Health reform moves to the states: What can reproductive justice advocates do?

1. Health reform moves to the states: What can reproductive justice advocates do? Lois Uttley, MPP Co-founder, Raising Women’s Voices APHA annual meeting November 9,2010

2. 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.

3. 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

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. 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?

16. 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.

17. 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.

18. 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.

19. 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.

20. 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.

21. 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

22. Count on Raising Women’s Voices to keep you updated on health reform • Visit our website atwww.raisingwomensvoices.net • Sign up for newsletter and alerts by contactinginfo@raisingwomensvoices.net