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Add Trump budget to Trumpcare and what do you get?

Trumpcare + Trump budget = Devastating news for women and families

The news from Washington this week really couldn’t be worse for women and our families. Yesterday, the Congressional Budget Office (CBO) issued its “score” of the final Trumpcare bill that passed the House of Representatives. The day before, the Trump administration proposed an alarming budget that would make things even worse. How does it all add up?

Next year, 14 million more people would be uninsured, according to the CBO. That number would climb to 19 million in 2020 and 23 million in 2026. This means that the historic coverage gains from the Affordable Care Act (ACA) would be eliminated, according to the Center on Budget and Policy Priorities analysis.  Because of the ACA, the rate of un-insurance among women had been cut in half.

The Medicaid program would be slashed by more than $834 billion in cuts over the next 10 years from Trumpcare, PLUS another $600 billion from the Trump budget. That’s because the ACA’s Medicaid expansion would be ended, and Medicaid would be radically restructured. Medicaid covers one in five women of reproductive health age and pays for half the births in the United States.  It covers 34 million children.

The ACA’s guarantee that maternity care and mental health care would be covered in our health insurance plans would disappear in many states. That’s because Trumpcare would allow states to drop requirements that insurers cover Essential Health Benefits (EHBs), which include maternity care and mental health care. As a result, the CBO predicted, “Out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year” for individuals who need that care and live in those states.

Women would once again face higher premiums for pre-existing conditions, like having been a victim of sexual assault or domestic violence, or having once had a Cesarean section delivery. That’s because under Trumpcare, insurers could go back to the pre-ACA days of having us fill out lengthy medical history questionnaires and then charging more to sick people and people the insurers decide have pre-existing conditions.

Yes, that’s right! The claims by Trump and House Speaker Paul Ryan that the final Trumpcare bill (H.R. 1628) would “protect people with pre-existing conditions” were false.  The CBO score explains:  “People who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all — despite the additional funding that would be available under H.R. 1628 to help reduce premiums.”

Heard enough? Want to take action to defend the health coverage we and our families need? Here are some things you can do at family events over the holiday weekend, and all next week, when members of Congress will be home in their districts for another recess:

  • At barbecues or other events over the long Memorial Day weekend, take the time to explain to your family and friends what’s at stake for women and our families. If we are to defeat Trumpcare and the proposed Trump budget, we will have to spread the word about what these proposals would mean for our health care.
  • If your family members will be remembering a loved one who died in service to our country,  share with them this analysis from Families USA about how  Medicaid cuts from Trumpcare would hurt the 1.75 million veterans who rely on Medicaid coverage.
  • Join a protest or Congressional town hall meeting to let your member of Congress know that women and our families do not want these devastating cuts to our health care. You can find an event near you by visiting the website of Resistance Near Me, a partnership between MoveOn, the Center for American Progress and the Town Hall Project.
  • Join Raising Women’s Voices in speaking out on line, with colorful graphics and lots of facts you can share with friends and family. You can find us on Facebook and Twitter.



Sound the alarm! We must #ProtectMedicaid

Now that the conservative campaign to repeal the Affordable Care Act (ACA) has moved to the Senate, we need to shift our ACA defense strategies and messages to anticipate what the Senate Republicans are likely to do. Many analysts expect the Senate, in writing its own ACA repeal bill, to drop or appear to address those elements of the House bill that undermine protections for people with pre-existing conditions. That will still leave us with legislation that slashes Medicaid coverage for millions of women and their families in order to fund tax cuts for the wealthy.

That’s why Raising Women’s Voices and many of our health care allies are focusing renewed attention on Medicaid as the cornerstone of coverage for low-income women across their lifespans. We urge you to help sound the alarm in defense of the Medicaid program. You can start today by joining the #ProtectMedicaid tweet chat from 3 to 4 p.m. Eastern (noon to 1 Pacific).  

