From the Field: Health Care Law's Positive Impact on Women

Making Change Happen in Florida

  Leah Barber-Heinz is the CEO of Florida CHAIN

Lost in all of the political wrangling over the Affordable Care Act is the fact that Florida’s women, an astounding 1.4 million of whom are uninsured, will see a huge positive impact thanks to these reforms.

The new law creates significant cost savings by eliminating annual and lifetime limits on how much insurance companies cover if women get sick, as well as prohibiting insurers from dropping women from coverage when they fall ill. Moreover, plans in the new health exchanges place a cap on how much insurance companies can force women to pay in co-pays and deductibles. Starting in 2014 women who cannot afford quality health insurance will be provided tax credits, and the Act will completely close the donut hole for prescription drugs by 2020.

The law also provides more and better health care options and ensures coverage of basic health services including maternity benefits. Maternity benefits are often not provided in health plans offered through the individual insurance market.

Also of particular relevance to women is the fact that the new law already prohibits insurance companies from denying children coverage based on preexisting conditions. Moving forward, it will prohibit insurance companies from denying any woman coverage because of a pre-existing condition, excluding coverage of that condition, or charging more because of health status or gender. Right now, a healthy 22-year-old woman can be charged premiums 150 percent higher than a 22-year-old man.

The Affordable Care Act also aims to crack down on excessive insurance overhead by limiting how much insurance companies spend on nonmedical costs such as executive salaries and marketing. And insurance carriers must justify their premium increases in order to remain eligible for the health exchanges.  

The positive impact these reforms will have on Florida’s women and their families cannot be overstated. A recent report by Families USA found that more than 70 percent of consumers in the individual market will be eligible for financial assistance through the Marketplaces, because they either qualify for tax credits that will make their coverage more affordable or for Medicaid.

As a result of these and other important reforms included in the Affordable Care Act, fewer Florida women will delay needed care or be forced to give up basic necessities in order to get the health care they need.

Voices from the Field: Callie Womble, Intern Extraordinaire

Hello Blog World! My name is Callie Womble and I'm a Masters of Public Health student in the Health Behavior Department at the University of North Carolina Gillings School of Global Public Health. My graduate program focuses on the social and behavioral sciences as a means of understanding and improving the health of populations. One of my academic passions is minority women’s health. I enjoy brainstorming innovative ways to improve wellness and reduce disparity. I first got involved with women’s health in undergrad when I co-founded the UNC Chapel Hill chapter of the Office of Minority Health’s Preconception Peer Educator program and interned at NARAL Pro-Choice North Carolina. These experiences were invaluable to me because they introduced me to the Maternal and Child Health (MCH) field, and ignited my passion.

 

As a graduate student, I wanted to build on that foundation and gain more research experience. In May of this year I began my practicum at the UNC Center for Maternal and Infant Health. My main responsibility has been to disseminate the Women’s Voices Survey, and analyze its results. Working on the Women’s Voices survey was a great because it directly addresses health disparities (an issue near and dear to my heart) and has given me a chance to sharpen my data collection, management and analysis skills.

At the end of August we closed the Women’s Voices survey with 1,950 responses from women of all nine EWSE states and our sample truly represented a life course perspective engaging women of all ages. (How awesome is that?!)  Analyzing the data has been incredibly fulfilling – the survey validates the stories of women in our region. The daily lived experiences of Southeastern women matter, and this survey both affirmed the women as individuals and provided a space for them to share how they see the world.  For me, the most thought-provoking aspect of the data analysis was coding the qualitative responses to questions asking women what they need in order to improve their health. Some of the quotes that really got my attention included:

·         I need an accountability partner.  I have the tendency to procrastinate and put other's needs before my own.  I need a gently forceful person to make sure I'm doing what I'm supposed to do.

·         More education and support on how to balance the many competing demands that women face today with work, family, friends, etc.

·          to have doctors treat me as a human and not just as a poor-Medicaid recipient.

·         A practitioner that listens.

·         A better job so I didn't have to work so hard.  More time. I feel like a lot of my health issues stem from my lack of time to do things like prepare meals and exercise. I work a lot, so that doesn't leave much time for me.

·         Access for the African American population, especially those in rural areas.  Transportation is an issue.  Fear is another issue.  Cost factors in.  Prescription costs prevent consistent medication being used.

