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RWVoices

Thursday
Nov172016

What if we lose coverage? Speak out!


Since the election of a President who has pledged to repeal the Affordable Care Act (ACA), with the help of a willing majority in Congress, women and families have been asking ourselves: “What if I lose coverage?”

The answers are disturbing: A return to high out-of-pocket costs for birth control and other women’s preventive services. No more guaranteed coverage of maternity care. Women left without coverage for cancer treatment. More medical bankruptcies that threaten our families.
 
Next week, Raising Women’s Voices will be launching a social media campaign encouraging women and our families to share our answers to the question: “What if I lose coverage?” We hope you will join us in raising our collective voices to tell Washington that we cannot afford to lose the coverage we have gained!
 
Get ready to share your story on Facebook and Twitter using the hashtag #IfILoseCoverage. And, if you are thankful that we are raising our voices about what would happen if we lose our coverage, please support our campaign with a donation
through the donate button on our website. It will take you to the Network for Good page of our fiscal sponsor, Community Catalyst. Earmark your donation for the Raising Women’s Voices #If I Lose Coverage campaign.

Meanwhile, keep enrolling in coverage!

Since the election, the number of people enrolling in coverage has been skyrocketing. That’s great, because if more people have coverage, there will be more people speaking up for keeping their coverage!

We know many of you are hearing from your base that people are discouraged from enrolling due to the belief that ACA will be gone in early 2017. It's important to assure people that their coverage will not be taken away so swiftly, encourage them to enroll, and assure and encourage them to join the fight to keep their ACA benefits. 

Under the ACA repeal legislation that has passed Congress previously, there is a two-year delay in the effective date, in order to allow health insurers, providers, and individuals to prepare for the changes. So, while raising our voices against losing coverage, we also need to help uninsured women and families enroll now, so they will have coverage in 2017.

What’s at stake: They’re coming for our birth control!

 
What will a Trump Administration and a Republican-led Congress do to the contraceptive coverage that millions of women have been enjoying because of the Affordable Care Act? Vice President-elect Mike Pence has been openly hostile to reproductive health as governor of Indiana. House Speaker Paul Ryan dismissed the birth control benefit as a “little nitty-gritty detail” in a news interview, and refused to say whether it will continue in any plan to repeal and replace the ACA.
 
But the coverage could be in jeopardy even before Congress acts to repeal the ACA. As faithful readers of this e-newsletter know, birth control coverage without copays or deductible payments is made possible by the ACA, but it isn't actually in the law itself. The law simply tasks an agency of the U.S. Department of Health and Human Services with coming up with a list of preventive services to be covered.
 
That means that the Trump Administration has the power to unilaterally repeal birth control coverage without Congress having to lift a finger. HHS simply needs to drop it from the list of approved preventive services. The process won’t be immediate. To change regulations, HHS will need to initiate formal rule-making and open a public comment period. The Office of Management and Budget (OMB) has the power to waive certain steps and expedite others, but 2017 plan years aren’t likely to be affected. That said, women are right to start planning now.
 
Right now, the people about to take charge in Washington aren’t hearing from the millions of women at risk of losing coverage. “No one is banging on my door saying, ‘Save this program,’” says Rep. John Shimkus, R-Illinois, who is in the running to chair the House committee with jurisdiction over health care. Help us change that now!
 
Speak out! #IfILoseCoverage.

Backing up our birth control with state-level contraceptive coverage laws

As we fight to maintain contraceptive coverage without co-pays as a federal requirement, Raising Women’s Voices will also be working with our state-based regional coordinators and our women’s health allies to enact state-level contraceptive coverage laws.  
 
A handful of states
 
have passed contraceptive coverage laws that aim to ensure comprehensive access to birth control. While the Obama Administration required insurers to cover all 18 FDA-approved methods of contraception without cost-sharing, as well as provide an easy-to-use exceptions process, inconsistent implementation and enforcement on a local level led states to pass legislation to fill in coverage gaps. Now, with expected threats to contraceptive coverage at the federal level, these state laws are becoming more important than ever.
 
