Hey Congress - We expect women to be treated equally!

President Obama stood strong on contraceptive coverage despite intense pressure from the U.S. Conference of Catholic Bishops (USCCB), but last week the struggle continued as conservative members of Congress rushed to the aid of the Bishops. 

The latest assault on women and contraceptive coverage came last week as the House Committee on Oversight and Government Reform held a hearing entitled “Lines Crossed: Separation of Church and State.  Has the Obama Administration Trampled on Freedom of Religion and Freedom of Conscience?"  The committee chairman, Darrell Issa (R-CA), allowed Republicans to submit eight witnesses (all of whom were men), and denied the Democratic witness, Sandra Fluke, the right to testify as a representative of the millions of women seeking access to safe and affordable coverage for basic preventive health care, stating that she is “not an appropriate witness.” 
 
Ms. Fluke, a student at Catholic-affiliated Georgetown Law School, was asked about her university’s freedom of religious conscience.  She responded, “We can only answer that we expected women to be treated equally, to have their medical needs met.”  Sandra, we couldn’t agree more because we know that a woman’s conscience matters the most in matters relating to her health and life! 

House member Rosa DeLauro, D-CT, had the right question about the hearing: "What I want to know is, where are the women?  I look at this panel, and I don't see one single individual representing the tens of millions of women across the country who want and need insurance coverage for basic preventive health care services, including family planning. Where are the women?"
 
In his turn in the spotlight at the House hearing, Bishop William Lori of Connecticut went so far as to suggest that requiring Catholic-affiliated institutions to cover contraception for their employees was like forcing a kosher deli to serve ham sandwiches.  Really? Basic preventive health care is the same as a ham sandwich? Funny how that food theme keeps cropping up.  The general counsel for the Bishops last week complained that while the USCCB is exempt from having to cover contraception for its employees, “if I quit this job and opened a Taco Bell, I’d be covered by the mandate.”
 
So the Bishops’ friends in Congress have introduced four bills that would allow any employer – including Taco Bells or kosher delis -- to deny employees coverage of any health care service based on religious or moral objections.  All four of the bills (S. 1467 Blunt/H.R. 1179 Fortenberry, S. 2043 Rubio/H.R. 3897 Chabot, S. 2092 Rubio-Manchin, and H.R. 3982 Luetkemeyer) nullify the contraceptive coverage rule issued under the authority of the Affordable Care Act’s  preventive care requirement. Each of the four bills has additional objectionable elements:

• S. 1467 and H.R. 3982 allow plans to refuse coverage for any essential health benefit, which would include maternity care, HIV/AIDS treatment, mammograms or cancer screenings;
• S. 1467, H.R. 3982 and S. 2092 allow employers to refuse coverage on a broad definition of “moral” grounds, not just religious grounds;
• S. 1467 and S. 2092 provides those individuals or entities a private right of action to protect violation of their rights of conscience in stripping away basic health care for women;
• H.R. 3982 would block the HHS regulation on preventive services from going into effect at all.

These outrageous proposals undermine the fundamental goal of the ACA -- to help more people be able to afford the services they need to stay healthy.  We need to tell Congress that women, regardless of where we work, should have health care insurance that covers the services we need.  

What difference does a co-pay make? Plenty!

What difference does a co-pay make?  Plenty!

I’m 57.  It’s been a long time since I’ve used contraception.   When I did use it, back in the last century, pills and other kinds of contraceptives were all very affordable.  If you picked up your pills at the drugs store and paid out-of-pocket – which is what you had to do back then since no insurance plans covered contraceptives – you might pay $5/month for a cycle of pills.  And if you were young or poor or both, it wasn’t hard to find a clinic that offered pills for $1/month.  Even though the minimum wage was only $3.35, pretty much everyone could afford to use contraception when they wanted. 

What’s it like now?  In a word – bad.  Most contraceptives are so expensive that I honestly don’t know a single person who tries to pay the full cost of a prescription contraceptive out-of-pocket.  It’s true that women with insurance are now much more likely to have coverage for contraceptives than back in the old days.  But sadly, as coverage has expanded, co-payments have gone up.  Way up.