Follow us @RWV4Healthcare to re-tweet our tweets! Here are a few sample tweets you can use to answer questions that will be posed by our colleagues at @Families USA, which is leading the Tweet Chat:

  • Medicaid cover half of all births in the U.S. #ProtectMedicaid
  • Family planning services funded by Medicaid prevent an estimated 2 million unintended pregnancies each year. #ProtectMedicaid
  • Screening for cervical cancer funded by Medicaid has prevented an estimated 2,000 deaths since the ACA expansion. #ProtectMedicaid
Join our Facebook live chat TODAY to get the big picture

Looking for the big picture of how the Senate Republicans are likely to make Medicaid cuts a big part of their own bill to repeal and replace the ACA? Join a Facebook Live chat this morning with Sarah Christopherson, who is Policy Advocacy Director for the National Women’s Health Network and Raising Women’s Voices’ expert on Congressional action. Sarah worked for Congress from 2005 to 2015, including serving as the Washington Director to Congresswoman Niki Tsongas (D-MA) from 2010 to 2015.
“The Trumpcare Fight in the Senate: What’s at Stake for Women” is taking place today at 11 a.m. on Facebook. Follow this link to watch live or share on social media.

Why is Medicaid so important for women’s health across our lifespans?

For low-income young women, Medicaid is an important source of coverage for family planning services and for preventive care, such as Pap smears and STD screenings. In 2014, family planning services funded by Medicaid prevented an estimated 2 million unintended pregnancies and 2,000 deaths from cervical cancer through preventive screening. Read more here.

For low-income pregnant women, Medicaid is an essential source of maternity care. Medicaid covers nearly half of all births nationally.

In 24 states, it pays for 50% or more of the births. You can see those states in the darker blue in the map at right, which was prepared by the Kaiser Family Foundation. 

To learn more, go here.

For millions of elderly women, Medicaid is an essential source of coverage. Women live longer and are more likely to have a chronic illness as we age. Women are 73 percent of the patients in nursing homes and 67 percent of those receiving home care. Medicaid finances half of long-term care in the U.S.

Holding the House GOP and Trump administration accountable!

While we are turning our attention to the Senate, Raising Women’s Voices and our regional coordinators are also working to hold accountable those members of the House of Representatives who voted for the American Health Care Act (AHCA, aka Trumpcare).

RWV regional coordinator Maura Collingsru of New Jersey Citizen Action (at left in photo, with megaphone) rallied outside of Congressman Tom MacArthur’s (R-NJ 3) Town Hall meeting in Willingboro, NJ, last week. MacArthur played a big role in the crafting of the AHCA, and as a result, was met by hostility from constituents who expressed their concerns over Republicans’ attempts to repeal the ACA. The meeting lasted for nearly five hours, and featured the voices and stories of New Jersey residents who would lose coverage if the House’s repeal bill were to pass in the Senate. New Jersey Citizen Action will continue weekly vigils outside of MacArthur’s office, and plans to organize vigils at other House GOP offices next week.

WV FREE, our Charleston-based regional coordinator, was there when Health and Human Services Secretary Tom Price visited West Virginia to speak to state and local policymakers about their efforts to combat West Virginia’s opioid crisis. Anduwyn Williams, WV Free’s Director for Reproductive Health Access, joined a crowd that stood outside of the Governor’s office, where Price’s meeting took place, holding signs that read "Don't Take Away My Health Care." Price refused to meet with or answer questions from WV FREE, or any of the other health care advocates who came to the Capitol in protest. One reporter was reportedly arrested after repeatedly asking Price whether domestic violence would be considered a pre-existing condition under the AHCA.
While West Virginia still has the highest drug overdose death rate in the country, Medicaid expansion has served to reduce the percent of people with substance use or mental health disorders who were hospitalized but uninsured from 23% in 2013 to 5% in 2014. Across the country, Medicaid continues to provide access to behavioral health treatment for several million people with serious mental illness or substance use disorders. The AHCA, a bill that HHS Secretary Tom Price supports, would slash funding for Medicaid, jeopardizing treatment for millions. 


Warning to Senate: Don’t poke the mama bear!


