly or wrongly pin every problem on the law they nicknamed for him. But now that they control both Congress and the White House, voters will hold them accountable for how well the system functions.
 
Every single member of the US House of Representatives and one-third of the US Senate will be up for election in November 2018. It’s our job to let them know that we will hold them accountable for what happens in Congress and in the Trump administration. If the executive branch takes away our contraceptive coverage, if they harm ACA insurance markets, if they block women from accessing care at Planned Parenthood, we will hold them responsible at the ballot box.
 
Last week’s victory showed just how powerful we are when we make ourselves heard. The fight is far from over, but we know we can win it!

 

Friday
Mar242017

House leaders pull bill that would have devastated our health care


Rep. Jan Schakowsky, D- Illinois, stood on the House floor today and addressed Republicans who were announcing their support for the American Health Care Act (AHCA): “Did you really come to Congress to take health care away from 24 million people?”

No, as it turned out, not all of the Republicans thought that was a good idea. Thousands of calls from constituents and warnings from the Congressional Budget office about the likely impact of the bill apparently convinced enough Republicans that the AHCA was not ready for prime time. Last-minute changes to the bill to assuage the far-right House Freedom Caucus had made the bill even worse by opening the door for insurers to drop coverage for maternity care, hospital stays, prescription drugs, mental health care, cancer treatment and more. People with pre-existing conditions faced the possibility of exorbitant prices for health coverage.

Raising Women’s Voices joins our colleagues in the #ProtectOurCare coalition in a big sigh of relief that the American public has been spared this devastating bill – at least for now. We helped make the case to moderate Republicans that this bill went too far.

We extend our deepest thanks to all of Raising Women’s Voices regional coordinators, supporters and allies who helped make possible today’s action halting the AHCA in its tracks. Our families can rest easier tonight, with peace of mind that the health coverage we count on will still be there for us.

But, we must stay vigilant. This is only the first attempt to roll back the advances we have made with the Affordable Care Act! We must be mindful that a number of the Republican members of the House who refused to support the bill thought it didn’t go far enough!

As you celebrate tonight and this weekend, plan to stay with us going forward. We need to pull together to protect our health care in this turbulent political time.
Friday
Mar242017

Action Alert! #Killthebill that devastates women and families!


 

Overnight, House Republican leaders have once again amended the already awful proposed American Health Care Act (AHCA) and they are rushing to vote on it this afternoon. We must do everything we can to #Killthebill today and stop the momentum in Congress to repeal the Affordable Care Act (ACA) and cut Medicaid.


We already knew that the proposed AHCA would raise premiums 20 percent, charge older people five times more than young people, provide only skimpy subsidies, cut Medicaid, block women from using their Medicaid coverage at Planned Parenthood and cause 24 million people to lose their health insurance. The new amendments have made a bad bill even worse:
  • Maternity coverage would no longer be guaranteed. Nor would coverage for any of the Essential Health Benefits that women and our families need, such as ER visits, doctor visits and prescription drugs.
  • As a result, women would once again end up paying more than men. Anyone who needed maternity coverage (women of reproductive health age) would have to pay more for it. Trei Clark of Atlanta recalls paying $350 a month extra for maternity coverage before the ACA.
  • People with pre-existing conditions would end up having to pay exorbitant prices for health coverage. That’s because insurers would eliminate from their basic plans coverage for things like breast cancer treatment. Coverage for such treatment would become an expensive extra, effectively pricing health coverage beyond the reach of people with pre-existing conditions.
  • Because the ACA’s ban on annual or lifetime caps on coverage applied only to the Essential Health Benefits, when the EHBs are eliminated, insurers are free to once again impose annual and lifetime limits on coverage. This means that once again, we and our families could find ourselves running out of coverage part way through treatment for an illness, such as breast cancer, or accident. Once again, families could face bankruptcy because of skyrocketing medical bills.
What can you do?
  1. Call your members of the House of Representatives immediately! Here are the toll-free call-in numbers: English: 866-426-2631 Spanish: 877-736-7831
  2. Find a protest event near you and join it today! Check out ResistanceNearMe.org for events.
  3. Use social media to alert your family, friends and colleagues about this emergency call to action to save our health care. Check out the Raising Women’s Voices Facebook page at RWV4Healthcare.