The new Republican Government: How Will an Obamacare Repeal Affect Family Planning in Colorado?
Photo by osucoverde at morguefile.com
The upset victory of Donald Trump in November left many Americans in shock. Whether you are celebrating or dreading the next four years, no one can deny the political seismic shifts taking shape here in the US and around the world.
A big concern on the minds of those of us in the pro-choice community is the future of Roe v Wade, since Trump may have the chance to appoint as many as four supreme court justices. Trump said during the campaign that women should face punishment for having an abortion.
Another area of anxiety for many Americans – and one that will have significant repercussions on women’s healthcare access – is the Republicans’ promised repeal of the Affordable Care Act. Preliminary steps to dismantle ACA have begun in the Senate, and an amendment to preserve mandatory birth control insurance coverage was rejected.
Obamacare now covers about 20 million people nationwide. Coverage by ACA, plus shrinking unemployment, has helped put the uninsured rate in Colorado at historic lows – down to 6.7% in 2015. That translates to 419,000 people in Colorado who obtained insurance since the ACA was enacted in 2010, according to the US Department of Health and Human Services. December 2016 data released by Connect for Health Colorado, the healthcare exchange in our state, showed a 30% increase in enrollees from the previous year.
What’s more, every woman with health insurance – whether it’s through the healthcare exchange, Medicare or Medicaid, or private insurance through an employer – is guaranteed free preventive coverage including all FDA-approved contraceptive options like the pill, Plan B, and long-acting contraception like IUDs and female sterilization – even if they work for an organization that objects to contraception for religious reasons.
Vasectomies and other forms of male contraception, and abortions, are not required to be covered under ACA rules.
And ACA also bans gender discrimination in premiums: prior to the gender discrimination ban, women in some states could pay as much as 50% more than their age-matched male peers from some plans.
What will happen to women’s health choices in Colorado if ACA is repealed, in whole or in part?
Connect for Health Colorado (referred to as “the exchange” from now on) assures enrollees that changes to federal law can’t impact Colorado plans already sold for the 2017 calendar year, so there’s a year of breathing room for healthcare consumers who have insurance through the exchange. Yet there could be big changes to family planning coverage, even if there’s only a partial repeal of ACA.
Pregnancy – a pre-existing condition?
Some pundits are predicting a possible dip in births, as women wait to become pregnant to see how the healthcare situation develops.
Deyanna Lambert, a married mom of two in Broomfield county, says she and her husband were considering having a third child. “That is, until the results of the election gave me a firm shove the other way. The costs of healthcare, childbirth, and childcare are already ridiculous. I worry it will only get worse under the new administration.”
So while pregnancy is not traditionally thought of by some as part of family planning, many considerations including access to quality prenatal care, birth costs, and even political factors go into the decision to prevent or continue a pregnancy.
The cost of a pregnancy today in Colorado varies widely, even for women who have insurance. A cost estimator from Anthem Blue Cross Blue Shield in January 2017 found the negotiated cost of an uncomplicated vaginal birth was between just over $9000 to $15000 in the Denver metro area, with out-of-pocket costs as low as $300 for a low-deductible plan, and into the thousands for high deductible plans.
Yet half of all pregnancies are unplanned and poor women are five times more likely to have an unplanned pregnancy than affluent women. How would an unplanned pregnancy be likely to play out if parts of ACA or the Medicaid expansion are repealed?
Let’s start with some possible good news: a post-election analysis by Colorado’s state exchange suggested that the preexisting condition ban under ACA is unlikely to be repealed since it enjoys strong bipartisan and popular support. If true (and there are dissenters), that would mean women who are or may become pregnant could continue to be covered for prenatal care and delivery even if they have to change insurance providers during their pregnancy.
And it’s worth remembering that the pre-existing condition clause only applied to individual health insurance even before ACA, i.e., insurance you purchased out of pocket, not through an employer – so if you changed employers during your pregnancy, you were still covered. Cold comfort, but it’s something.
Now for the not-so-good news: Medicaid expansion is very vulnerable to changes in federal funding levels. Colorado has one of the largest state Medicaid expansions, enrolling almost 300,000 people in the first year and a half after the expansion was signed into law by Governor Hickenlooper in 2013.
The Medicaid expansion as it exists now increases the income cap for pregnant women to qualify from $48,000 to $64,000 per year for a family of four. Expectant families with income up to $97,200, or four times the poverty level, qualify for tax credits through the exchange. The federal government pays for most of the additional expenditures with these expanded income limits.
The impact of federal restructuring of Medicaid reimbursements to lower levels will mean that the state will have to cut services,make service more efficient, shrink the rolls to maintain services, or all three. This will hit the working poor and lower middle class women the hardest, as they’re the likeliest to have coverage under expanded Medicaid.
