There are a number of state and national legislative issues that impact on our ability to provide care for our patients. Many also will impact our patients’ access to care.
Recently, President Trump announced that the Affordable Care Act (ACA) would be replaced by a Republican-initiated healthcare plan. The specifics of this new plan have not been presented and the President is now stating that a vote won’t take place until after the 2020 election. Prior to the ACA, most insurance plans charged women higher premiums for the same insurance as men while excluding benefits such as maternity care and refusing to cover or charging higher premiums for pre‐existing conditions. The pre‐existing conditions included pregnancy, obesity, depression, history of cancer, diabetes, substance use disorder or a history of domestic violence. Approximately 65 million women prior to the ACA were at risk for higher costs or denial of insurance because of pre‐existing conditions. i,ii
In 2018 the Administration permitted short‐term, limited duration insurance plans to be marketed for a full year and renewable for up to 3 years. Previously these plans were for use for only 3 months. Other plans permitted include Association Health Plans (AHPs) which are marketed to small employers and self‐employed individuals. The Administration also indicated it will now approve Section 1332 waivers, originally designed to encourage state innovation to increase access to health coverage that allow the sale of insurance plans that do not have to comply with the coverage required by the ACA. iii, iv
Currently there is federal legislation to combat theses harmful regulations: HR 986/S466, the Protecting Americans with Pre‐Existing Conditions Act, would return Section 1332 waivers to their original purpose and ensure health plans comply with ACA patient protections; HR 1010, to return short‐term limited duration plans to their original intent; and HR 1143 the Educating Consumers on the Risk of Short‐Term Plans, to require insurers selling short‐term plans to disclose coverage exclusions. v
It is critical that we advocate for the continued comprehensive coverage of our patients for pre-existing conditions including maternity care. To get involved, contact the District IV Fellow or Junior Fellow legislative chairs or contact your state legislative chair. vi
Another option is to go to www.acog.org/advocacy to become an advocate. If you are on social media, join the conversation by following @ACOGaction.
Another concern is the removal of Title X funding from Planned Parenthood Health Centers. Title X is the only federal program exclusively dedicated to providing low‐income patients with access to family planning. It also provides access to cancer screening, pregnancy counselling, STI screening and treatment and preventive care. None of this funding goes towards abortions. The Administration announced last week that Planned Parenthood affiliates in two DIV States, North Carolina and Virginia, were stripped of funding. With the harmful Title X regulations scheduled to take effect nationwide in a few weeks, which will make it impossible for any Planned Parenthood health center to participate in Title X, access for low‐income women is at grave risk. The Title X regulation also prevents all providers who receive Title X funding from referring patients for abortion and provides a pathway for Faith‐Based Family Planning Clinics, often referred to as Crisis Pregnancy Centers, to gain access to this federal funding as approved Title X entities. What can we do? As these regulations are being challenged in courts, we should not pursue state legislation. However, we should use our voice to help continue to demonstrate the harm of this regulation. ACOG is collecting personal stories from ob‐gyns to show how this regulation will impact on our ability to care for our patients. Share your story here!
ACOG has stated, “Facts are very important, especially when it comes to women’s health. As with all of women’s health, policy related to abortion care, including abortion later in pregnancy, must be based on medical science and facts. Politicians should never interfere in the patient-physician relationship.” vii
HB481, a six-week abortion ban, has passed the Georgia Legislature and has been sent to Gov. Brian Kemp who has stated he is eager to sign it. This bill bans abortion after a fetal heart rate is detected which is typically around 6 weeks gestation, often before a woman knows she is pregnant. South Carolina is also considering a six‐week ban. While these alarming restrictions have been introduced in a number of states, other states are taking proactive action, introducing bills to decriminalize abortion (by both providers and patients) and protect the right to an abortion, even if federal protections are undermined or eliminated.
In November, West Virginia passed Amendment 1 which excludes abortion from the state constitution’s privacy protections, thus opening the door for politicians to interfere in the patient-physician relationship. Members of the West Virginia Section opposed this Amendment. vi
In Maryland, the ACOG Section has responded to lawmaker interest in establishing local MMRC, mainly in Baltimore City. A compromise bill (SB 602) would allow data sharing between the state-level MMRC and local health departments. A bill that has cleared the legislature in Maryland and awaits the Governor’s action requires the Secretary of Health to include maternal mortality rate comparisons by race/ethnicity in their annual report.
It is imperative that we advocate for our patients and their access to care as well as our ability to provide patients with the care they need and deserve. It will take all of us working together to maintain the care currently available in most areas. If you are not already an advocate, now is the time to begin. Please.
Constance Bohon, MD, FACOG
Holly Puritz, MD, FACOG
ACOG District IV Legislative Chairs
i,ii,iii,iv footnotes at bottom of Ask 2: Don’t Turn Back the Clock on Women’s Health, March 2019
v Ask 2: Don’t Turn Back the Clock on Women’s Health, March 2019
vi DIV Fellow and JF Legislative Chairs, DIV State Fellow Legislative Chairs
vii Facts are Important: Abortion Care Later in Pregnancy is Important to Women’s Health, ACOG , February 2019