Countdown to Health Care: Fighting for Equity for Women

By: Ellen Liu, Director of Women's Health for The Ms. Foundation for Women

There is a lot that organizations like Northwest Health Law Advocates (NoHLA) can do to make sure women are front and center in the Affordable Care Act, according to NoHLA’s Staff Attorney, Emily Brice. “More specifically, [we need to prioritize] women who are particularly vulnerable because they’re lower income, immigrants, have limited English proficiency, or who face other barriers to enrollment.” In Washington State, nearly one in five women between 19-64 years old is uninsured.

The Seattle, Washington-based organization is a Ms. Foundation grantee and works to increase access to health care and basic health care rights through legal and policy advocacy.

“We always knew that the federal government clearly cannot do this alone,” Health and Human Services Secretary Kathleen Sebelius recently told The Washington Post. While the Obama administration has highlighted aspects of the health care overhaul that are important to women — like preventive services without cost sharing and contraception coverage with no co-pays — current government outreach to support women’s enrollment in health coverage is limited, especially among the women who stand to benefit the most.

In Washington state, NoHLA and its network of partners have stepped in, pushing for greater equity in enrollment services ahead of the October 1st launch of the signup period for insurance plans in state marketplaces under the new law.

After learning from state officials that the Washington exchange would provide only very limited language access services — merely translating the state’s exchange website into Spanish — they “leapt into action and started doing education work,” Brice said. The effort, which began in December 2012, included raising awareness about the changing demographics in Washington state. In the past two decades alone, the number of limited English proficiency persons has risen 210 percent representing one of the fastest growth rates in the country. Spanish, Chinese, Vietnamese, Korean and Russian-speaking communities account for the highest numbers.

Of course, demographic shifts have become a national reality, as well. The Kaiser Commission on Medicaid and the Uninsured reports that as of 2009, approximately 21 percent of nonelderly people in the United States spoke a language other than English at home. People who identify as having limited English proficiency are uninsured at much higher rates than the rest of the population, at a staggering 50 percent.

Beyond demographics, it all comes down to a person’s right to health. The ACA prohibits discrimination on the grounds of race, color and national origin for any health program or activity receiving government funding and for any plan offered through the new ACA insurance marketplaces. This requirement was derived from Title VI of the historic Civil Rights Act, and was bolstered in 2000 by President Clinton's Executive Order 13166 to improve access to services for individuals with limited English proficiency.

NoHLA’s pioneering initiative invoked the legal requirements for Washington state to provide language-access services. As a result of the ongoing negotiation process, today, the Washington exchange has agreed to translate the enrollment application and other key materials immediately into eight languages, and into every other language as needed by individual clients. It will provide oral interpretation services in more than 150 languages, as well as offer relay services and other key services for those who are deaf or hard of hearing. Washington has now become a leader in language-access services and an example for other state exchanges.

In addition to language access, there were concerns about cultural competency and sensitivity in outreach, or “what we call ‘plain talk’ here in Washington State,” Brice explained. “Are the materials that are being distributed understandable for someone with a 6th grade education? Are they written in a way that regular people can access?”

Expanding access to care also means an expanded need to improve health care literacy. “Folks who have never before been able to access insurance coverage need to be able to learn how to use it,” Brice said.

NoHLA’s solution to making sure these important concerns become institutionalized was advocating for the creation of a Health Equity technical advisory committee, appointed by the state’s health Exchange Board and charged with considering issues of health literacy, cultural competency and hard-to-reach populations. Currently, NoHLA works closely with members of the committee to advocate for joint goals in overcoming access and enrollment barriers.

Thanks to NoHLA and its partners, Washington women will experience a considerably easier process of enrollment that is culturally sensitive, produces materials in their appropriate language and demystifies complicated health care terminology.

But the goal is not simply higher rates of women’s enrollment; it’s the improved health outcomes of thousands of Washington women previously denied that opportunity.

The Ms. Foundation is proud to support pioneering leaders like NoHLA as they eliminate barriers for women, fight discrimination and ensure that affordable, quality health care is not a privilege but a basic human right for all.

Memo to the Right: Preventing Pregnancy IS a Preventive Service

Yesterday, the Republican-controlled House of Representatives passed a repeal of the Affordable Care Act -- our nation's boldest, if flawed, step in the direction of health care equity since the New Deal. While this is tremendously disconcerting, little will happen as an immediate result. Democrats in the Senate, who still hold a slim majority, have vowed to block a vote for repeal, leaving the House vote in Congressional limbo.

While this means, for the time being, that the Affordable Care Act is here to stay -- a very good thing for the millions of people who will benefit from the law, many of them women -- it doesn't mean it isn't in jeopardy. The health-care law faces continued attacks at the state level, in the judiciary, and will likely be taken up again in Congress as House Republicans attempt to undo it piece by piece. What's more, certain provisions of health care reform, as passed, are still being debated by federal agencies -- with significant implications for women. 

High on the list of provisions in question is coverage of birth control -- specifically, whether new insurance plans will be required to provide free coverage of contraception as part of the preventative care services mandated by the Affordable Care Act, and supported by the Women's Health Amendment. This is not a small issue. If coverage of birth control is not included as basic, preventative care, low-income women and women of color (many of whom are disproportionately poor) will continue to face an undue economic burden in protecting their reproductive health. In short, if coverage is not an option, many women will continue to find themselves priced out of the market for contraception, resulting in more unplanned pregnancies and potentially higher abortion rates -- a fate you'd think the anti-choice movement would be working to avoid at all costs.