An unplanned pregnancy in Colorado is a lot less likely than it was even a few years ago. The decrease in unplanned pregnancies could be partly due to improved access – both because of the record numbers of women insured through the exchange and Medicaid expansion, and because ACA requires insurance plans to cover all eighteen FDA-approved forms of contraception including IUDs, which are highly effective but had very high out-of-pocket costs before ACA.
Just before the rollouts of ACA and Medicaid expansion, the state launched the Colorado Family Planning Initiative (CFPI) in 2008. Funded by a $27M anonymous donation and run by the Department of Public Health and Environment, the CFPI has been extremely successful, cutting the teen birth rate and abortion rates in half in just five years.CFPI provides funding to Title X clinics – a family planning program aimed the poor and uninsured enstated in 1970 by Nixon. The goal of CFPI was to increase access to the most effective forms of reversible birth control, long-acting contraception like IUDs. Insertion of IUDs quadrupled over the first six years of the program.Over the same period, revenue to participating Title X clinics became much more reliant on third party payers, flipping from 80% client paid to 75% third party payer paid, mostly from Medicaid which paid out $4M in 2015.
A January 2017 report on CFPI by the state public health department cited revenue from public and private insurance claims under ACA and new state funding as part of its financial sustainability model. Public records in 2015 indicate that the state would have to pick up a $3M shortfall if federal funding for expanded Medicaid and ACA dry up, but it is unclear at this time how deeply affected the program will be with cuts in federal funding. The Family Planning Program office declined to comment on possible impacts from federal cuts.
Planned Parenthood of the Rocky Mountains (PPRM) is another of the biggest providers of women’s healthcare in the state, serving 72,000 women per year. PPRM does not receive Title X funding in Colorado. About 30% of PPRM clients are Medicaid recipients, roughly double the percentage prior to Medicaid expansion. Rolling back Medicaid coverage to pre-expansion limits would cut off over eleven thousand PPRM clients from care.If congressional Republicans succeed in halting reimbursements to Planned Parenthood by Medicaid – they tried to again in early January – that’s an estimated 22,000 women in Colorado who would lose their provider. In some rural counties of Colorado where Planned Parenthood is the only provider for low income women, that could mean women going without necessary preventive care.
Thinking about the big picture, there are 650,000 women of childbearing age in Colorado who require family planning services. As is often the case, the most vulnerable women are the ones who are likeliest to have their access to family planning threatened. Women who are at risk fall into three main categories:
- Lower income women who stand to lose their coverage, if they are currently covered through expanded Medicaid.
- The uninsured – or women who feel they can’t use their insurance for family planning services – who may face reduced access to services due to decreased funding.
- Those whose private insurance companies may choose to rescind or reduce contraceptive coverage when no longer required to by law.
Federal changes to ACA and expanded Medicaid have the potential to directly impact many women in Colorado and their families. Michelle Lueck, CEO of the Colorado Health Institute issued a challenge last month at the annual Hot Issues in Healthcare 2016 conference, “How can we sharpen our gaze, find a way forward, and wisely choose our battles – for the things that matter most?”
As we Coloradans chart our course through this tumultuous time in history and an uncertain healthcare future, it’s important to keep our focus on what matters most: the tenacious women, men, and children who are at the beating heart of this state.
What will we be doing, as pro-choice women and men of faith, to help chart a caring and compassionate course that provides healthcare and family planning for all?
Ways you can help
- Attend a Women’s March! The Women’s March on Denver starts at 9:30 am on Saturday, January 21 in Civic Center Park. Visit the website for updates and schedule of speakers. If you’re not in town, attend a sister march in one of the many around the country. At time of writing there were 281 scheduled solidarity marches around the world!
- Watch the “anti-inauguration” Love-a-thon, a facebook live stream event, with proceeds benefiting Planned Parenthood, the ACLU, and other progressive organizations. Read more: http://money.cnn.com/2017/01/04/technology/loveathon-facebook-live/
- Make a donation to Planned Parenthood of the Rocky Mountains, or the Colorado Religious Coalition for Reproductive Choice.
- Write a letter to the editor. These DO make a difference!
Don’t see your local paper? Check here for a full list.
- Post a comment below in the comments section of this article with YOUR ideas of how to impact choice in this difficult time.
Adamczyk, A. (2017, January 13). Obamacare Repeal: What Happens to Birth Control Coverage? Money Magazine.
Assistant Secretary of Public Affairs. (2016, December 16). Impact of the Affordable Care Act in Colorado.
CDPHE Title X and Medicaid / Insurance Reimbursement (2011-2014). (2015, March 4).
