California Coalition for Reproductive Freedom

A woman knows what's best for her and her family
CA Reproductive Health and Justice Leaders Take A STAND against Graham-Cassidy
September 25, 2017
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Over 25 CA Reproductive Health and Justice Organizations Take a Stand to

OPPOSE the Graham-Cassidy Bill  

California has made tremendous gains from the passage of the ACA, and now stands to have much to lose if the ACA is repealed. The Graham-Cassidy bill proposes to reverse the progress that California and the rest of the country has made on making health care coverage more affordable and accessible across the country.

The bill fundamentally threatens women’s reproductive health access to maternity care, contraception, family planning services, abortion care, and other basic health care services that the state has long championed.

Twenty-seven members of the California Coalition for Reproductive Freedom have signed on in strong opposition to the bill introduced by Senators Lindsey Graham (S.C.), Bill Cassidy (La.), Dean Heller (Nev.), and Ron Johnson (Wis.) -Graham-Cassidy – to repeal the Affordable Care Act (ACA), eliminate the current financing structure of Medicaid, and restrict access to essential reproductive health services. This bill is extremely similar, and in some ways worse than, the Senate’s failed Better Care Reconciliation Act. We urge you to denounce this bill, which strips coverage from millions, strikes a death blow to Medicaid as we know it, and fundamentally threatens access to maternity care, contraception, and abortion care for women across the state.

This bill is extremely similar, and in some ways worse than, the Senate’s failed Better Care Reconciliation Act. We urge the Senate to denounce this bill, which strips coverage from millions, strikes a death blow to Medicaid as we know it, and fundamentally threatens access to maternity care, contraception, and abortion care for women across the state.

The California Coalition for Reproductive Freedom is a statewide alliance of nearly 40 organizations working to promote sexual and reproductive health, rights, and justice. Rooted in 30 years of experience, CCRF coordinates policy advocacy efforts and information to deepen relationships with advocates and community members to benefit California’s diverse women, youth, transgender persons, and communities.

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September 25, 2017

To: The California Congressional Delegation

Re: OPPOSE – Graham-Cassidy Bill Threatens Reproductive Health Access and Jeopardizes California’s Gains in Expanding Coverage and Consumer Protections

The undersigned members of the California Coalition for Reproductive Freedom write to express our strong opposition to the bill introduced by Senators Lindsey Graham (S.C.), Bill Cassidy (La.), Dean Heller (Nev.), and Ron Johnson (Wis.) (hereinafter “Graham-Cassidy) to repeal the Affordable Care Act (ACA), eliminate the current financing structure of Medicaid, and restrict access to essential reproductive health services. This bill is extremely similar, and in some ways worse than, the Senate’s failed Better Care Reconciliation Act. We urge you to denounce this bill, which strips coverage from millions, strikes a death blow to Medicaid as we know it, and fundamentally threatens access to maternity care, contraception, and abortion care for women across the state.

The California Coalition for Reproductive Freedom is a statewide alliance of nearly 40 organizations working to promote sexual and reproductive health, rights, and justice. Rooted in 30 years of experience, CCRF coordinates policy advocacy efforts and information to deepen relationships with advocates and community members to benefit California’s diverse women, youth, transgender persons, and communities.

Thanks to the ACA, California has reduced its uninsured rate by more than half, from 17% to 7% — the biggest drop of any state in the nation. The ACA has also played a critical role in helping to slow the growth of health care costs, providing critical protections for people with pre-existing conditions, and ending policies and practices that discriminate against women, LGBTQ people, people with disabilities, as well as racial and ethnic minorities.

Similar to the previous repeal attempts, Graham-Cassidy would:

  • rip away health care coverage from millions of Californians;
  • result in a decrease of $28 billion per year from the California health system;
  • eliminate critical consumer protections;
  • defund Planned Parenthood and restrict reproductive health access; and
  • increase health care costs for everyone.