These quotes remind me that women in our region often have many responsibilities. They are moms, daughters, friends, sisters, employees, students, church members, sorority members, girlfriends, wives and the proverbial list of “hats women wear” goes on and on. Subsequently, prioritizing others’ needs above their own is a current norm for most women. It also reminds me that the social determinants of health (e.g. where you live, work, play and pray) are REAL and they truly impact how women experience life and wellness. In order to create lasting change we as public health professionals need to strategize ways to make self-care for women the default choice, as well as ways to positively influence the social determinants of women’s health. Indeed, this is a tall order but it’s necessary to change the status quo.

As my practicum comes to close, I have started to reflect on all I have learned these past six months. While the technical skills are indeed significant to me, what resonates most to me about my practicum is the well-rounded nature of my experience. From meetings with stakeholders, to capacity development webinars, to daily in-office conversations with my supervisor and the fellow staff, this experience has been a total emersion in all things MCH. I’ve learned countless new jargon, discovered new thought leaders and followed intense political legislation alongside my fellow staff. 

The most meaningful part of my practicum has been interacting with professionals from different disciplines. It has been both informative and rewarding to hear about women’s health issues from their perspective and then share my thoughts from the HB point of view. These interactions have highlighted how all disciplines have significant expertise necessary for accomplishing our shared goal: improve the health of populations. By working together we are able to put the different pieces of the puzzle together, have a collective impact and achieve our shared goal. Although my practicum is ending, I am excited to continue this versatile experience of personal and professional development as a part of the EWSE leadership team.  As a North Carolina partner I am looking forward to continuing our work towards health equity in our region.

Connecting in Mississippi

Last week I had the opportunity to travel to Gulfport, Mississippi to partner with EWSE Leadership Team member Juanita Graham and her colleagues on promoting the life course approach to reducing infant mortality.The focus of my trip was a presentation to the District 9 FIMR Teams (fetal, infant mortality review) coordinated by Mary Craig and Cheryl Doyle, both experienced and dedicated leaders on this project. Teams have now reviewed over 50 cases and 7 area hospitals have introduced some new policies and classes, particularly around SUIDS risk reduction. The group is now eager to expand their thinking about new approaches to preventing infant death. The meeting was very well attended, including several staff from the state health department in Jackson. The group had a lively discussion about life course and shared ideas about how it could be applied in Mississippi. 

Part of the trip included the chance to network with Juanita's colleagues on behalf of the coalition. My visit happened to coincide with the MS Nurses Association Conference which was themed “Hunting for Evidence-Based Practice” (thus the camo gear). I had the great opportunity to go with them on an evening boat ride in the Gulf. The sunset over the Gulf was amazing and those MS nurses know how to have fun! I also had the chance to recruit some new members to the state team and learn about the MS Coast Interfaith Task Force which is doing some fantastic work on community resilience, access to health care, life planning for 8th graders and more.

While the landscape is lovely and the people are really warm, Mississippi faces many challenges, including poverty, obesity, few resources for programs and high rates of maternal mortality. Fortunately, the state also has a cadre of nurses and public health leaders who are determined to make change happen. Seeing how the community has rebuilt from two recent disasters (Katrina and the oil spill), it was clear that the people of Mississippi are resilient. Hearing that in 2012 Mississippi has achieved its lowest rates of infant mortality ever (while other Southern states have seen increased rates or stagnation) absolutely affirms that these leaders are making a difference. We look forward to connecting with new colleagues and continuing to build the  Mississippi Connection!

Savannah Cooksey, Connie Bish, Juanita Graham, Cheryl Doyle, Sarah Verbiest and Mary Craig (start top left to right)

What Southern Women Need to Know about the ACA

Cecilia Sáenz Becerra is the field organizer with Raising Women's Voices for the Health Care We Need. She works with RWV’s state partners throughout the South and resides in Atlanta, GA.

What about health care reform is exciting for you?

As October 1 draws arrives, I am excited that thousands of people across the nation who previously did not have health care will finally have the opportunity to get covered through the Affordable Care Act (ACA)! Specifically, I'm excited about mobilizing women, women of color, immigrants, and LGBT folks to enroll for affordable insurance options - especially in the southern states where we know the highest percentage of uninsured populations reside, many of whom don't earn enough to be able to buy private insurance and aren't eligible to be covered by Medicaid.

