Domestic Gag Rule / Title X

Domestic Gag Rule

Strategies for Action

Resources and Information in support of mobilization efforts to protect Title X. Compiled by CCRF HealthCare Coverage Cmte. 

 

Constituent Engagement

  • Planned Parenthood. Take a minute to submit a comment to stop Trump-Pence from demolishing access to preventive and reproductive care.
  • National Partnership for Women & Families. Submit a comment
  • Stop Trump’s Gag Rule. Generation Progress and Center for American Progress. Target audience: Young People. Factsheets, social media tools, and a comment submission portal.   

Published Rules   

  • Federal Registry. Statutory Requirements of Title X of the Public Health Service Act and the Title X Appropriations Acts. Agency: Office of the Assistant Secretary for Health, Office of the Secretary, HHS. Comments Close 07/31/2018.

The Basics

Title X in CA 

The Impact  

  • Impact of Family Planning Legislation. The University of Texas at Austin Texas Policy Evaluation Project. TxPEP link to their research on the impact of Family Planning legislation (includes all articles/press releases/briefs)

Specific articles and press releases that provide evidence of the impact of restricting Title X funding:  

Press Releases / Statements 

Federal Funding / Appropriations

#RFW2019 Reproductive Freedom Week

Advocacy Week of Action April 15 -19

Join the Movement for Reproductive Freedom during this week of Action

Accross CALIFORNIA advocates will join efforts to take our message to directly to our statewide representatives. We will conduct in-district lobby visits to garner support to increase access to vital resources to ensure that all women, girls, and their families can fully achieve reproductive freedom. 

 

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Want to join the efforts: sign up here

Local organizations will visit their representatives in Los Angeles, Bay Area, Central Valley, and Sacramento. 

 

VIRTUAL ADVOCACY

Can’t make the meetings in person? You can still be an advocate! We will have a virtual advocacy event April 17 at 6 pm (PST) to learn about advocacy and directly advocate for action. Sign-up here for this 1-hr event

 

Rule to drop abortion coverage from state health exchanges: California Q/A and Resources

Yes – you heard right. Take action and submit comments by Jan 8 to oppose this new rule that would restrict coverage for comprehensive reproductive health coverage. 
 
California Q & As – Proposed changes to Section 1303 of the Affordable Care Act

 

What does the Affordable Care Act (ACA) say about abortion coverage in the marketplaces? (i.e. Covered California) The Affordable Care Act allows states to mandate or prohibit coverage in the marketplaces.  The ACA also included other notable provisions that affect abortion coverage. Section 1303 of the ACA sets forth “special rules” regulating abortion coverage in the marketplaces (see below). 

Does California cover abortions in the marketplacesYes. Most health plans in California* – whether they are private, public, or marketplace plans – are required to cover abortions. California is one of the four states in the US that mandate abortion coverage. (*Self-funded plans and a narrow group of religiously affiliated self plans are not governed by state benefit requirements.)

What are the “special rules” that plans that cover abortions must followThe Affordable Care Act requires insurance plans to collect a separate premium amount (at least $1 per month) for each enrollee to cover non-Hyde abortion services, and hold it in a segregated account. The ACA prohibits insurers from using exchange subsidies to pay for non-Hyde abortions; therefore all services for non-Hyde abortions (beyond rape, incest, and life endangerment) must be funded from the separate account. The separate payments must be collected on behalf of everyone enrolled in the plan without regard to the enrollee’s age, sex, or family status.   

What do the proposed rules changeThe proposed rule would require issuers to send—and consumers to pay—two entirely separate bills for the amount of the premium attributable to certain abortion services and the amount of the premium for all other services. In essence, qualified health plan issuers must send an entirely separate monthly bill for only the portion of the premium related to the non-Hyde abortion; this means separate billing, a separate mailing, and separate postage. If bills are sent electronically, plans must send two separate electronic bills and possibly provide separate payment links for the portion of the premium related to the non-Hyde abortion services in the electronic bills. In turn, enrollees must pay this premium using a separate check, a separate envelope, and use separate postage.