My 21-year old daughter and her friends are facing co-payments that are so high, there’s almost no way these young adults can earn enough to pay for contraception … assuming that they’re also paying for rent, food, transportation and all the other costs faced by young adults.  Yes, it’s true that the minimum wage has more than doubled since the last time I was a regular contraceptive user.  But what’s happened to costs?  Have they doubled, too?  Hardly!  My daughter’s friends are being charged $40/month co-payments when they buy their pills at the drugstore.   Even student health centers, traditionally a go-to place for low-cost prescriptions, are charging $20/month co-payments.   And don’t even get me started about the cost of IUDs!  Would you believe $800 for the device itself, not including the practitioner’s fee?

I’m angry at pharmaceutical companies for charging such outrageous prices.  And as a leader of a consumer advocacy group, I can promise you that we’ll keep putting pressure on these companies.  But in the meantime, we need to rally round the administration’s new rules that require insurance companies to cover contraception without any additional fees like co-payments or deductibles.   It’s the best chance we have, right now, to make sure that costly co-pays don’t stand between a woman and the contraception she needs. 

Part of the #HERvotes blog carnival.

Our voices were heard!

After reviewing more than 200,000 comments from the public – many of them from RWV supporters like you!-- HHS Secretary Kathleen Sebelius announced earlier today that almost all employers will have to include coverage for women’s preventive health services, including contraceptive services, starting in August 2012.  The administration, which had faced criticism from religiously affiliated organizations that do not currently cover contraception, announced that it will allow those organizations an additional year, until August 2013, to come into compliance.   This new rule requires insurers to offer policies that cover important preventive services with no extra fees, such as co-pays and deductibles. 

This is a huge and important victory for women.  The US Conference of Catholic Bishops and a few other religious leaders were lobbying the administration to create a broader exemption, allowing them to continue to deny women who work for a wide range of organizations affiliated with religious institutions coverage for comprehensive reproductive health services.  But thanks to you, HHS heard from more than just conservative religious leaders.  Women like you spoke out and told them just how important these services are to our health. 

Raising Women’s Voices for the Health Care We Need told HHS that we believe that women deserve full coverage of all their health needs, regardless of where they work, and HHS listened.  The administration’s decision maintains the narrow exemption for churches and religious organizations that serve primarily members of their own faith, rather than broadening the exemption as the bishops had urged.  It affirms the rights of the vast majority of women to make their own decisions about their health, while giving religiously affiliated organizations that currently don’t provide contraceptive coverage an extra year to comply with the requirement.

The preventive health services to be covered with no extra fees include comprehensive contraceptive care, screening and counseling for intimate partner violence, screening for gestational diabetes, breastfeeding counseling and equipment, screening for sexually transmitted infections (STIs) and a well-woman preventive care visits once a year. The requirement that all FDA approved methods of contraception be covered includes both long-acting methods such as the IUD and emergency contraception (EC).

You can read the formal announcement, here.

And you can send a new thank you to HHS by clicking here!

Thank YOU Affordable Care Act, For Helping Cervixes Stay Healthy!

My cervix is excited for 2012 and yours should be too!  The Affordable Care Act (ACA), despite its tender age of not-even-two, has and will continue to uphold its promise to provide more women with the quality affordable care we need to stay healthy and cervical health is no exception. 

In honor of cervical cancer awareness month, thank YOU Affordable Care Act, for helping cervixes stay healthy!

We know cervical cancer rates, with timely screenings, can be significantly reduced - introducing screening programs to populations naïve to screening reduces cervical cancer rates by 60% to 90% within three years of implementation.  This is a considerable reduction in cervical cancer rates, meaning when women have access to the health care they need, they stay healthy.  We also know that without those screenings and early detection, women face dire consequences - 85% of women who die from cervical cancer were never screened.