It is undeniable that of all states, California would be among the biggest losers under Graham-Cassidy. This is because the bill intentionally penalizes states that were successful in enrolling millions of people in Medicaid and in the marketplace. According to an Avalere study, California would experience a cumulative reduction of $78 billion in federal funding by 2026, $129 billion by 2027, and $800 billion by 2036. For the sake of our state’s financial stability and prosperity, we cannot let these drastic cuts come to pass.

 We urge you to reject and speak out against the Graham Cassidy bill, which among other things proposes to:

  • Impose devastating caps and cuts to Medi-Cal, undermining coverage for the 14.1 million women, children, older adults, people with disabilities, and others who rely on the program. Medi-Cal funds half of all births in California, and changes to the financial structuring of the program could result in devastating cuts in services or eligibility for vulnerable Medi-Cal populations, including pregnant women. Medi-Cal cuts could also put access to family planning services at risk. California currently offers a robust scope of family planning and related services under Medi-Cal and the Family Planning, Access, Care and Treatment (PACT) program, thanks to the enhanced federal match rate of 90/10 for family planning care.  Eligibility and scope of services under Medi-Cal and Family PACT could be sharply reduced if the state loses federal funding. Lastly, the per capita cap proposed would force the state to shoulder the financial burden of public health crises, including those impacting Californians’ reproductive health, such as the Zika virus. Over time, Medi-Cal would cover fewer women and provide less comprehensive reproductive health services to those who remain enrolled.
  • Gut and then end Medi-Cal expansion, which has expanded Medi-Cal coverage to over four million Californians statewide and has directed an estimated $2.2 billion per year into the state’s health care safety net. Graham-Cassidy first weakens the program by permitting redeterminations for the Medicaid expansion population every six months, and then effectively eliminates the program altogether by reducing the federal match rate to 0% for any state that continues to cover Medicaid expansion enrollees past January 1, 2020. California would likely be unable to shoulder the full cost of continuing to cover our Medicaid expansion population.
  • Eliminate Medi-Cal funding to Planned Parenthood by prohibiting the organization from receiving federal funds through Medicaid for one year, starting on the date of the bill’s enactment. Planned Parenthood is a critical provider of basic health care services in California, serving an estimated 800,000 men and women at 115 health clinics throughout the state. 87% of the men and women who receive services at Planned Parenthood in California are Medi-Cal or Family PACT beneficiaries. Prohibiting Planned Parenthood from receiving federal Medicaid funding for providing health care services to Medi-Cal recipients in California would result in hundreds of thousands of Medi-Cal patients no longer being able to receive services from their trusted provider of choice.  Federally qualified health centers have said that they do not have the capacity to absorb and provide care for Planned Parenthood’s patients.  In many parts of the state, particularly in rural areas and areas with large numbers of low-income patients, people would lose access to critical reproductive health services.
  • Impose draconian requirements on Medi-Cal enrollees, such as incentivizing states to re-determine eligibility for the Medicaid expansion population every six months, allowing states to implement Medicaid work requirements for most adult enrollees (including women who have recently given birth), and reducing Medicaid retroactive eligibility to two months for most enrollees.
  • Eliminate federal tax credits that help people afford health care. Nearly 7 million women and girls across the country selected a private insurance marketplace plan in 2016, and the majority of them relied on the ACA’s federal subsidies to help make coverage more affordable. The proposed reductions in federal tax credits would result in higher premiums and deductibles, and make it harder for women and girls across California to afford high-quality comprehensive health care that meets their needs.
  • Restrict access to abortion care by prohibiting individuals and small employers from using federal tax credits to purchase private health insurance plans that include abortion care. These provisions could cause insurance companies to stop offering plans that include abortion coverage altogether, thereby putting abortion access further out of reach for women in the private market. A restriction of this type also directly conflicts with California law, which requires nearly all private plans to cover abortion, and threatens to dramatically reduce the number of Californians who may use federal tax credits to help pay for health insurance coverage.
  • Eliminate the individual and employer mandates, which would exacerbate undermine California’s risk pool, raise premiums overall, and in the long run risk collapsing the individual marketplace entirely.
  • Allow states to waive coverage of the Essential Health Benefits requirements for plans in the individual and small group markets, which guarantee coverage for critical basic health services including maternity care, newborn care, and preventive services. Elimination of the Essential Health Benefits requirement would leave many women without adequate maternity care or force them to incur debt in order to obtain maternity care. It would also effectively allow plans to practice gender discrimination by requiring women to pay more for plans that do include maternity care.
  • Weaken protections for people with pre-existing conditions by allowing states to modify or eliminate EHBs, and therefore permit them to offer less comprehensive plans that lack the specific services that people with pre-existing conditions need. The result would be an end run around the ACA’s prohibition on discriminating against people with pre-existing conditions. Prior to this ACA protection, health plans routinely denied coverage or charged higher premiums to people with pre-existing conditions, which included having had a cesarean section or previous pregnancy, having received medical treatment due to domestic violence or sexual assault, being a cancer survivor, or even being pregnant.

