Guest post by Ann Danforth, Progressive States Advocacy and Policy Manager at Raising Women’s Voices-NY.
In their latest attack on women’s health, the Trump Administration released two new rules that weaken the Affordable Care Act (ACA)’s birth control benefit. The interim final rules (see here and here), which went into effect immediately, allow employers to deny their employees birth control coverage because of an employer’s moral objection to birth control. In addition, the rules expand the scope of employers who can cite religious objections for denying their employees birth control coverage. Luckily, here in New York, many (but not all) women will be protected by new state regulations that require insurers to cover birth control with no cost sharing.
The ACA guarantees coverage for a set of women’s preventive health care services, which through federal regulations issued by the Obama administration, include birth control. As a result, employers are required to cover all methods of FDA-approved birth control for employees with no cost sharing. Under the Obama administration, houses of worship were exempt from the requirement to cover birth control for their employees. An accommodation ensured that women who work for a narrowly-defined group of employers that object to providing coverage on religious grounds still had access to seamless birth control coverage.
The Trump Administration’s recent actions expand the exemption to include all employers, universities, and insurance companies, and make the accommodation optional. Now, instead of an accommodation that protects employers’ religious views and women’s access to vital health care, these new rules simply allow almost any employer to refuse to provide birth control coverage to their employees for either moral or religious objections to contraception.
While not all employers will choose to deny contraceptive coverage to their employees, these rules create sweeping new exemptions that put women’s coverage at risk, and roll back important gains in women’s health. Thanks to the ACA, 62.4 million women have insurance coverage for their birth control with no out-of-pocket costs. The percentage of women with employer sponsored insurance who were paying out-of-pocket expenses for birth control pills fell from 1 out of every 4 women before passage of the ACA to just 1 out of every 28 women in 2014. And in 2013 alone, women saved $1.4 billion in co-pays and deductibles on birth control pills.
Here in New York, an estimated 3,855,517 women between the ages of 18 and 64 have preventive services coverage, including birth control, with zero cost sharing thanks to the ACA. Fortunately, many New York women will still have guaranteed access to contraception with no cost sharing because of recently finalized New York State regulations. These regulations require coverage without co-pays for one type of contraception in each of the 18 FDA-approved categories (the federal ACA standard), and allow for the dispensing of 12 months of contraception after an initial three-month allotment (June 28, 2017 Register: Page 13, Notice of Adoption). Unfortunately, however, our state requirements do not reach “self-funded” insurance plans, which are regulated by the federal government, and not subject to the New York regulations. Because as many as 40 percent of New Yorkers have these self-funded plans, there are a number of New York women who will not be protected. The Trump Administration’s new rules have put us in a place where a woman’s zip code, employer, or income determine her ability to access the contraception she needs.
While our colleagues at the ACLU and the Center for Reproductive Rights have already filed lawsuits challenging the new rules, we must call on employers to stand up for their employees and publicly declare they will continue to provide contraceptive coverage. In addition, all of us who are employees can demand that our employers affirm they will continue providing contraceptive coverage. We will also continue to support legislation here in New York – the proposed Comprehensive Contraception Coverage Act – that would place even stronger contraceptive coverage requirements into state law.
Although it has no immediate effect, the executive order the President signed yesterday morning instructs several federal agencies to consider proposals that could destabilize the individual insurance markets established under the Affordable Care Act (ACA).
The executive order instructs relevant agencies to propose regulations that would:
- Expand the use of association health plans, which allow small businesses to group together to purchase health insurance;
- Allow more people to enroll in short-term limited duration insurance, which are exempt from ACA consumer protections, for longer periods of time; and
- Allow the sale of health insurance across state lines.
The expansion of association and short-term limited duration health plans would both create loopholes for younger, healthier consumers to purchase one of these plans instead of plans offered through the Marketplace. If younger, healthier people leave the Marketplace, premiums will rise for consumers that remain and may become unaffordable.
Selling insurance across state lines presents a different problem, especially for states like New York. New York has worked really hard to pass insurance regulations that protect consumers. Insurance sales across state lines would essentially allow insurance companies to choose their regulators, which would make insurance less available and less accountable to the needs of New Yorkers and consumers across the country.
If federal agencies do propose these rules as the President instructs, there will be an official notice of proposed rulemaking and at least a 30-day comment period before any new regulation would go into effect. It is therefore unlikely that any changes will take place before 2018.
This does not affect the upcoming open enrollment period, which will begin on November 1. If you or someone you know needs help enrolling in health insurance, please call (888) 614.5400 for in-person assistance in your area. Don’t forget, consumers enrolling in Medicaid, the Essential Plan, and Child Health Plus can enroll year-round.
You can check out additional resources on the executive order here.
Guest post by Max Hadler, Senior Health Policy Manager at the New York Immigration Coalition. On Tuesday, September 5, the Trump administration announced that it was terminating the Deferred Action for Childhood Arrivals (DACA) program in six months. The announcement sets in motion a process to further disrupt the lives of 800,000 individuals who President Trump has been threatening since he launched his campaign in 2015. Created by an executive order signed by President Barack Obama in 2012, DACA provides two-year work authorizations and deferral of deportation to DREAMers – people who came to the U.S. before the age of 16, have resided in the country continuously since 2007, do not have a criminal record, and have either graduated from high school, are currently enrolled in an educational program, or have served in the U.S. military.
The cruelty and inhumanity of Trump’s DACA decision have serious health implications. Most acutely, the stress and anxiety caused by the uncertainty around DACA have created an immediate need for mental health services for recipients and their families. The rescission undermines the powerful emotional healing effect DACA has had on U.S. citizen children with DACAmented mothers, an impact recently highlighted in this Science article.