Preventive care services, like cervical cancer screenings, are critical to women because they allow us to monitor our health and catch illnesses before becoming catastrophic.  Regrettably, women are less likely than men to access these services due to cost.  Even small co-pays can dramatically reduce a woman’s ability to obtain preventive care.  A study by the Commonwealth Fund reported that in 2009, more than half of women delayed or avoided preventive care because of its cost.  This financial barrier has contributed to the dangerously high rates of cervical cancer and consequential high rates of mortality in some communities, particularly with women of color who don’t have good access to timely screenings and effective treatments.  Vietnamese American women experience a five times higher rate of cervical cancer than white women, and Korean American and Latina women have twice the rate of white women. In addition, black women diagnosed with cervical cancer are twice as likely as white women diagnosed to die from it. 

Two important provisions of the ACA have the potential to decrease these alarming rates of cervical cancer by eliminating the burden of cost-sharing for preventive health screenings for women.  The first has already taken effect, and women are already benefiting from it!  Starting on January 1, 2011, the ACA required Medicare to provide cervical cancer screenings without cost-sharing to the 22 million women who get health care through the Medicare program.  The second will extend similar protections – and more -- to women with private health insurance.  The ACA requires private insurers to cover preventive care services specific to women, including cervical cancer screenings, without any extra charges or co-pays starting as soon as August 2012.  This part of the law will help more women access not only cervical cancer screenings, but a full complement of the preventive health services women need to stay healthy.

We know that eliminating cost sharing is an essential element in ensuring that women are able to access the services we need.  So, from my cervix and millions of others, thank you ACA for upholding your promise to provide us with the health care we need to stay healthy!   

Dear HHS, Remember Women are Essential. Love, RWV.

On Friday, the U.S. Department of Health and Human Services (HHS) issued its first pre-rule bulletin on the Essential Health Benefits (EHB) provision of the health reform law.  

To meet the EHB requirements states will have to ensure that all insurance plans offered through the insurance exchanges cover the minimum set of benefits established by the law, including the 10 categories of care, like comprehensive maternity care and preventive health care that Congress laid out. The Friday bulletin from HHS says that states will be allowed to choose from several options to set up a benchmark plan, and the benefits offered under that plan will be the starting point for the state’s EHB.  A state might choose as its benchmark plan:

• One of the three largest small group plans in the state;
• One of the three largest state employee health plans:
• One of the three largest federal employee health plan options;
• The largest HMO plan offered in the state’s commercial market.

States that are hard at work creating exchanges were glad to get some direction about this important issue from HHS, and RWV is pleased that the process continues to move forward.  But health justice and women’s health advocates still have a lot of questions about what this approach will mean for people’s ability to get meaningful health care coverage, as promised by the health reform law.  We’re concerned that the approach outlined in the bulletin allows states so much flexibility that it won’t fix the problems women have been struggling with in states where high quality services are not accessible at an affordable price.

Strong federal standards for the EHB are essential to ensuring that health reform fulfills its promise to women of access to a core set of health services we need to stay healthy.  The EHB provision was supposed to correct longstanding gaps in coverage that many women currently face.  We are counting on HHS to uphold these promises by providing states with specific and enforceable direction.

HHS has requested comments on the bulletin by the end of January.  RWV plans to hold a series of calls to gather input on its strengths and on the issues that still need to be addressed before writing and submitting our comments.  To be part of this process, sign up for our newsletter to receive more information in the new year!  

Releasing a new "watch list" for state health reform advocates

 

State health insurance “exchanges” are supposed to offer consumers and small businesses quality, affordable health coverage beginning in 2014. But, as these exchanges are being developed, how can we guard against the introduction of policies that would restrict reproductive health coverage, discriminate against LGBTQ people, poorly serve immigrants or fail to adequately address health disparities?

To make this job easier for all of our reproductive justice and health reform colleagues out in the states, Raising Women’s Voices and the National Health Law Program (NHeLP) have partnered to produce a “watch list” of key exchange development issues, policy decisions and procedures.  We benefitted from the suggestions of RWV regional coordinators who have been grappling with exchange development issues in their states, and from some of our colleagues at national organizations working on health policy for women, people of color, immigrants, LGBTQ people, low-income communities and people facing end-of-life care decisions.

