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

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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?

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.

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.

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.

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.

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.

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

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 info@raisingwomensvoices.net