Another exciting aspect about ACA is how it's making insurance improvements. For example, no more gender rating (women will no longer have to pay more simply because they are women), no more lifetime or annual limits, no more pre-existing condition bans, no more taking away insurance when you get sick!

To help women learn about the new options ahead of us, Raising Women's Voices for the Health Care We Need and the Ms. Foundation have collaborated on a campaign that will complement, support, and amplify state level ACA outreach and enrollment efforts. The campaign, women 4 health care (@Women4HC), premiered on October 1 and includes an array of resources, tools, and materials for organizations engaging in this work, including Facebook and Twitter. Get the latest updates on Women 4 Health Care and learn more about how to get involved by filling out this simple form: http://bit.ly/Women4HealthCareSignUp.

What worries you / keeps you awake at night?

The new health care law will bring peace of mind and security to millions of Americans, but I worry about the people who will still fall into gaps that remain - some of which directly affect some of the people I'm closest too.

In many Southern states, conservative politicians have so far refused to accept federal funds that would allow them to provide insurance coverage through state Medicaid programs to more low-income people living and working in their states.  This is a heart-breaking missed opportunity that will leave many people with no affordable way to get health insurance, like my partner.  And according to economic experts in states that have done the analysis, it’s also a fiscal mistake because using federal money to expand Medicaid eligibility could actually save money for states, support well-paying health care sector jobs, and generate new tax revenues.  It’s not too late, though, and I hope we’ll be able to make this worry go away by persuading more states to accept the federal funds and cover the new eligible populations.

Another gap that exists throughout the country is that undocumented immigrants, like my mother, are not allowed to buy insurance on the marketplace (even if they have the money and are able to pay full price). Immigrant youth who have filed for Deferred Action for Childhood Arrivals (DACA) are also not eligible, despite being recognized as "lawfully present" in the U.S.  And even immigrants with documentation will face some barriers because of the five-year ban making them ineligible for the financial help they might need to make insurance affordable in the Marketplaces.  People who can't get insurance because of these gaps will have to rely on the same, limited sources for care that were available before the new law, including community health centers, which did at least get some new funding, thanks to the ACA.

For the millions who are eligible to buy insurance in the Marketplaces, I worry that women, women of color, and LGBT folks might not get the information they need to make informed decisions about plans that will meet their health care needs. These are constituencies that historically have been ignored and marginalized and, in the South and other rural states (like Montana), often face additional access challenges. To make sure they do get the necessary information, there will have to be outreach that's specifically designed to overcome these challenges -- taking the information directly to these communities -- in their homes and by phone -- and to places where people from various underserved communities are already coming together -- like at community events, festivals, using social media channels where people congregate virtually.

Yet, there isn't a challenge out there that doesn't come with great opportunity. The need to do this targeted outreach creates space for organizations big and small to come together for a common goal. And there are some great organizations that are targeting these populations and engaging in outreach in the ways I just mentioned, like RWV, Out2Enroll, Enroll America, along with a slew of local and state-wide organizations. These are the challenges we face, that for one keeps me worried, but it’s also motivating to know there is a lot collaborative work being done.

What charge might you issue to women in the South about what we should be doing now?               

I would give women in the South a charge of three things to do right now:

1.    If you’re uninsured, get ready to enroll by identifying your health care priorities

2.   Draw on local available help to figure out which health insurance plan fits your budget and meets your needs, and sign up! 

3.   Whether you have insurance or not – find formal and informal ways to talk with friends and community members about these exciting changes and share the tools that are available with your networks.

To expand on number one, you really have to think about what is important for you in an insurance plan.  Does the plan include the doctor, clinic or hospital that you use? Does it cover your medical needs? Which plan best fits your budget? You can more information and other thought provoking things to keep in mind in the Choosing a Plan section of the RWV website.

                                                                                                                                                                                             

If you have enrollment questions you want to ask to a person, Healthcare.gov suggests you visit LocalHelp.HealthCare.gov to find help in your area, and you can also contact one of RWV's Regional Coordinators if we have one in your state. (As a side note, we are currently looking to expand our Southern partners, contact me if you know of an organization that might be a good lead!).

For number three, even if you don’t feel like an expert, remember that the best messenger for these very personal issues is often a person we know. You can use the RWV Fact Sheets to help your friends and family members learn about the changes that are coming, and share the 10 ways to get ready for the Health Insurance Marketplace with anyone you know who doesn’t have insurance!