Maryland, Vermont, and Illinois are among the group of states that have recently passed state contraceptive coverage laws—with two RWV regional coordinators playing key roles. Advocates in states such as Massachusetts and New York have been working hard to advance similar bills that would protect and expand contraceptive coverage.
 
Stay tuned to future RWV newsletters to learn how you can help Raising Women’s Voices and women’s health advocates in your state back up your birth control, in case we lose coverage under the Trump administration.
 
Please support our campaign with a donation through the Network for Good page of our fiscal sponsor, Community Catalyst. Earmark your donation for the Raising Women’s Voices #If I Lose Coverage campaign.

Thursday
Nov102016

Our plan: Raising Our Voices in difficult times

A word from the founding mothers
 
This is not the update we had hoped to be sending this week. Like many of you, we are shocked and worried about the future of our country and our work. The tone set during this campaign was so hurtful to so many of us. It is difficult to see these messages accepted and even embraced by many Americans.
 
But, as the founding “mothers” of Raising Women’s Voices, we know that after we recover and regroup, we must redouble our efforts. We must be the voice of the opposition in Washington and in many states across the country. We must speak effectively and powerfully for the health
care needs of women, people of color, LGBTQ people, immigrants, people with disabilities, low-income people and all those who are likely to be even more marginalized come 2017.
 
We will use the coming weeks to strategize about how to protect the gains we have made with the Affordable Care Act. In the meantime, stay strong and be in touch with us!
 
Byllye Avery, Cindy Pearson, Lois Uttley
Co-founders, Raising Women’s Voices for the Health Care We Need

 
The coming battles

The battles ahead are likely to be just as unpredictable as was this election result. We have a much clearer understanding of the true policy priorities of House and Senate Republicans than we do of our president-elect. Trump’s announced policy priorities have been thin and his campaign rhetoric and promises often contradicted those of his congressional allies and even his own earlier statements. Deep divisions remain within the party—as exemplified by the failure of the House and Senate to pass a budget resolution this year—and between the party and the president-elect over Social Security, Medicare, infrastructure spending and more.
 
But in other areas, we expect Republicans to attempt quick action. Trump has promised to make repealing the Affordable Care Act a top priority and congressional Republicans have proven willing to vote on repeal without having a replacement proposal in hand. In late 2015, congressional Republicans used a procedural tool known as budget reconciliation to sidestep a filibuster in the Senate and pass an ACA repeal. Vetoed by President Obama, the bill would have phased out the ACA’s Medicaid expansion and tax credits for purchasing insurance on marketplaces over a 2-year period while doing nothing to replace lost coverage. This is widely expected to be their template for 2017.

While Speaker Ryan is unlikely to win White House support for his proposal to voucherize Medicare, he is likely to win Trump’s blessing for deep cuts to the Supplemental Nutrition Assistance Program (SNAP, or food stamps) and to Medicaid—with devastating consequences for women.
 

In June, we highlighted Ryan’s plan to not only eliminate the ACA’s Medicaid expansion but also to slash the federal investment in traditional Medicaid. Under Ryan’s plan, states would be given the choice between a per capita cap on funds or a block grant. In either case, states would be stuck with 100% of the costs above the capped amount. As with Ryan’s Medicare voucher, both the cap and the block grant would be designed to lose significant value over time, saving the federal government money by shifting costs onto the most vulnerable.
 

The Ryan outline would also eliminate current federal rules that require states to cover poor children and pregnant women. Instead, the states would determine which groups to cover, would be free to impose harmful work requirements and charge premiums (read our brief to learn more about how these provisions impact women), and could establish enrollment caps and waiting lists. Many of these changes could be rolled into the same reconciliation bill repealing the ACA.
 
