The Administration’s Attempt to Punish CA over Abortion Access

The Trump Administration is trying to bully California into decimating abortion access in the state. California has long required insurers to cover basic health care services, and in 2014 the state clarified that reproductive health care — including abortion care — is basic health care. With exceptions for some religiously-affiliated insurance companies, health plans in the state cannot treat abortion differently than other pregnancy-related care.

The Administration is now claiming that California’s policy violates the Weldon Amendment – a federal rule prohibiting local, state, and federal governments from requiring health care entities to cover, provide, or refer to abortion services. It doesn’t make sense. The Administration is singling out California – one of six states with this abortion coverage requirement. What’s more, this issue has already been decided! The Obama Administration rejected a similar challenge to California’s policy in 2016.

This is a pathetic attempt to punish the state of California for respecting the human right to health care. In the process, the Administration is threatening health care access for millions. Californians will not be bullied. We will not accept subpar plans denying people the full range of reproductive health care options. We will not accept insurance companies interfering in medical decision-making and reproductive freedom. Learn more from the resources below.

Factsheets and Resources

California Sets Example for Comprehensive Women’s Health Care Coverage

Notice of Violation from HHS and CA Response Letter (PDF)

Weldon Amendment, Consolidated Appropriations Act. HHS

Opinions, Blog, Commentary

HHS Issues Notice of Violation to California for its Abortion Coverage Mandate. HHS Press Release

Abortion is Basic Health Care. Phyllida Burlingame, ACLU NorCal

Trump’s Attack on Abortion Coverage in California Puts Politics Over Health. Dr. Jessica Beaman

Attorney General Becerra Issues Response to Trump Administration’s Baseless Allegations of Weldon Violation. Press Release.

From 2004: Attorney General Lockyer Readies Court Challenge to Fight Federal Attack on Women’s Right to Choose. Press Release. (with Pelosi and Boxer quotes)

News Articles

Trump administration threatens funds to California over the requirement that health plans cover abortion.

Trump administration threatens to cut health funding for California over abortion insurance law

The battle over abortion rights: Here’s what’s at stake in 2020

Editorial: Trump seeks a new fight with California on abortion

Trump threatens to cut California funding over abortion coverage

Separation of Abortion Payments in the Marketplaces

The Trump Administration is trying to make it more complicated and burdensome for health plans to cover abortion care. The rule impacts qualified health plans – health plans that are on the Affordable Care Act (ACA) Marketplace and include ACA protections, such as the essential health benefits and potential subsidies.

Federal policies, such as the Hyde Amendment, prohibit federal funds from covering abortion except in the limited circumstances. States, however, can allow or require health plans to cover the abortion care that pregnant people need.  When that happens, insurers have to collect at least $1 per month as a premium covering abortion services. They then keep that $1 separate from the rest of the premium to ensure no federal funds are used for abortion services.

This rule takes that separation requirement to the point of absurdity. It requires insurers to send enrollees two separate bills – one for the abortion part of the premium and another for the rest of the coverage. Apparently it’s not enough for the insurer to separate the funds, now the enrollee must send two checks.The rule is dangerous. It stigmatizes abortion care, making it seem separate from other basic health care services. It could lead to confusion and people losing health care coverage. Additionally, the administrative and reporting burden will likely raise costs, leading to higher premiums or encouraging health insurance plans to drop abortion coverage all together. The rule goes into effect June 27, 2020 unless it is stopped in the courts first.

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

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.