The Road to Health Reform: Securing Reproductive Health Rights for Underserved Populations

1. The Road to Health Reform: Paving the Way for Reproductive Health Susan Berke Fogel JD November 14, 2011 “Securing Health Rights for Those in Need”

2. NHeLP • National public interest law firm working to advance access to quality health care and protect the legal rights of low-income and underserved people • Offices in Washington D.C., Los Angeles, and North Carolina • Comprehensive analysis of health care reform law; ongoing updates • Visit our website at: www.healthlaw.org

3. Where are we going?

4. The Road Forward

5. Goals and Ideals * “everyone” excludes undocumented immigrants

6. Health disparities and reproductive health Women of color of child bearing age are disproportionately poor • 10.7% non-Hispanic white • 11.1% Asian Pacific Islander • 25.5% African American • 22.4% Latina • 24.2% Native American/Alaska Natives People of color are the majority of individuals enrolled in Medicaid

7. Health Disparities and Pregnancy

8. Who Will be Eligible?

9. What is Covered?

10. Forks in the Road

11. State must certify plan as “Qualified” in order to participate in the Exchange • Cover essential health benefits • Cover preventive services • Abide by insurance reform rules • Have an adequate network • Include essential community providers • Meet other criteria as established by the Secretary HHS and the state Exchange

12. Sufficient numbers and types of providers • Ensure access to women’s heath services including abortion • Meet needs of geographic population • Language access • Contract with Essential Community Providers

13. Must contract with essential community providers that: • Primarily serve low-income medically underserved such as: • Family planning clinics • FQHC or other community health centers • HIV/AIDs health care service centers

15. Standards of Care are medical guidelines and accepted practice which are evidence-based, patient-centered, and prevention-oriented • Refusal clauses give permission to providers or institutions to opt-out of meeting accepted medical standards of care • Refusal clauses allow institutions to prevent providers from meeting the standard of care • Regardless of health outcome

16. Impact of Religiously-controlled Health Systems • 16% of California hospitals are Catholic; 20% of acute care hospital beds • Ethical and Religious Directives for Catholic Health Care Services - Direct Control by Church Hierarchy: • Absolute bans: abortion, sterilization, family planning • Limits on treatment miscarriage mgmt, ectopic pregnancy care, EC, end of life care • No health or life exception • May refuse some services to LGBT communities • Refusal to provide referrals = barrier in managed care • Actively lobbying against contraceptive coverage

17. Yes, women may die Q: Isn’t it better to save one life as opposed to allowing two people to die? A: We will never be able to eliminate all risks associated with pregnancy. What we should not do, however, is lower risks associated with pregnancy by aborting children. It is not better for a woman to have to live the rest of her existence knowing that she had her child killed because her pregnancy was high risk. Roman Catholic Diocese of Phoenix

18. A few of the many remaining questions • Ensure smooth transitions between Medi-Cal and Exchange • Fluctuations in income • Pregnant women • Preserve FamilyPACT & Pregnancy programs • Title X, Ryan White, Every Woman Counts • Citizenship documentation – ease the process and reduce barriers • Resolve problems using Medicaid model: notice and hearing • Eligibility denials, care denials • How much “flexibility to the states” is good for consumers?

19. The Basic Health Plan (SB 703) • State option (ACA § 1331) • Eligibility: • Under age 65, satisfactory immigration status • 134 – 200% FPL • Some cost-sharing allowed • EHB = minimum, state can provide more • Due Process • Administration – MRMIB or DHCS?

20. NHeLP www.healthlaw.org www.healthconsumer.org Fogel@healthlaw.org 310-204-6010 ext 113