Health reform moves to the states: What can reproductive justice advocates do?
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Health reform moves to the states: What can reproductive justice
advocates do?Lois Uttley, MPP
Co-founder, Raising Women’s VoicesAPHA annual meeting
November 9,2010
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What happens next?• Starting in January 2011, states must begin
constructing new health insurance “exchanges” that will open in 2014.
• We will see dramatic expansion of the Medicaid program to cover millions more people, with the same old Hyde restrictions.
• And, state regulators will get enhanced powers over insurance companies.
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RWV on the front lines
• Working in both reproductive justice and health reform coalitions in these states:– AK, CA (north and south), CT, FL, GA, IL,
LA, MD, MN, MO, NJ, NM, NY, NC, OR, PA (East and West), DC, WV, WI
• Nationally, working within HCAN, FUSA, Community Catalyst, UHCAN coalitions
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What to do? Educate ourselves, get ready • We need to get the reproductive justice
community up to speed and ready to act!• We need to be “plugged in” to state-level
implementation of health reform. • We need strategy and messaging for
reproductive health advocates working in pro-choice, anti- and mixed-choice states.
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What is an insurance exchange?• Think of it as a health insurance supermarket
or Travelocity, where you can compare offerings and choose the one best for you.
• Eligible individuals and small businesses will be able to buy commercial insurance policies, with the aid of federal subsidies or tax credits.
• Ideally, individuals can also enroll in public insurance plans through a state exchange.
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What are the issues for us?• First, will insurers be allowed to offer
abortion coverage in your state’s exchange?
• Under the Nelson amendment to the Affordable Care Act, each state has the power to allow, prohibit or restrict abortion coverage in a state exchange.
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What has happened so far?• 12 states have introduced bills to ban
abortion coverage plans offered within state insurance exchanges.
• Five states (Arizona, Louisiana, Mississippi, Missouri and Tennessee) have enacted these bans.
• Florida and Oklahoma legislatures passed bills banning abortion coverage, but their Governors vetoed these measures.
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What are we likely to face next?• The Pennsylvania bill restricts abortion
coverage to only 3 circumstances:– Rape cases, when the victim personally reports
the crime and identifies the assailant, if known, within 72 hours;
– Incest, if the crime is reported to authorities within 72 hours of confirmation of pregnancy;
– Life endangerment from physical, not mental, cause.
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Concerns from 2010 elections
• Some states with previously pro-choice and pro-health reform Governors now will switch to anti-choice/and or anti-reform.
• Kansas, New Mexico, Pennsylvania, Wisconsin, Maine, Michigan, Ohio among these states.
• In addition, anti-choice and anti-reform forces increased in some state legislatures.
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Will insurers offer abortion coverage, even if they can?
• Insurers are not required to offer abortion coverage, even if it is permitted in a state exchange.
• In fact, the health reform law specifically excludes abortion from the minimum required benefits package.
• And, no federal subsidies may be used to pay for abortion coverage.
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What would deter insurers?
• Requirement to process two separate payments for coverage – one for abortion coverage and one for everything else.
• Administrative burden of segregating the abortion coverage payments.
• Potential anti-choice campaigns against insurers offering abortion coverage.
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What would encourage insurers to offer abortion coverage?
• Minimizing administrative burden of the two-payment systems, such as by getting HHS and state insurance commissioners to allow one instrument to include two payments.
• Encouraging folks to sign up for insurance plans that offer abortion coverage.
• Potential cost savings for insurers.
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Find the right strategy for your state• In anti-choice states, consider alternative bills
or “poison pill” amendments.• Consider messaging carefully. Possible
emphases: health needs for abortion, consumer ability to use own funds for coverage, insurer freedom to offer plans.
• In pro-choice states, work with insurance commissioner to minimize burden on insurers.
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Paying attention to the fine print• There are other issues that could affect access to
reproductive health care:– Adequate provider networks: Will health plans that are
allowed to sell policies in the exchange have enough reproductive health providers, including abortion providers?
– Information: What will consumers be able to learn about plans before making an enrollment choice?
– Disenrollment rules: What if we make the wrong choice? – Insurer rules: Rules prohibiting the offering of different
coverage outside the exchange could spread abortion bans to non-exchange insurance plans.
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Another big challenge ahead
• Abortion coverage in Medicaid expansion. Millions more women will experience the Hyde amendment restrictions. Can we organize them and press for change?
• Will we be fighting defense in states that now fund Medicaid abortions, as budget cutters look for places to trim expenses?
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What is the opposition doing?• Claiming that health reform represents the
biggest-ever allocation of taxpayer money to abortions.
• Trying at Congressional and state levels to substitute Stupak for Nelson.
• Going beyond Stupak to try to bar employers from taking tax deductions for employee health insurance that covers abortions.
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Reach out to progressive allies• Many “consumer health” activists don’t know
what the abortion restrictions actually say.• They don’t realize that anti-choice forces will
be targeting 2011 state action on authorizing bills for state insurance exchanges.
• Better to get to them this fall, instead of having them be surprised (and antagonistic) in January.
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Work within progressive state coalitions
• Coalitions are deciding on their priorities for operation of state insurance exchanges.
• We can press for inclusion of “gender equity” and “comprehensive reproductive health coverage” within coalition priorities.
• Model coalition: Health Care for All New York.
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Get a seat at the table• Most states working on health reform have
set up advisory councils to the state agencies that are in charge.
• These councils typically have at least some consumer representatives.
• Repro justice advocates should try to gain representation, either directly or through membership in a coalition.
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Reach out to progressive state officials
• Educate state legislators about abortion and health reform, and prepare them for the battles ahead.
• Put this topic on transition requests for friendly incoming governors.
• Build working relationships with current or incoming state insurance commissioners, who will be carrying out key implementing steps.
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Models of engagement
• RWV-NYS has representation on NY Governor’s Council on Health Reform.
• RWV’s NM coordinator convened a women’s health in health reform advisory group to state legislators.
• RWV board member from Seattle serving on WA insurance commissioner’s advisory board
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Count on Raising Women’s Voices to keep you updated on health reform
• Visit our website at www.raisingwomensvoices.net
• Sign up for newsletter and alerts by contacting [email protected]