With Mother’s Day coming up on Sunday and National Women’s Health Week starting Monday, moms across the country are speaking out against the American Health Care Act (AHCA) approved by the House of Representatives last week. Among other things, it would empower states to allow insurance companies to drop coverage for maternity care and other Essential Health Benefits. Insurers could also charge women more if they have pre-existing conditions, such as pregnancy, or for having been a victim of domestic violence or having been sexually assaulted.
What else would moms stand to lose if the Affordable Care Act (ACA) is repealed and replaced by the AHCA? Check out our new fact sheet.

Allison Hooban, a pregnant 40-year-old mother of a 4-year-old girl, spoke out at a press conference held by U.S. Senator Kirsten Gillibrand of New York to blast the AHCA:

“They poked the mama bear. We won’t stand for it. Me and other moms refuse to let this pass.”

She explained that “The Affordable Care Act has been so helpful to my family. All of my wellness visits for pre-natal care are covered with nothing out of pocket... For my daughter and son -- when he’s born -- all their [routine] pediatrician visits are completely covered with nothing out of pocket for me and my husband, which
is huge.” She said she is worried that “If this [pregnancy] becomes a pre-existing condition and for some reason I have a gap in my health insurance, they could use that as an excuse to make my premiums prohibitively expensive so that I can’t afford it.”

Watch Allison speak out and share the video with your friends and family. Share our new #DontPokeMamaBear social media cartoon on Facebook and Twitter. You can find it on our Facebook page. Like our page and share our posts widely this Mother’s Day weekend!
Want to take grassroots action? A new initiative, the Payback Project, has been created to help health consumers hold accountable those members of the House who voted for the AHCA. It’s being sponsored by Indivisible, Moveon, the Town Hall Project and the Women’s March. Visit their website to find out about actions happening near you. 

What’s likely to happen as the Senate takes up ACA repeal/replace?

With the battle over Trumpcare now moving to the Senate, there are reasons to be both hopeful and concerned.

In the column for optimism:
The Senate won’t simply take up the House Trumpcare bill. Instead, they are writing their own bill. While there has been talk of a Senate vote in early June, Senate Republican leadership has made clear that they won’t schedule a vote until the Congressional Budget Office (CBO), Congress’s official scorekeeper, provides an estimate on cost and coverage. They have also promised to abide by rulings from the Senate parliamentarian if she finds that certain provisions don’t qualify under the narrow “Byrd rule” restrictions mandated by “budget reconciliation,” the parliamentary process that would let the GOP pass Trumpcare with just 51 votes.
There had been chatter among conservatives that the Senate GOP could simply change Senate rules and eliminate these restrictions. But forgoing a CBO score or overruling the Senate parliamentarian as she plays referee would be a de facto elimination of the legislative filibuster—something most Senate Republicans have been reluctant to do.
When CBO scored an earlier version of the House Trumpcare bill, it concluded that 24 million people would lose insurance—and that was before the bill turned more sharply to the right, making critical consumer protections optional for states.
Senate leadership can only afford to lose two GOP senators (with Vice President Mike Pence casting the tie-breaking vote), and there are likely more than three unwilling to vote for the kinds of coverage losses that the AHCA’s deep tax cuts require. If the Senate passes a less radical bill that retains most of the Affordable Care Act’s taxes and infrastructure, it’s possible that House conservatives would then balk when the Senate bill goes over to the House.
Similarly, the decision to abide by the rules of reconciliation could have complicated, unpredictable ripple effects on both women’s reproductive health and the politics of the vote. In 2015, the Senate parliamentarian ruled that blocking Planned Parenthood from accepting Medicaid patients (aka “defunding Planned Parenthood”) qualified under the Byrd rule, in part because CBO had concluded in 2015 that more providers than just Planned Parenthood could possibly be affected. In 2017, the CBO has come around to what we already knew: only Planned Parenthood will be affected. That, in turn, could impact the parliamentarian’s view.
Meanwhile, the House-passed version of Trumpcare eliminated the ACA’s subsidy to help low- and moderate-income households purchase private health insurance. The bill created a new, much skimpier subsidy, and tacked on a provision to prevent any of the funds from being used to pay for private insurance coverage of abortion. That provision is unlikely to qualify under the Byrd rule.
Should the Senate parliamentarian reject either the attack on Planned Parenthood or the attack on private insurance coverage of abortion—and certainly if she rejects both—anti-abortion groups have threatened to withdraw their endorsements.
In the column for pessimism: The House’s vote on Trumpcare is a good reminder that members of Congress under fire from their leadership and wealthy donors can be pushed into voting against their principles and their electoral self-interest. They might do so even to pass a bill with a sub-17% approval rating and in the face of overwhelming opposition from the American Medical Association, AARP, patient groups like the American Cancer Association, the American Hospital Association, and their own constituents. (In fact, the only true enthusiasm for the GOP proposal has come from groups dedicated to lobbying Congress on behalf of tax cuts for the rich.)
Right now, groups of GOP senators are meeting to hash out a substitute proposal to the House bill with
the goal of bringing it to a vote in early June immediately following the Memorial Day recess. A formal leadership-blessed working group of 13 white male Senators (pictured at right) representing the conservative wing of the party has already begun meeting regularly. Informal groups of GOP moderates and Medicaid expansion state members are also meeting. 
The Senate could eliminate some of the higher-profile problems with the House-passed Trumpcare bill—such as its attack on consumer protections for pre-existing conditions or its 67% increase in premiums for seniors—and delay the end of the Medicaid expansion, while leaving the core of the House bill in place, including its radical restructuring of original Medicaid. That would still leave us with a terrible bill.
Advocates must use the next three weeks to delay and divide the Senate GOP! While a number of Republican senators have been quick to voice their opposition to the House’s Trumpcare bill, few have yet drawn lines in the sand about what they won’t support in a Senate version. We are urging senators to state their opposition to any bill that does any one of the following things:

  1. Ends the Medicaid expansion, regardless of when;
  2. Ends Medicaid as we know it by switching to a per capita cap or block grant structure; or
  3. Increases the number of uninsured Americans, which encompasses everything from dismantling essential health benefits, driving up premiums, cutting subsidies, and more.

Hold them accountable for assaults on women’s health care!

The Trump Administration and Republican majority in the House of Representatives have given us the worst week for women’s health in a long time. By a narrow margin of 217 to 213, members of the House of Representatives voted today to approve an amended version of the American Health Care Act (Trumpcare) that would:

  • Bar Medicaid enrollees from using their coverage at Planned Parenthood.
  • Give states the option to allow insurance companies to drop coverage of maternity care and other Essential Health Benefits, such as hospitalizations, prescription drugs, and mental health services.
  • Give states the option to allow insurance companies to charge higher premiums to people with pre-existing conditions, such as women who have had babies through c-section deliveries.
  • Cause at least 24 million people to lose their health insurance.
  • Allow states to do away with caps on annual and lifetime spending limits.
  • Cut money from Medicaid, Medicare and other health programs to finance a huge tax cut for wealthy individuals. 

The amended American Health Care Act was voted on without a new official Congressional Budget Office (CBO) score to determine the impact on people and the health care system.

Raising Women’s Voices and our regional coordinators and supporters across the country will hold accountable those members of the House who voted for this terrible bill. As this legislation moves forward to the U.S. Senate, we will join the fight to defeat it.  We call on our Senators to reject this blatant assault on women’s health and the health care that our families need!

Earlier today, Donald Trump issued an Executive Order that appears to open the door to creating even broader religious or conscience exemptions to the ACA’s contraceptive coverage mandate.

U.S. Health and Human Services Secretary Tom Price, a long-time critic of contraception coverage, welcomed the opportunity to reexamine the contraceptive mandate. New Trump appointees to HHS this week are likely to embrace this idea since they are  opponents of contraception, as well as abortion:

  • Charmaine Yoest, the former CEO of Americans United for Life, is a new assistant secretary for health and human services; and
  • Teresa Manning, a former lobbyist for the National Right to Life Committee, is expected to be appointed to oversee the nation’s family planning program.