Cohen, C. (2016, November 9). Donald Trump sexism tracker: Every offensive comment in one place. The Telegraph.
Colorado Department of Public Health and Environment (2017, January). Taking the Unintended Out of
Connect for Health Colorado Metrics. (n.d.) http://connectforhealthco.com/resources/stay-informed/metrics/
Healthcare.gov staff. (n.d.) Health Care Benefits: Birth Control Benefits.
Johnson, E., Brooks, R. (2016, December 22). Medicaid Midstream – The Impact of Expansion So Far and Options for the Future. Colorado Health Institute 2016 Hot Issues in Healthcare.
Kaplan, T., Thrushjan, G. (2017, January 4). Senate Republicans Open Fight Over Obama Health Law. The New York Times.
Liptak, A. (2016, November 9). What the Trump Presidency Means for the Supreme Court. The New York Times.
Laliberté F, Lefebvre P, Law A, Duh MS, Pocoski J, Lynen R, Darney P. Medicaid spending on contraceptive coverage and pregnancy-related care. Reprod Health. 2014 Mar 3;11(1):20.
Norris, L. (2017, January 10). Colorado health insurance exchange / marketplace.
Pear, R. (2017, January 4). Republicans’ 4-Step Plan to Repeal the Affordable Care Act. The New York Times.
Pollack, H., Jost T. (2017, January 10). Seven Questions about Health Reform. The New York Times.
Stein, P and Somashekhar, S. (2017, January 4). It started with a retiree. Now the Women’s March could be the biggest inauguration demonstration. The Washington Post. Retrieved on 1/4/2017 from http://www.chron.com/national/article/Women-s-March-on-Washington-is-poised-to-be-the-10833059.php
The Associated Press. (2017, January 4). GOP House Panel: Halt Federal Money for Planned Parenthood. The New York Times.
End of Year 2016 Recap
Dear Friends and Supporters of Reproductive Choices, Health, Rights and Justice,
The Colorado Religious Coalition for Reproductive Choice (CORCRC) does something that no one else can do. We speak out using religious authority to correct the misconception that there is only one moral response to a pregnancy. We bring a unique and needed voice to the work of reproductive health and rights. We are able to authentically and accurately counter the claims of the religious right. 2016 has been a year of significant growth for CORCRC.
- In January our “Clergy Day of Learning”, was led by the national RCRC to train clergy and theological students in counseling and responding to women dealing with unwanted pregnancies. No one else offers pregnant women this non-judgmental, faith-based and supportive counseling.
- Our film series expanded to two film showings: “If These Walls Could Talk” and “Cider House Rules”. Both films challenged those who would limit women’s rights and encouraged our pro-choice allies.
- Our Faith and Freedom event was especially poignant as we honored a legislative leader and committed abortion providers who have been impacted by the attacks on Planned Parenthood.
- We have joined a new coalition of pro-choice organizations in Colorado with the goal of introducing positive reproductive justice legislation; this in addition to working against the many anti-choice bills that are introduced annually. We bring an important faith voice to the coalition and to the Legislature.
- We hosted an outstanding forum on “The Separation of Church and State”, which is available for listening on the website http://www.corcrc.org.
- We are focused on several technical initiatives to improve our outreach. We premiered an electronic newsletter available on the website. Work is commencing on data-based strategies to improve our communication with constituents and legislators to strengthen our public and social media presence.
- We are growing our leadership and infrastructure to become a more effective organization in the faith community and in the community as a whole.
You can be a part of helping women in their struggle for religious freedom and reproductive justice. Please give us an end of year gift so we can expand our mission to advocate for, educate and support women in their choices. Please do so using the enclosed response envelope or online at http://www.corcrc.org. Also please help us be good stewards of our communication dollars by using the enclosed card to give us your email address. We will keep it confidential and not share it.
Senator Betty Boyd
CORCRC Board President
P.S. Please donate today. Thank you for your caring support and generous giving.
Dear Friends and Supporters,
Regardless of your political stance, Colorado’s Religious Coalition for Reproductive Choice recognizes that this has been a difficult election for all of us. As supporters of reproductive choices, health, rights and justice – we know that more difficult times lie ahead.
Democracy requires a dialogue between citizens and elected officials. The in-coming administration is proclaiming that they will “protect innocent human life from conception,” bringing “personhood” into the White House. CORCRC represent the many people of faith who believe in women’s agency over their own bodies and reproductive lives. The intent of a democratic process is to create an environment that allows for compromise, the development of inclusive and diverse communities, and acceptance of respectful disagreement. Dialogue, is an interactive process that requires listening as well as speaking.