At the same time, the continued existence of the filibuster shouldn’t be assumed. As long-time Senate watchers know, only 51 votes are required to change Senate rules on the first day of the legislative session—and the “first day” can be extended through many calendar days. During the campaign, several prominent Republican senators and high-profile conservative think tanks argued for leaving the ninth Supreme Court seat unfilled during the entirety of a Clinton administration—a once-unthinkable departure from Senate norms and precedent. Following an election in which so many norms were violated, we shouldn’t take any for granted.
 
—Analysis by Sarah Christopherson, Policy Advocacy Director for the National Women’s Health Network
 
So what can you do?

 

 Now, more than ever, your voice is needed to highlight the real-world consequences of these actions. The true impact of repealing the ACA and gutting the social safety net has long been ignored by media outlets that knew Republicans couldn’t enact their proposals. Now they can. Join us in raising women’s voices to speak loud and clearly in opposition.   

Emily Brostek, Executive Director for RWV’s regional coordinator in Maine, Consumers for Affordable Health Care, reminds us:
 
“If you are hearing from consumers who are worried about what will happen to their coverage in the future, encourage them to contact their elected officials—both at the state and national level—to share what affordable health care means to them and their families. And people should also continue to sign up for health coverage through HealthCare.gov to get affordable health care. The ACA is still the law of the land.”
 
And we are going to fight to keep it!

 

Tuesday
Nov012016

Open Enrollment 4 starts today, with new challenges

Today is the start of the fourth open enrollment period since the Affordable Care Act (ACA) health insurance marketplaces first opened in the fall of 2013. To date, we’ve seen a great deal of success, with approximately 12.7 million people enrolling in private ACA marketplace plans and more than 14 million qualifying for expanded Medicaid and CHIP coverage.
 
Despite the historic reduction in the number of uninsured people in our country, there are an estimated 11.7 million people who are eligible for coverage, but currently uninsured. Many of these uninsured people are the women, LGBTQ people and families for whom Raising Women’s Voices advocates. We and our regional coordinators around the country will be working hard to reach and enroll these still-uninsured people during Open Enrollment Period 4.
 
What are the challenges we face this year? News coverage of premium rate increases is certainly one of them. Insurers offering health plans in the ACA marketplaces have received approval for significant rate hikes in a number of states. Also troubling have been reports that some insurance companies have dropped out of the ACA marketplaces. This kind of news could discourage some still-uninsured people from applying for coverage.
 
In fact, most people applying for coverage will still qualify for premium subsidies, which will go up to offset the increased premiums. So, the overall cost to most enrollees will not be substantially higher. The U.S. Department of Health and Human Services (HHS) reported that 85 percent of current Marketplace health enrollees receive premium subsidies, in the form of tax credits, to reduce the cost of their health care coverage. The percentage of new applicants who would qualify for the premium subsidies is expected to be about the same.
 
To counter some of the recent negative news, HHS has predicted that 72 percent of people applying for coverage using the HealthCare.gov federally-run insurance marketplace will be able to find a plan for $75 or less in premiums per month, and that enrollees will be able choose, on average, among 30 plans.
 
What advice can we offer still-uninsured people worried about premium rates? Consumer health advocates recommend comparing prices, just as you would with any other big purchase. “’Go shopping,” said  Elisabeth Benjamin, Vice President for Health Initiatives with the Community Service Society in New York. “You may be eligible for more financial help than you think.”
 
What can we tell current enrollees trying to decide if they can afford to renew their coverage for 2017? HHS suggests that switching plans can provide enrollees with significant savings on their premiums. “If all consumers switched from their current plan to the lowest premium plan in the same metal level, the average 2017 Marketplace premium, after tax credits, would be $28 per month less than the average 2016 Marketplace premium after tax credits – a 20 percent reduction,” HHS reports. Enrollees should also be sure to check their eligibility for Medicaid and, in New York, for the new low-cost Essential Plan, which has premiums of no more than $20 a month, and no deductible.
 