So, what should you be watching and seeking to influence as a health exchange is created and developed in your state? Here are key categories in our “watch list” for state advocates:

• Exchange Leadership: Who will be making the decisions about your exchange’s policies? How do we guard against undue influence by insurance company representatives and people promoting anti-choice, anti-gay, anti-reform and other regressive policies?
• Governance: Will your exchange operate in a transparent way and engage the public?
• Consumer Assistance:  Will a diverse array of consumers really get the help they need in choosing health coverage that meets their needs and fits their budgets?
• Provider Network Adequacy: Will the health plans offered in your state exchange include enough reproductive health providers, community health centers, providers who can serve LGBTQ people and providers who speak languages other than English?
• Coverage Benefits: Which reproductive health services will be covered? Will coverage work to reduce health disparities?
• Refusals/Restrictions: What demands are you likely to encounter that providers, insurers and even people enrolling in plans be allowed to refuse to provide or pay for services that conflict with their moral or religious beliefs?
• Effects on Providers: How will family planning providers accommodate an anticipated increase in patients seeking care? Will provider reimbursements be sufficient?

Yes, we know that not all states are moving forward rapidly in creating state exchanges, and some are outright resisting doing so – essentially betting that health reform will be repealed by a new Congress or struck down by the Supreme Court. But 11 states already have officially created exchanges and more will be moving to do so in 2012. State officials are being spurred by the availability of federal  exchange development grants and by worries that they might be caught unprepared and have to let the federal government run their exchange.

Need more advice on anything we’ve covered in this “watch list”? Want to offer a suggestion or an example of how you have handled one of these issues in your state? Contact us at info@raisingwomensvoices.net.

Calling On President Obama to Demonstrate His Respect for Women

President Obama LIKES TO TALK ABOUT THE FACT THAT HE LIVES IN A HOUSEHOLD OF STRONG WOMEN.  When he does it, he seems genuinely pleased and proud to be able to talk about his daughters, his wife and his mother-in-law in those terms.  And as a feminist, it makes me happy that we have a president who respects women and takes pride in his association with strong women.

But I’m hearing rumors lately that the president may be about to announce a decision that fundamentally disrespects women.  Instead of standing strong in defense of contraceptive coverage – a provision of health reform that will help to make the promise of affordable access to the health care we need real for millions of women – the White House may be about to strip that promise away from some women.

It’s not just women’s health advocates, like me, who think that contraceptive coverage is good policy.  Medical experts from the Institute of Medicine reviewed the evidence and concluded that CONTRACEPTION IS A PROVEN AND ESSENTIAL PREVENTIVE HEALTH SERVICE FOR WOMEN.  Public opinion research shows that most people agree that insurance companies and employers should cover contraception without co-pays. 

But there’s a narrow minority of religious leaders who don’t agree, and they’re pulling out all the stops to put pressure on the White House to let some employers play by different rules, denying women who work for those employers the coverage they need to lead healthy reproductive lives.  The US Conference of Catholic Bishops is calling for a broad exemption from the contraceptive coverage policy that would give employers the right to make health care decisions for the women who work for them.  That’s not respecting women – and it’s not what we expect from President Obama!

The consequences of allowing religiously affiliated employers to deny contraceptive coverage have become painfully apparent in some states in recent years. The president should listen to the voices of the women who have had to live with the results.

In Muskegon, MI, employees of secular Hackley Hospital lost their contraceptive coverage when the hospital became part of a Catholic healthcare system.  One nurse described the burden and anxiety that the coverage exclusion imposed on her family, and the desperate need they feel for help:

“We are just praying I don’t get pregnant until we can figure out how to get something. … My third pregnancy I lost twins. … I can’t go through more. It’s taken a toll on my marriage.”

Another woman noted that although the policy respects the religious view of her employer, it fails to respect her own views:

 “If I have health insurance,” she said, “I should get birth control . . . why should I have to follow what they believe?” 

The broader religious employer exemption being proposed would replicate these women’s experiences, nationwide.  President Obama, we’re calling on you to show your respect for ALL women – please, stand up for the contraceptive coverage policy that respects our right to make our own decisions about contraception

This blog entry was part of the HERvotes blog carnival.