The CORCRC is committed to providing pathways to unity by expanding difficult conversations in safe and accepting environments while bringing a progressive voice to that conversation. By continuing to provide forums, educational tools and opportunities for dialogue, CORCRC is committed to increasing understanding and compassion between people with different viewpoints.
We are working on our infrastructure over the next months, to be ready for the 2017 Colorado legislative session. We are working with partner organizations, allies in this critical work.
Please join us! Please listen to our recent forum on the Separation of Church and State. Attend our educational events. Help us grow our educational tool box. Join a committee. Help move your voice forward.
A FORUM: WHY THE SEPARATION OF CHURCH AND STATE IS IMPORTANT FOR MAINTAINING REPRODUCTIVE JUSTICE
|CONGRESS SHALL MAKE NO LAW RESPECTING AN ESTABLISHMENT OF RELIGION, OR PROHIBITING THE FREE EXERCISE THEREOF; OR ABRIDGING THE FREEDOM OF SPEECH, OR OF THE PRESS; OR THE RIGHT OF THE PEOPLE PEACEABLY TO ASSEMBLE, AND TO PETITION THE GOVERNMENT FOR A REDRESS OF GRIEVANCES.
— THE FIRST AMENDMENT TO THE UNITED STATES CONSTITUTION
Welcome Joyce Lisbin Executive Director CORCRC
Betty Boyd, President of CORCRC Board of Trustees
Introduction of Panelists Savita Ginde, M.D. CORCRC Board of Trustees Education Chairperson, Medical Director of Planned Parenthood of the Rocky Mountains
Religious diversity is respectfully expressed in the First Amendment.
Eliza Buyers, MD, FACOG
Barriers to the medical practice of reproductive justice- personal stories.
Dr. Jim Ryan
“Reproductive Justice: Faith Community As Advocate Not Dictator.”
Political Activities of Tax-Exempt Religious Organizations.
Questions and Time for Discussion
On October 19th, 2016 the CORCRC proudly hosted a discussion on the impact of the separation of church and state on reproductive justice. The evening was recorded so that this exchange could be shared with those not fortunate enough to attend. The information shared by the expert panel generated valuable discussion and important questions.
Before you listen to the recording you may want to familiarize yourself with the program and information about the panelists. The recording is located below for your listening pleasure.
The Board and staff of CORCRC is saddened by the
ongoing fatal encounters between the police and the
black communities across our country. We endorse the
efforts being made in communities toward outreach and
understanding between law enforcement and the
communities which they serve. Our faith traditions call us
to stand in solidarity with civil rights organizations that
are working toward building a more just and accepting
society in which every human being is seen, heard and
accepted as a contributing member of society and not
judged by their race, religion, sexual orientation or
political views . We believe that social justice will prevail
only when all people can live with dignity, in safety,
abiding by human rights law.
Colorado Clergy and People of Faith Commitment to Reproductive Justice
As clergy, faith leaders and people from a wide spectrum of faiths in Colorado, we stand together for reproductive justice and religious freedom. This stand is critical now as we have seen recent violence at a Colorado Springs Planned Parenthood clinic, and we have seen how unethical anti-reproductive justice proponents used area Planned Parenthood staff to create a nationally released false tape which told lies about this critical service.
We affirm the sanctity of life and support laws and policies that provide access to legal, comprehensive reproductive healthcare, including contraception and access to safe and legal abortions. A woman must have control over her own body and her healthcare decisions. Because there are many religious, ethical and compassionate positions on reproductive issues, no single perspective, restrictive or not, should govern the rights of all.
We know that women have the capacity for their own ethical agency, and we support women as they seek guidance and counsel from pastors, clergy, their families and doctors to make personal and private decisions. We support religious and medical professionals as they advocate for women to be their own primary decision makers. We stand by the work of women’s health centers, including Planned Parenthood, for providing quality and affordable medical care and comprehensive sex education so vital to the well-being of our communities.
We support the needs and rights of women to live their full lives. This commitment requires that women receive equal pay for equal work and access to educational and professional opportunities. We continue to strive for access to affordable health care, safe and affordable housing, nutritional food, clean water and air, reliable childcare and excellent public education.
We support evidence-based policies that provide comprehensive sex education; research concludes that comprehensive sex education reduces sexual violence and improves the sexual health of Colorado’s youth. We join the efforts of many to erase all forms of violence, especially the normalized violence against women and children.
We support policies and leadership that do not discriminate against women or men on the basis of their gender identity or the very personal decisions about who they love, how they form their families and how they express their genders.
We value genuine religious liberty, which upholds the right of each person to make faith-based or conscience-based health care and reproductive decisions. We honor and defend the American principle of separation of church and state.
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