Open Enrollment Period 4 will run through January 31, 2017. You must enroll in a plan by December 15 in order to qualify for coverage that goes into effect January 1, 2017. While there are a number of ways to sign up for coverage, including online and over the phone, the easiest way for many people may be meeting with a trained “navigator” who can help you weigh your options and enroll in a plan that is right for you.
 
RWV regional coordinators will be doing their part. For example, the Lesbian Health Initiative in Houston, TX, is offering free in-person enrollment help during its fall health fair this coming Saturday morning, Nov. 5. Enroll Michigan has several enrollment events taking place around the state today and tomorrow. To locate a navigator in your area, you can enter your zip code into HealthCare.gov, where you can also browse through 2017 plans and prices.
 
Raising Women’s Voices at APHA Conference
 

Raising Women’s Voices Co-founders Byllye Avery, Cindy Pearson and Lois Uttley have been busy at the American Public Health Association conference underway this week in Denver, Colorado. The three have been staffing a booth in the giant Exhibit Hall being visited by more than 12,000 conference attendees. In photo above, Avery (second from left) and Pearson (second from right) talk to visitors at the exhibit booth.
 
RWV health insurance literacy materials have been a big hit at the APHA conference! For this Open Enrollment Period, RWV is offering copies of two one-page fact sheets – 5 Steps to Getting Started Using Your Health Insurance, and 4 Costs You May Have to Pay – which are available in both English and Spanish. These fact sheets are designed for newly-insured people who may not be familiar with how to use health insurance effectively and may not understand about premiums, deductibles, co-pays and co-insurance. We also have available copies of our popular Personal Health Journal. Check out these materials on our website, www.MyHealthMyVoice.com.
 
On Monday, the three RWV co-founders were joined by RWV Colorado Regional Coordinator Cynthia Negron of COLOR, a Denver-based organization of Latinas advocating for reproductive justice. She is at far left in the photo, next to Cindy Pearson, Byllye Avery and Lois Uttley, as they prepared to give a panel presentation on what is ahead for the ACA in 2017. They described the need to build on ACA accomplishments for women’s health and LGBTQ health in the years ahead, while working to improve affordability, continue to expand Medicaid in new states and extend coverage to those immigrants currently ineligible for ACA coverage.

 

Thursday
Oct272016

Raising Women’s Voices where we’ve been missing!

Raising Women’s Voices was in Pittsburgh last week for our first-ever visit to the National Academy for State Health Policy (NASHP) conference. We had a two-fold purpose: learn and influence. The conference -- an annual convening of state health officials, policymakers, medical associations and others -- covered a host of valuable topics, including Medicaid expansion, maternal health and health equity. But we discovered that in too many sessions one thing was missing: the voices and lived experiences of the women who participate in public health programs.

 
RWV has a special mission of engaging women who are not often invited into health policy discussions: women of color, low-income women, immigrant women, young women, women with disabilities, and members of the LGBTQ community. We place a priority on asking women to share their experiences navigating the health care system. Because women are often arrangers of health care for families and communities, we believe women are grassroots experts in what is wrong with the current health system and what it will take to fix it. To further that mission, staff from two of RWV’s three co-founding organizations attended the NASHP conference, speaking up for women. Pictured from left to right are Christy Gamble of the Black Women’s Health Imperative, and Cecilia Sáenz Becerra and Sarah Christopherson of the National Women’s Health Network.
 
This fall, RWV and our regional coordinators are gearing up to bring the voices of women to the policy debates surrounding health system transformation -- the emerging area of ACA work that aims to achieve truly “patient-centered care” and to deliver “the right care, at the right time in the right place.” A number of our regional coordinators are starting by conducting listening sessions with the women, LGBTQ people and families who make up their constituencies to hear firsthand what is needed. For example, grassroots constituents might suggest having doctors’ offices stay open later, making sure patients are not given the same test over and over, or having more community health workers and promontoras.

