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BWHI Submits Letter for Record for Senate Hearing on Graham-Cassidy Bill

WASHINGTON, D.C. (September 25, 2017) Today, the Senate Committee on Finance will hold the only congressional hearing on the Graham-Cassidy proposal—the latest proposal to repeal the Affordable Care Act (ACA).  The Black Women’s Health Imperative (BWHI) submitted a letter for the record to reiterate the devastating impact that this proposal would have not just on Black women and their families but also on millions of low- to moderate-income Americans.

“Unaffordable health coverage has the potential to jeopardize the economic security of Black women and their families and cause serious financial difficulty such as bankruptcy.  Overall, the Graham-Cassidy bill will remove an important safety net for Black women and their families while reversing the progress made by the ACA.  So, instead of supporting a proposal that will physically, mentally, and financially devastate millions of Americans, we should be building upon the progress we have made through the ACA and work to make it even more effective in improving the health outcomes of not just Black women but all Americans,” Linda Goler Blount, president and CEO of the Black Women’s Health Imperative, wrote.

In June, several Black women of all ages provided testimonials to BWHI on the impact of an ACA repeal.

Here is a link to today’s Senate Committee on Finance hearing to consider the Graham-Cassidy proposal. Below is the text of the BWHI letter submitted into official committee record.


Dear Chairman Hatch, Ranking Member Wyden, and Members of the Senate Committee on Finance:

The Black Women’s Health Imperative is the only national organization solely dedicated to improving the health and well-being of the nation’s 21 million Black women and girls. As such, we are vocal on issues that we believe will impact this population. We write you today regarding the hearing to consider the Graham-Cassidy-Heller-Johnson Proposal (“the Graham-Cassidy proposal”) to express our concern about its impact on Black women and their families. It is our belief that access to quality, affordable health care is a basic human right, regardless of race, gender, income, or zip code. The Graham-Cassidy proposal will dismantle the positive progress made by the Affordable Care Act (ACA), especially for marginalized communities such as Black women.

Historically, Black women have faced significant barriers to accessing quality and affordable health care, which has substantially contributed to a litany of health disparities that we have seen in this country. For example, Black women are twice as likely to suffer from heart disease as a result of high rates of chronic health conditions such as obesity, elevated cholesterol, high blood pressure and diabetes.  Also, while Black women have slightly lower breast and cervical cancer incidence rates than their white counterparts, Black women are more likely to die from these cancers.  Black women are also up to four times more likely than white women to die from pregnancy-related causes.

The ACA has been critical in moving towards the elimination of health disparities that Black women and their families face. Between 2013 and 2015, among Black Americans, the percentage of uninsured working age adults, those skipping care because of medical costs, and those lacking a usual source of care greatly increased causing the narrowing of racial disparities between Blacks and Whites.  The ACA requires that all plans in the individual and small group markets include ten specified essential health benefits (EHBs), which include services essential to Black women’s overall health such as preventive and wellness services, mental health and substance use disorder services, and prescription drugs. Generally, since the ACA went into effect, 55 million women have accessed screening mammograms, HIV and sexually transmitted infection screenings, contraceptive counseling and well-woman visits.  Moreover, the ACA’s contraceptive coverage mandate has saved women approximately $1.4 billion in out of-pocket costs since it went into effect.  In addition, much of the narrowing of health disparities has been the result of low-income Americans gaining access to health insurance. Specifically, the percentage of low-income uninsured Black women decreased from 26 percent to 16 percent from 2012 to 2016.  The expansion of Medicaid enacted through the ACA has provided a significant source of coverage for millions of women, and has been critical to improving both maternal and child health outcomes by providing access to comprehensive health care services, including preconception services, for women who will or plan to conceive.  The results of the ACA have proven that providing Black women with health care services with these covered benefits leads to better prevention and management of serious health conditions that impact Black women and other populations of color, as well as low-income populations.

The Graham-Cassidy proposal seeks to repeal key provisions from the ACA that have been critical in increasing positive health outcomes for Black women.  Nearly 7 million women and girls selected a private insurance marketplace plan during the 2016 open enrollment period.  The majority relied on the ACA’s federal subsidies to help make their coverage more affordable. This proposal aims to eliminate this financial assistance — income-based premium tax credits and cost-sharing reductions effective January 1, 2020. Taken together, these changes would raise premiums, increase deductibles, and make it harder for many low- to moderate-income Black women to afford health coverage.

The proposal also seeks to decimate Medicaid, a safety-net program that is disproportionately comprised of vulnerable women of color. The Graham-Cassidy proposal would cap Medicaid spending and eliminate Medicaid expansion. Medicaid is a critical source of reproductive health services for low-income women, covering half of all births in the United States and three quarters of all publicly funded family planning services. Nearly 1 in 3 Black women of reproductive age are enrolled in Medicaid.  Converting Medicaid to a block grant or a per capita system and ending Medicaid expansion will result in states being forced to cut benefits, enrollment, and reimbursements to providers. In addition, the harmful work requirements encouraged through this proposal would also cut enrollment and remove health care access for a population in desperate need of medical services. Without Medicaid coverage, low-income Black women lose access to preventative services, reproductive health services, education and counseling, and many other life-saving health care services.

The Graham-Cassidy proposal, like previous ACA repeal bills, targets Planned Parenthood by barring reimbursements to the organization and prohibiting the organization from participating in the Medicaid program for one year. This essentially results in the nation’s most vulnerable citizens being denied access to life-saving and life-altering medical care from a trusted, reliable, and available provider of their choice. Currently, Planned Parenthood services nearly one-third of all women in need of publicly funded birth control.  Since federal funds are already restricted from being used to cover abortion services in almost all circumstances under the Hyde Amendment, defunding Planned Parenthood eliminates access to essential preventative care, contraceptives, tests and treatment for sexually transmitted infections, and breast and cervical cancer screenings. As a result, in some areas of the country, particularly rural areas, people would lose access to critical reproductive health services. These rural areas are much more likely to have high percentages of low-income black women.  This decision would not only impact Planned Parenthood clinics, but also other safety-net providers such as community health centers, which lack the capacity to absorb the 2.5 million Planned Parenthood clients — Medicaid enrollees and the non-Medicaid patients impacted by defunding.

Finally, the Graham-Cassidy proposal grants states the overwhelming authority to determine which health care services are considered essential for mandatory insurance coverage, which sets up different standards of care across the country. The elimination of the current EHB protections, including maternity coverage, will only make it harder for Black women to prevent unintended pregnancy, have a healthy pregnancy, and raise a family. Given the higher rates of maternal mortality for Black women, these cuts could be deadly.  In addition, states that choose to modify or eliminate EHBs would likely offer less than adequate plans for people with living with pre-existing conditions resulting in rising premiums and increasing out-of-pocket costs for this subset of the population. Because Black women are disproportionately affected by health conditions that could be considered pre-existing conditions such as breast and cervical cancers, and pregnancy they will be more susceptible to health insurance that is financially out of their reach.

Overall, the Graham-Cassidy proposal will not only remove a safety net for Black women and their families but will also reverse the progress made by the ACA, which has resulted in the narrowing of health disparities. Unaffordable health coverage has the ability to jeopardize the economic security of Black women and their families due to higher out-of-pocket costs, which have been shown to cause serious financial difficulty such as bankruptcy.  So, instead of supporting a proposal that will physically, mentally, and financially devastate millions of Americans, we should be building upon the progress we have made through the ACA and work to make it even more effective in improving the health outcomes of not just Black women but all Americans. We encourage you and your Senate colleagues to return to regular order and work together in a true bipartisan fashion to ensure all Americans have access to the quality, affordable health care they deserve.