California has made tremendous gains from passage of the ACA, and now stands to have much to lose if the ACA is repealed. The Graham-Cassidy bill proposes to reverse the progress that California and the rest of the country has made on making health care coverage more affordable and accessible across the country. Moreover, the bill fundamentally threatens women’s reproductive health access to maternity care, contraception, family planning services, abortion care, and other basic health care services that the state has long championed.

For the above reasons, we strongly urge you to preserve the progress California has made in expanding health access and consumer protections, and oppose the Graham-Cassidy bill.

Sincerely,

The following 27 Members of the California Coalition for Reproductive Freedom:  

ACCESS Women’s Health Justice

Rachel Coe, Public Policy & Trainings Director 

ACLU of Northern California

Phyllida Burlingame, Reproductive Justice Policy Director 

ACLU of Southern California

Melissa Goodman, Audrey Irmas Director, LGBTQ, Gender & Reproductive Justice Project

ACT for Women and Girls

Sarah K. Hutchinson, Policy Director

American Association of University Women – California

Nancy Mahr, Chair – Public Policy Committee

American Congress of Obstetricians & Gynecologists, District IX

Shannon Smith-Crowley, Director of Government Relations

American Nurses Association California

Phillip Bautista, President

Bay Area Communities for Health Education

Heidi Winig, Director

Black Women for Wellness

Janette Robinson Flint, Executive Director

California Latinas for Reproductive Justice

Myra Duran, Senior Policy Manager

California NOW

Jerilyn Stapleton, President

California Women’s Law Center

Amy Poyer, Senior Staff Attorney

Center on Reproductive Rights and Justice at UC Berkeley Law

Jill E. Adams, Executive Director

Citizens for Choice of Nevada County

Elaine Sierra, Public Policy Director

Essential Access Health

Amy Moy, Vice President of Public Affairs 

 Forward Together

Kalpana Krishnamurthy, Policy Director 

Fresno Barrios Unidos

Socorro Santillan, Executive Director 

Ibis Reproductive Health

Caitlin Gerdts, PhD, MHS, Vice President for Research

If/When/How: Lawyering for Reproductive Justice

Mariko Miki, Director of Academic & Professional Programs 

Maternal and Child Health Access

Lynn Kersey, Executive Director 

NARAL Pro-Choice California

Amy Everitt, State Director

National Council of Jewish Women CA

Claire Lipschultz, State Policy Advocate

National Health Law Program

Susan Berke Fogel, Director, Reproductive Health

Physicians for Reproductive Health

Toni M. Bond Leonard, Director, Partnership for Abortion Provider Safety

Planned Parenthood Affiliates of California

Gregory Cramer, Legislative Advocate

Positive Women’s Network – USA

Arneta Rogers, Policy and Advocacy Manager

TEACH (Training in Early Abortion for Comprehensive Healthcare)

Sara-Cate Jones, Program Coordinator


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