 What will happen to enrollees if they do not follow these requirements? Will they lose coverage? The proposed rules are unclear about this. The proposed rules maintain that enrollees should not be dropped off coverage if the enrollee sends one combined payment. However, the proposed rules do not indicate what the consequences will be if the enrollee fails to send the second payment for the non-Hyde abortion coverage. It is likely that consumers may get confused or simply refuse to make the second payment. At that point, there is nothing explicit in the rule that prohibits plans from dropping enrollees from coverage. The impact of this rule will fall harshest on low-income individuals, particularly women of color, immigrant populations, and other individuals who struggle to navigate the health care system. 

Resources 

All Above All Webinar and Toolkit “Fight Back Against Trump’s ACA Abortion Coverage Rule”

Description: Many of you may have heard that the Trump administration recently released a rule on abortion coverage in the state exchanges. The intent of the rule is to force insurers to drop abortion coverage from their policies by making it very difficult, if not impossible to comply. The state exchanges have been an important tool in narrowing racial disparities in health insurance enrollment – this also means that communities of color will be disproportionately impacted by roll backs in abortion coverage in the exchanges. On this webinar, Kelsey Ryland from All*, Kelli Garcia from National Women’s Law Center, and Fabiola Carrion from the National Health Law Program discussed the changes, what it means for states (including California), what tools are available, and how organizations can activate their constituencies. 

Toolkit

Slidedeck from CCRF Member, Fabiola Carrion (National Health Law Program) 

Proposed Rule

 

 

 

 

 

 

 

The Impact of Public Charge

The NEW Proposed Public Charge Rules
  • The Trump Administration published a Notice of Proposed Rule Making for the “public charge” immigration rule.  
  • Under the current public charge rule, immigrants who are in need of long-term care or cash assistance can be denied visas or legal permanent residency. 
  • The new rule proposes to extend denials to immigrants for a wide range of programs and services including Medicaid, food aid, and public housing. 
  • If approved, the rule could deter millions of low-income immigrant individuals and families from applying for and accessing critical services, including sexual and reproductive health care. 
  • Public comments on the proposed rule can be submitted through December 10th.
CCRF Nov 19  Presentation:  Priscilla Huang, Senior Attorney, National Health Law Program – Los Angeles and Sylvia Castillo, Senior Manager of Government + Community Affairs, Essential Access Health 
Sample talking points 

National Asian Pacific American Women’s Forum (NAPAWF), National Latina Institute for Reproductive Health (NLIRH), In Our Own Voice: National Black Women’s Reproductive Agenda and National Women Law Center (NWLC)

Writing Comments: Tips and Best Practices
  • Make 30 percent of your comments unique.
  • Don’t mention programs that are not included in the NPRM.
  • Don’t suggest fixes.
  • Attach/upload the research, data, etc. you cite.
  • Comments must be submitted in English or accompanied by an English translation.
  • Commenting is not a lobbying activity.
  • You are an expert!
Citing your Research

It has been brought to our attention that any cited research should now be attached to your comments. In addition to the inserting links, you should have as an appendix digital copies of the actual reserach papers, reports, etc. (Yes, that means that your comments can be dozens of pages long). 

Campaigns

Hospital Mergers Restrict Repro. HealthCare: Action Guide and Resources to Push Back Against Mergers

Issue

Dignity Health and Catholic Healthcare Initiatives are creating a mega Catholic health entity that would forbid all reproductive health services, including all birth control methods, sterilization, miscarriage management, abortion, the least invasive treatments for ectopic pregnancies, and some infertility treatments.

No exceptions for risks to a patient’s health or even life. LGBTQ patients would face discrimination and be denied health services at some of these hospitals, too. (The NYT just did a story on these issues, which you can read here.)  We have concerns that Dignity will try to reduce its commitment to emergency services, charity care, and other services that are of particular importance to low-income and uninsured or underinsured communities.NHeLP, the ACLU, and other advocates across the state have been working together for years to push back against health care restrictions at these and other hospitals.

The ACLU has sued Dignity Health in particular twice in California over denial of reproductive health services and health care for transgender patients. This proposed merger, affecting Dignity Health hospitals across California, could further restrict access to essential health care. 

Advocacy
The California Attorney General will be holding a total of 17 public meetings across the state, at each of the counties where a Dignity hospital is located. These counties are Kern, Los Angeles, Merced, Nevada, Sacramento, San Bernardino, San Francisco, San Joaquin, San Luis Obispo, San Mateo, Santa Barbara, Santa Cruz, Shasta, Siskiyou, Tehama, Ventura, and Yolo. 
 