While we didn’t have the results from those listening sessions in hand for this year’s NASHP conference, we found it was often important just to start asking the right questions. Too often, the disparate impact of policy decisions on women, and particularly women of color, didn’t enter the conversation until RWV and our allies raised it. RWV Regional coordinator La'Tasha D. Mayes, Founder & Executive Director of New Voices for Reproductive Justice, pictured at left, joined RWV Regional Field Manager
Cecilia Sáenz Becerra of the National Women’s Health Network in raising these concerns.
 
For example, in our research earlier this year, we’d found that because women live in poverty, fall into the Medicaid gap, and lack reliable access to transportation at disproportionately high rates, they are particularly vulnerable to the decisions of policymakers during the Medicaid expansion waiver process. So we pressed public health officials from Indiana and Iowa to defend their decision to deny non-emergency medical transportation to the Medicaid expansion population and questioned whether their evaluations were accurately representing women’s experiences.
 
Drawing on our background fighting sterilization abuse and reproductive coercion directed toward women of color, low-income women, and immigrant women, we and our allies pushed back when panelists sought to override women’s reproductive autonomy in deciding for themselves which contraceptive was best.
 
And when several speakers noted the challenges faced by individuals accessing health insurance for the first time, RWV was there to talk about our fabulous health literacy guides—in English and Spanish!
 

Next up for the RWV team: Meet us at the APHA conference in Denver!

 
This coming week, RWV’s three co-founders – Byllye Avery of the Black Women’s Health Imperative, Lois Uttley of MergerWatch and Cindy Pearson of the National Women’s Health Network -- will be at the American Public Health Association conference in Denver. If you are going to be there, stop by our booth (# 1407) in the exhibit hall when it opens Sunday afternoon, October 30, or on Monday (all day), Tuesday (all day) or Wednesday (until noon). All three co-founders will be there on Sunday afternoon to greet visitors, offer free copies of our health insurance literacy fact sheets and Personal Health Journals and discuss what the Affordable Care Act means for women, LGBTQ people and our families.
 
On Monday, Oct. 31, you can hear from the three co-founders and from RWV’s Denver-based regional coordinator, Cynthia Negron from the Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR) during a panel presentation sponsored by APHA’s Women’s Caucus. It’s session #3181, taking place from 10:30 a.m. to noon at the Hyatt Regency Denver Hotel, Centennial Ballroom B. Here’s what they will be discussing:

  • Improving the Affordable Care Act for women and LGBT people in 2017 and beyond (Uttley).
  • Medicaid expansion, waivers and women: Community organizing and advocacy makes a difference (Pearson).
  • What’s at stake for Latina health in 2017 and beyond? (Negron).
  • From the margins to inclusion:Working with trans and queer immigrant-led activists on the ACA (Avery).
Open enrollment starts November 1!

 
The fourth open enrollment period for coverage through the ACA marketplaces starts next Tuesday. We’re getting ready, and will have a full report next week. Stay tuned!

Thursday
Oct202016

How do we find and enroll still-uninsured people?

The Affordable Care Act (ACA) has dramatically reduced the number of people living in the U.S. without health insurance. U.S. Secretary of Health and Human Services Sylvia Mathews Burwell predicted this week that another one million people will enroll in marketplace coverage for 2017, bringing the total of people who have purchased private marketplace plans to 11.4 million people.

As the November 1 start of Open Enrollment Period 4 approaches, state and federal marketplace officials, enrollers and health care advocacy organizations such as Raising Women’s Voices are focusing on a set of key questions: Who are the remaining uninsured people? Where do they live? Are they actually eligible for coverage, and if so, how do we reach and enroll them?
 
A new report by the Kaiser Family Foundation takes a close look at the estimated 27.2 million non-elderly people in the U.S. who lacked health coverage in 2016. The good news is that 43 percent of these uninsured people (11.7 million) are believed to be eligible for Medicaid, children’s health insurance or for tax credits that would subsidize the cost of private insurance purchased through the ACA marketplaces. The graphic below shows those eligible people in shades of blue.