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Washington State Win! Pharm Board Protects Access to Emergency Contraception

It's always nice to be able to report a little good news around the holidays, and the folks in Washington State are giving us the opportunity to do exactly that!

You may remember that just over a month ago, we reported on a challenge to an existing rule in Washington State that requires pharmacies to fill customer prescriptions for legal medications -- regardless of how individual pharmacists may feel about whether these products should or should not be legal. If the rule had been overturned, pharmacies in the state could have refused to provide certain medications to customers on the basis of "moral objection" -- medications like Plan B (the "morning after" pill) and other types of contraceptives.

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WA Group Takes on Threat to Emergency Contraception: Act Now!

In Washington state, there's a battle brewing over access to emergency contraception -- and our grantee, NARAL Pro Choice Washington, is standing tall, right at the center of it.

Back in 2007, the Washington State Board of Pharmacy -- with the explicit support of the state's governor, Christine Gregoire -- put in place a rule that requires pharmacies to fill customer prescriptions for legal medications regardless of how individual pharmacists may feel about whether these products should or should not be legal. The issue that drove the Board to implement this rule initially was concern over access to contraception in general, but specifically to Plan B, or the "morning after pill," which a particular grocery store in the state had refused to stock and dispense, citing "moral objection."

Once the 2007 rule was put in place, that grocer -- Ralph's Thriftway in Olympia, WA -- filed suit against the pharmacy board, seeking to overturn it. That lawsuit has dragged on all these years, with no resolution -- even though both public and judicial support falls distinctly in favor of upholding the 2007 measure and protecting women's access to the contraception of their choice.

Now, however, there is a new and troubling twist to the story: just recently, instead of letting the case go to court, the state's Attorney General attempted to negotiate a settlement between the Board and the suing pharmacists -- urging the Board to put in place a new rule, which would "[allow] druggists to refer patients to a different pharmacy" for service, "including for conscientious reasons." This would effectively overturn the 2007 rule, and provide cover for business owners and pharmacists to opt-out of providing customers with medications that they find "morally objectionable."

The people of Washington State have apparently been none too pleased to learn about the AG's actions -- or that the Board has since voted 3-2 to put this new rule in place. (Of particular note: two out of the three women who serve on the pharmacy board voted against accepting the AG's suggestion; the third woman was not present when the vote was taken.) To date, thousands of people have spoken out on the issue by sending letters directly to the pharmacy board; 4 out of every 5 comments has registered support for retaining the 2007 rule.

We're proud to report that Ms. Foundation grantee NARAL Pro Choice Washington is playing an active role in opposing these new limits on women's reproductive choices. The group has launched an online campaign that allows Washington State residents to send comments directly to the pharmacy board members -- and to Governor Gregoire -- to share their concern about pharmacies being allowed to take the law into their own hands. The decision is not yet written in stone -- people have until November 30 to urge the Board to reconsider its stance.

So if you're a Washington State resident, link up with NARAL -- and act now. Don't let your rights slip away without a fight!

Help NLIRH Ensure Contraception is Prevention in Health Reform Law

Coverage for contraception is still on shaky ground as the health care reform laws are beginning to be enacted. The US Department of Health and Human Services is currently in the process of determining what “preventive services” means, and birth control is one of the most hotly contested arenas. For you and the women you love, this means that women still have to fight for the right to fair and equitable health care in this country. And with the backlash against health care reform growing, we all need to support the work of our colleagues at the National Latina Institute for Reproductive Health (NLIRH) who fight to bring systemic and lasting change through the new law.

Help them in their quest. Call your representatives to demand that prevention is defined to include birth control.

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No-Cost Contraceptives a Possibility Under New Health Insurance Rules

Each year, 3 million unplanned pregnancies occur in the United States. Though there are any number of complicated reasons why women find themselves facing parenthood unexpectedly, one of them is quite simple: the cost of contraception.

With the roll out of new health-care mandates in the fall, however, an opportunity may arise to finally take the cost burden out of the picture for many women. The overhaul will force new insurers to provide a number of preventive care services to women at no cost -- and according to a recent Washington Post article, activists for reproductive justice are working to ensure that contraception becomes one of the no-cost services every insured woman qualifies for.

The article, which quotes spokespeople from the National Partnership for Women and Families and the National Women's Law Center -- both Ms. Foundation grantees -- notes that even the $20 -$50 co-payments currently required by many health plans that do cover contraception can often prove too much for young and low-income women. The goal, then, would be to remove cost barriers from access to birth control on the consumer side (as is done with "well-baby" visits for infants and young children, for example), which also protects the bottom lines of insurers and employers -- by helping prevent pregnancies that cost thousands of dollars to cover, versus the relative pennies contraceptives cost.

Predictably, religious and other conservative groups are opposing the measure, some on the basis that, "Fertility is not a disease to be cured." The final decision about whether contraception will make the grade as a covered service will be based on the recommendations of the Health Resources and Services Administration, which may take up to a year to come to a decision -- but from where we stand it's a no brainer: no woman should find herself facing an unwanted pregnancy because she can't afford birth control. The government has it within its power to make sure this is never the case; asking insurers to provide full coverage for contraception strikes us, quite simply, as the right -- and rational -- thing to do.