Upcoming Actions
 Nevada           Yolo           San Mateo           
Merced          San Joaquin          Shasta          Siskiyou

There will be over a dozen more meetings across the state, throughout September and possibly into October, at the fourteen other counties that contain a Dignity hospital (possibly: Calaveras, Kern, Santa Cruz, and Tehama). 

Email Karen Camacho at kcamacho@aclunc.org with your name, organizational affiliation if any, email address and/or phone number, and the public meeting(s) that you are interested in attending.  We will circle back with you when we have more information about your county.

Resources

Some Things to think about

  • Depending on how many people attend, the meeting will last between 2-5 hours. 
  • You should expect to speak for 3-5 minutes (so far, no one has been cut off from speaking)
  • We recommend submitting your public comment card early. If you arrive late, you’ll still have the opportunity to submit your card and make public comment closer to the end of the meeting.
  • We highly recommend personalizing your public comment, mentioning your expertise and experiences, if possible.
  • You can print out the attached signs to increase your visibility in the room.

Ending women’s right to abortion

Opinion by CCRF Member, Katrina Cantrell, Executive Director, Women’s Health Specialists

We are fed up. Over the past decade,  the assault on women’s reproductive rights has accelerated rapidly. Today, in a devastating 5-4 decision the Trump Administration’s stealthy engineered Supreme Court’s majority of misogynistic males and corporate lackeys voted in favor of predatory faith-based pregnancy “clinics” to coerce and misinform women seeking pregnancy options. This ruling will have a devastating impact on American women and their families for generations to come.

Today’s decision, however, only adds to the multiple aggressions the Republican party has been systematically crafting to undermine and threaten women’s hard-won right to self-determination over our own bodies. Let’s just look back to last month’s “gag rule”, which will prevent patients from obtaining birth control or preventive care from reproductive health care providers like Women’s Health Specialists in rural CA or Planned Parenthood, nationally — effectively silencing doctors, nurses and hospitals from referring patients for abortion and providing life-saving information on a legal medical procedure and violating medical ethics.

We cannot shrink from these attacks against women — as our right to abortion and contraception, is chipped away in the states and now in federal law by the Supreme Court, anti-choice extremists are approaching their ultimate goal: Ending women’s right to abortion.

With Roe v. Wade in the crosshairs of the most powerful assault on women’s rights in our lifetime, we must stand strong and stand together.

For over 40 years, Women’s Health Specialists in Northern California has stood up for women’s reproductive rights – surviving multiple arson and chemical attacks, ongoing threats, vandalism and harassment on a daily basis. As an independent reproductive health clinic,  we realize that this moment in history is the crucial step that will ensure or doom the hard-won reproductive freedom our foremothers fought for.

Women’s Health Specialists calls on women and our allies across the country to resist the Administration’s misogynistic, fascist assault on women’s bodily integrity and independence. Pledge to support your local women’s clinic — volunteer, spread the word, advocate for safe spaces. Help to get out the vote and pledge to hold candidates accountable to preserve women’s full reproductive rights — from contraception to abortion. Stand up and speak out — together.

Let’s seize this moment and flood the HALLS of power and the STREETS to protect our right to choose. And in the future, when we look back on this crisis, we’ll remember where we stood and what we stood for — and so will our daughters and granddaughters.

6/26/2018

Interactive Webinar for Reproductive Freedom, 3/27/18

Step Into Power for Reproductive Freedom 2018
ON MARCH 27TH over 60 advocates from across CA joined to TAKE ACTION FOR REPRODUCTIVE FREEDOM

We’re at a critical moment for gender and reproductive freedom. On this interactive webinar, we learned about important 2018 legislative bills in California that will protect and advance reproductive freedom. 

This was a CALL FOR ACTION.  

#RFW2018

Reproductive Freedom Week 2018
Reproductive Freedom Week 2018 

In-person lobby visits • Statewide Interactive Advocacy Webinar

Reproductive Freedom Week (#RFW2018) is a statewide advocacy event, coordinated by California Coalition for Reproductive Freedom (CCRF). #RFW2018 features advocacy training, in-district lobby visits, and other community-building events.