At a time when DACA recipients most need access to comprehensive health coverage, the termination of the program profoundly threatens their eligibility for any coverage at all. As a result of the work authorizations granted by their DACA status, many of the 42,000 DACAmented New Yorkers are covered by employer-sponsored insurance. Once their work authorizations expire, these individuals will lose access to both their jobs and their health insurance.
The impending end of DACA is particularly important in New York. Our state considers DACA recipients to be “permanently residing under color of law,” or PRUCOL, and thus eligible for state-funded Medicaid. As a result, between 5,000 and 10,000 DACAmented New Yorkers have Medicaid coverage. Many advocates believe there is a legal argument that DACA recipients should still be considered PRUCOL after they lose DACA status, but it remains unclear if the State agrees.
Even without a specific legal underpinning, the state can and should continue to cover this population. The Department of Health seemed to acknowledge this by releasing a statement on Tuesday that read in part, “New York State believes it has a legal and moral obligation to exhaust every available avenue to protect immigrants and their families by providing comprehensive access to health care, regardless of circumstance.”
The Coverage 4 All campaign has proposed a number of solutions for New York State. To start, New York can ensure the continued coverage of DACA recipients through state-financed Medicaid. There are also existing policy proposals that would protect a broader range of young adult immigrants, including those who lose their employer-sponsored insurance. Assembly Bill 8054 would expand the Child Health Plus program to age 29, extending New York’s universal children’s coverage program to young adults currently excluded because of their status, including many of the DREAMers who stand to lose their coverage when their DACA authorizations expire.
The DACA decision is only the latest attack on immigrant communities from the Trump administration. In this hostile environment, it is imperative that New York State take action to meaningfully protect and promote the health coverage of its immigrant residents.
*Anyone in New York City in need of mental health services should call NYC WELL, a hotline staffed by licensed counselors trained to help with anxiety, depression, and other issues. NYC WELL counselors have been specifically trained to work with call-ins related to DACA.
Guest post by Ann Danforth, Progressive States Advocacy and Policy Manager at Raising Women’s Voices-NY. A recent analysis by the Commonwealth Fund confirms what many women already know — the Affordable Care Act (ACA) has dramatically improved our rates of health coverage and our access to care. The Commonwealth Fund used data from its biennial health insurance surveys to compare women’s health coverage and health care experiences before and after the ACA, and the results make one thing clear: the ACA is working.
The uninsured rate for women in the U.S. is at an all-time low
Thanks to the ACA, the number of uninsured working-age women fell by almost half from 2010-2016, dropping from 20% (19 million) in 2010 to 11% (11 million) in 2016. Low-income women across all races and ethnicities made the greatest gains, while young women ages 19-36 made larger gains in coverage than women in other age groups. After the ACA went into effect, the percent of women reporting difficulty finding an affordable health plan that meets their needs fell by nearly half, the Commonwealth Fund found.
Women in states that expanded Medicaid under the ACA, like New York, have higher rates of insurance than women in states that chose not to expand Medicaid. As you can see in the graph below, the rates of uninsurance among women here in New York, a state that fully embraced Medicaid expansion, are five times lower than for women in Texas, a state that did not expand Medicaid. Women in New York have expanded coverage options, since our state was the first in the country to establish a Basic Health plan called the Essential Plan, as permitted under the ACA. This extremely affordable coverage option for low-income New Yorkers, which HCFANY and RWV-NY successfully advocated for, went into effect in early 2016. As of January 2017, 665,324 New Yorkers have enrolled in New York’s Essential Plan, 54% of whom are women.
ACA consumer protections and subsidies improve access to care
The ACA put in place requirements that insurers cover 10 Essential Health Benefits, including maternity and newborn care, as well as preventive services. Under this requirement, insurers must cover a number of women’s preventive services with no cost-sharing, like contraceptive coverage, cervical cancer screenings and well-woman visits. Although New York had contraceptive coverage requirements prior to the ACA, the ACA expanded them by prohibiting insurers from charging women co-pays for contraceptive coverage and counseling.
These consumer protections, along with the ACA’s health insurance subsidies, have made it easier for women to find affordable health plans that cover their needs.
New York builds on the ACA’s success by protecting and expanding key provisions of the ACA that impact women
The Cuomo Administration, responding to requests from RWV-NY and other women’s advocacy groups, recently finalized regulations to keep in place the ACA’s contraceptive coverage protections, even if the ACA is repealed. These regulations require coverage without co-pays for one type of contraception in each of the 18 FDA-approved categories (the federal ACA standard) and allow for the dispensing of 12 months of contraception after an initial three-month allotment.
More recently, the Cuomo Administration proposed a rule that would require insurance carriers offering health plans in New York’s individual and small group market to continue to cover the ACA’s 10 Essential Health Benefits, regardless of what happens at the federal level. The proposed rule also includes a non-discrimination provision, which includes discrimination based on race, color, creed, national origin, sex (including sex stereotyping and gender identity), age, marital status, disability and preexisting conditions. RWV-NY has joined other members of the Health Care for All NY coalition in praising these proposed measures, while urging the addition of sexual orientation to the non-discrimination policy.
There is still more work to do!
The Commonwealth Fund report adds to overwhelming evidence that the ACA is working for women here in New York and nationwide. But the survey results suggest there is still work to do to make health care more accessible and affordable for women. In the U.S., there are almost 11 million working-age women who are still uninsured and large proportions of women who find it difficult to afford comprehensive health plans. As the ACA faces new challenges, including a hostile Administration that aims to “let Obamacare fail,” it is critical that we inform the public about the ACA’s successes while continuing to advocate for affordable and quality health care for all.