Raising Women’s Voices deplores any effort to deny women the contraceptive coverage we need, just because our bosses do not approve of it.


Act now to protect people with pre-existing conditions!


Desperate to revive Trumpcare and get it across the finish line in the House before members return to their districts for another recess at the end of this week, House Republicans have announced an amendment to include an additional $8 billion in funds for high-risk pools. We aren’t sure whether to laugh or cry.
As Republican Congresswoman Ileana Ros-Lehtinen (FL) noted, even adding six times that amount to the high-risk pools would still only be "a little baby down payment." In fact, experts think high-risk pools could actually need more than a trillion dollars (i.e. seven times more than what the entire bill provides) to match the coverage that people with pre-existing conditions currently have under the Affordable Care Act (ACA).
Tell your member of Congress you aren’t fooled
Even if your member of Congress has said “no” to previous versions of this bill, it’s critical to once again call and tell him or her that
Trumpcare would be a disaster for millions of Americans (read more about the bill here). This amendment is nothing more than an empty talking point. Let your member of Congress know you aren’t fooled.
The toll-free number to call Congress is 1-844-898-1199.
So what’s this amendment really about?
Maybe it’s an attempt to look responsive to the emotional appeal made by late-night show host Jimmy Kimmel, who revealed this week that his newborn son has a serious heart condition that required immediate surgery and will constitute a pre-existing condition for the rest of his life:

“We were brought up to believe that we live in the greatest country in the world, but until a few years ago, millions and millions of us had no access to health insurance at all,” Kimmel told this television audience. “Before 2014, if you were born with congenital heart disease like my son was, there was a good chance you’d never be able to get health insurance because you had a pre-existing condition. You were born with a pre-existing condition. And if your parents didn’t have medical insurance, you might not live long enough to even get denied because of a pre-existing condition.”

This new amendment could be about giving members of Congress “cover” to vote yes, without actually doing much to protect people with pre-existing conditions. Maybe they don’t want to take the blame among the conservative base for “killing Obamacare repeal.”

Let’s talk about pre-existing conditions
But whatever their true reason, let’s be clear: this bill would take us back to the days before the ACA, when millions of Americans with serious illnesses couldn’t get coverage. Some went bankrupt paying for treatments their insurance would not cover. Others died waiting to get into underfunded high-risk pools.

Those days will be back if Republicans pass Trumpcare. That’s because it would allow each state to eliminate the ACA’s protections for people with pre-existing conditions like cancer, asthma, or depression in two ways: 1) Insurance companies would once again be able to charge sick people sky-high premiums and 2) they wouldn’t be required to offer the coverage sick people actually need. Sure, insurance companies would still be required to offer everyone coverage, but they would be allowed to offer a cancer patient $10,000/month coverage that didn’t actually cover any cancer treatments or hospital stays.
Before the ACA, 47 states allowed insurance companies to charge people with pre-existing conditions exorbitant rates and exclude treatment for their known illnesses. Experts think the same thing will happen again because the proposed law also phases out the ACA rules and federal funding that help keep the insurance market financially stable. Once those rules are gone, states will be under enormous pressure from insurance companies to let them weed out the sick people.

Because Trumpcare also makes it easy for the states to stop requiring insurance companies to cover 10 Essential Health Benefits including maternity care, mental health care, and emergency room visits, insurance companies will be free to go back to setting yearly and lifetime caps on coverage.
Forced out of regular insurance, those with pre-existing conditions would be shunted into those high-risk pools we mentioned above. When programs like this were tried in the past, they resulted in limited coverage, higher costs, and long waiting periods for coverage for people in need.
And don’t forget, Trumpcare
strips $880 billion out of Medicaid and funds high-risk pools at a tiny fraction of what they need to work in order to give the 400 wealthiest households in America an average tax cut of $7 million each.
Remember: The toll-free number to call Congress is 1-844-898-1199.

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