 
The more discouraging news is that, at least for now, more than half of the remaining uninsured people (15.5 million or 57 percent) are not eligible for ACA coverage. Why? Kaiser’s analysis found that about 2.6 million (or 10 percent) fall in the coverage gap that has been created in states that still are refusing to expand their Medicaid programs. Another 5.4 million (or the 20 percent of the total uninsured) are ineligible for coverage due to their immigration status. We need policy changes at the state and/or federal level to address those barriers to coverage!
 
The rest of the uninsured people who are not eligible for ACA coverage either have an offer of employer-sponsored insurance they have not accepted (4.5 million people or 16 percent of the total uninsured) or have incomes that are too high to qualify them for tax credits (3 million or 11 percent of the total). In both of those cases, the cost of insurance may be discouraging enrollment.
 

Case Study: New York’s Remaining Uninsured

 
NY State of Health, the state-based marketplace in the Empire State, has had a track record of success, enrolling more than 2.8 million people in marketplace plans, children’s health insurance, Medicaid and a new low-cost option called the Essential Plan. As a result, the state’s uninsured rate has dropped from 10 percent to 5 percent.

“So, that remaining 5 percent – that’s what we are working on now,” explained Danielle Holahan, Deputy Director of NY State of Health, during an ACA Outreach and Enrollment Summit in Manhattan Wednesday (see photo) that attracted more than 125 people. Raising Women’s Voices-NY is working in partnership with the Health Care Education Project (HEP) of 1199 SEIU and with members of the Heath Care for All New York coalition to co-sponsor eight such summits around New York State to help boost outreach and enrollment during OE4.  
 
The Kaiser study estimated that New York still has 1,183,000 remaining non-elderly uninsured people. Of this group, Kaiser estimates that more than half (54 percent) are believed to be eligible for coverage -- an estimated 36 percent are eligible for Medicaid and 18 percent are eligible for tax credits to subsidize private coverage.
 
NY State of Health’s Holahan provided some suggested geographic targets for outreach to the remaining uninsured, based on marketplace research. For example, in the Bronx she listed eight neighborhoods (such as Soundview, Mott Haven and Morris Heights) where the uninsured rates range from 22 to 33 percent – much higher than the statewide uninsured rate. In Manhattan, she listed six neighborhoods (Washington Heights, Harlem, Central Harlem, East Harlem, Inwood and Hell’s Kitchen) where the uninsured rates range from 16 to 25 percent.  
 
Demographic targets for outreach include young adults and Latinos, both groups with higher than average uninsured rates. Holahan and participants in the summit discussed various ways to reach the still-uninsured, such as through targeted outreach at barber shops and beauty salons, cultural heritage events and at job centers. One enroller suggested outreach at urban shopping malls, since the enrollment period coincides with holiday shopping.
 
The summit was also designed to help navigators and their clients cope with a number of post-enrollment problems that newly-insured people are likely to encounter. RWV-NY Director Lois Uttley  (in photo at left) presented health insurance literacy fact sheets that enrollers can use to help their clients learn how to use their new coverage more effectively to get the care they need and avoid unexpected costs. The fact sheets are based on RWV’s popular My Health, My Voice literacy campaign materials, but have been specifically tailored for use in New York State. For example, the fact sheets use actual examples of co-pays, deductibles and co-insurance common to plans being sold through the NY State of Health marketplace.

Uttley stressed the importance of teaching enrollees how to get started using their health insurance right away, such as by making appointments for preventive care visits. “We want people to see value in their new insurance, so they don’t stop paying their premiums part way through the year, or decide not to re-enroll,” she explained. She distributed copies of RWV’s Personal Health Journal, which enrollees can use to set personal health goals, assemble family medical histories, take notes on medical appointments and record contact information for their families' medical providers. Want to learn more about these materials? Visit www.MyHealthMyVoice.com.

 

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