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.
We have been talking a lot about the ACA Cost Sharing Reductions or CSRs in the last couple of months. CSRs are crucial subsidies that help make out of pocket health care costs, like deductibles and copayments, more affordable for people who earn incomes up to 250 percent of the Federal Poverty Level (about $61,000 for a family of four or $30,000 for an individual). CSRs are even more important in New York because they are a major source of funding for the Essential Plan, which provides low-cost insurance with no deductible and low copayments to more than 665,000 New Yorkers earning incomes under 200 percent FPL (about $49,000 for a family of four or $24,000 for an individual).
In 2014, the House of Representatives sued the Obama administration, alleging that the CSR payments were unconstitutional because the funds to pay for them were not appropriated by Congress. In 2016, a federal judge ruled in favor of the House, and the case is currently on appeal. U.S. Secretary of Health and Human Services, Tom Price, has not provided clarity on whether or not he will pursue the appeal, and President Trump has not provided consumers or insurance companies clarity on whether or not he will continue CSR payments in the meantime. An analysis from the Kaiser Family Foundation estimates that insurers would have to raise premiums nearly 20 percent to compensate for the loss of CSRs.
However, according to an article in the Washington Post, a federal appeals court issued a ruling earlier this week that could help keep the CSR payments in place. The U.S. Court of Appeals for the District of Columbia Circuit ruled that a coalition of 16 state attorneys general, including New York Attorney General, Eric Schneiderman, could intervene in the pending appeal and defend the CSR payments. As the article points out, this ruling could make it more difficult for President Trump and the House of Representatives to end CSRs without a fight in court.
Last night, Senate Republicans failed in their last ditch effort to repeal the ACA and dismantle Medicaid. A huge thank you to our members, partners, and friends for all of your hard work and activism over the last nine months.
Your resistance is the reason they keep failing.
Unfortunately, the fight is not over. The President is still threatening to end Cost Sharing Reduction payments that reduce out of pocket costs for moderate income Americans and there is a House budget proposal that would cut trillions of dollars from Medicaid and other health care and entitlement programs over the next 10 years.
Seven of NY’s Representatives voted to pass an anti-health care bill in the House: Chris Collins, John Faso, Peter King, Tom Reed, Claudia Tenney, and Lee Zeldin. They may soon have another chance to decide our fate through the budget process – this Saturday, show them in person that those first votes were a mistake!
Here’s what you ca do to stay engaged:
- Join people across the country at demonstrations. We already know about events in places like Beacon, Kingston, Delhi, New Hartford, New York City, and Glens Falls. We’ll add events to our eventspage as soon as we learn about them so keep checking!
- You could also plan your own event! The Our Lives on the Linesite has some tools to help you do this, but all you really need to do is show up at your Representatives’ offices with signs or letters telling them not to support any bill that takes health care away from people.
We’ve come so far – and we won’t stop fighting now!
Guest blog by Ann Danforth, Progressive States Advocacy and Policy Manager at Raising Women’s Voices-NY. It’s no secret that since day one, the current administration and the Republican-led Congress have been dead set on chipping away at the gains we’ve made to women’s health under the Affordable Care Act (ACA). Republicans have pushed forward a number of ACA repeal bills, but all of them have one thing in common: they would be devastating for women at every age across our life span. These proposals have included provisions that would gut Medicaid, defund Planned Parenthood, and impose restrictions on abortion coverage in private insurance. And in early May, the President attacked women’s health through administrative channels, signing an Executive Order that opens the door for broad religious or conscience-based exemptions to the ACA’s contraceptive coverage mandate. (For more on the ACA’s contraceptive coverage mandate, see RWV’s blog post on the topic here.)
Since the Executive Order, rumors have circulated about an interim final rule – said to be currently undergoing review – which would allow employers of any size, location, or business type to refuse to provide birth control to their employees based on their religious or moral objections (read the leaked draft here). This would undermine the ACA’s contraceptive coverage benefit, undoing one of the most popular features of the ACA, and one that has provided coverage without co-pays to more than 55 million women across the United States. Of course, not all employers would choose to deny contraceptive coverage to their employees, and women’s health groups are standing ready to call on employers to maintain this coverage.
Luckily, regardless of what happens down in D.C., New York has moved to protect contraceptive coverage without co-pays in our state. Recognizing the value of the ACA’s contraceptive coverage benefit, the threat posed by a hostile federal administration, and the inconsistent implementation of the contraceptive mandate by New York insurers (identified by RWV-NY in our 6/26/14 and 3/1/16 letters to NY State of Health and NYS Department of Financial Services), the Cuomo Administration issued draft regulations to expand contraceptive coverage protections in New York. These regulations, which we wrote about in a previous HCFANY blog post, were finalized last month. They 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).
In addition, and as part of their efforts to secure coverage for a full range of reproductive health services in New York State, the Cuomo Administration finalized another regulation that requires private insurance coverage for medically necessary abortions without cost sharing (June 21, 2017 Register: Page 18, Notice of Adoption). While the draft regulation included an overly broad religious exemption – which would have followed the disturbing national trend of allowing employers to use their personal religion to discriminate against employees – the finalized regulation includes a much narrower religious exemption, reflecting that of the NY Women’s Health and Wellness Act. The change came in response to hundreds of comments that individuals and organizations like RWV-NY and HCFANY submitted in support of the proposed regulations, and urging the Administration to narrow the scope of the overly broad religious exemption.
It is worth noting the serious implications of the potential conflict between New York’s new abortion regulation and the ACA repeal proposals’ restrictions on abortion coverage. In both the House-passed and Senate versions of ACA repeal, individuals would be banned from using federal subsidies to buy health plans that cover abortion. Since New York’s new regulation requires all New York health plans to cover abortion, this provision, which we are likely to see in future attempts to repeal the ACA, would mean that no one – not just women – could use federal subsidies to buy a health plan in New York.
Given the potential implications of ACA repeal for women’s health, it is critical that New York remain a leader in ensuring access to reproductive health care. HCFANY and RWV-NY will continue to work to protect New Yorkers from harmful federal policies that threaten the well-being of women, LGBTQ people, and our families.