This year #RFW2018 will be conducting in-district lobby visits in 4 regions across the state: Central Valley, Los Angeles, San Francisco and Oakland & one virtual statewide event to protect and advance reproductive freedom in California.

#RFW2018 is an opportunity to bring the issues HOME! At #RFW2018 you will meet with your legislator at the district office to talk about how important reproductive freedom is to your local community.

Sign-up for the Webinar here

CA Reproductive Health and Justice Leaders Take A STAND against Graham-Cassidy

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

Opinion: Obamacare Repeal Would Decimate Social Safety Net for California Women

CCRF’s Executive Director, Juana Rosa Cavero, relates how California created one of the greatest social safety nets in the nation and how the ACA would have helped her and her family. 

Obamacare Repeal Would Decimate Social Safety Net for California Women

By Juana Rosa Cavero, Director, California Coalition for Reproductive Freedom

I was already racked with stress when the organization I had been working for shuttered. My husband was in his last year of graduate school, and I was suddenly unemployed. What was supposed to be exciting news of my first pregnancy abruptly became anxiety when faced suddenly with having very limited and costly health care insurance options.

This was my reality just a few months before the Affordable Care Act (ACA) was enacted, and I was hardly alone. Today the provisions of the ACA protect women in my situation to ensure that they are not cut off from health care insurance if they become unemployed, and that coverage will include basic health services including maternity and reproductive health care coverage.

What changed for me and millions of women with the ACA were provisions that expanded Medicaid to cover more low-income individuals (known as Medicaid Expansion); created health insurance marketplaces where individuals and families could shop for and purchase health coverage, in many cases with federal subsidies to help bring down the cost of premiums and cost-sharing; and provided protections for specific vulnerable groups such as young people, women, and people with preexisting conditions.

California lawmakers and agencies worked hard to make the ACA work for our state.  Because of their efforts to fully implement the ACA, California was able to reduce its uninsured rate by more than half, from 17 percent to 7 percent – the biggest drop of any state in the nation. Because of these efforts to provide broader access to high-quality, comprehensive health care, women now make up just over half (54 percent) of the 13.4 million Californians enrolled in the state’s Medicaid program, Medi-Cal.

Medi-Cal covers more than half of all births in the state as well as 83 percent of the state’s publicly funded family planning services. The expansion of Medi-Cal alone provided health care coverage to more than 1.8 million nonelderly adult women. In addition to insuring more people, the ACA has also provided more robust consumer protections against discrimination in health care – something women, communities of color, and LGBTQ people have long faced.  

Now with its so-called Better Care Reconciliation Act of 2017 (BCRA) seemingly doomed in the Senate, Republican leadership is now vowing to repeal the ACA. We know that a viable replacement plan is unlikely. There are simply too many hard right conservatives in Congress who have stated over and over again that their goal is to “let the ACA fail,” and how better to accomplish that goal than repeal the ACA with no replacement, regardless of the very real on the ground impacts that such repeal would have for tens of millions of Americans?

Repeal of the ACA would disproportionally harm women in California and nationwide. The California Coalition for Reproductive Freedom (CCRF), which I lead, has urged our state’s congressional delegation to stand against any effort to gut Medicaid funding or repeal the ACA. The letter notes that if the ACA were repealed, more than 4 million Californians “stand to lose their health care coverage, the California health system would lose tens of billions of federal dollars, consumer protections would be eliminated, and everyone would see increased health care costs.” Moreover, according to the California Department of Health Care Services, by 2027, the state would lose $30.3 billion annually in federal funding. More than twenty state and national groups working to promote reproductive health and health care rights signed on to our CCRF letter.

California lawmakers in Congress must do everything they can to fight a reckless and callous repeal of the ACA. Access to quality health care is a right for all Californians, not a privilege merely enjoyed by the well-to-do. Politicians pushing or supporting these extreme attacks on Medicaid and the ACA must be called out for attacking the nation’s social safety net. My reproductive healthcare coverage and the coverage of tens of millions of other Californian women should never be a political pawn. I hope you can join me in making sure that our state’s Congressional delegation be front and center in protecting Medicaid and the ACA.

Juana Rosa Cavero, Director, California Coalition for Reproductive Freedom

Read our Letter Urging Our CA Congressional Delegation to Oppose Any Repeal here.