Shaffer in AJPH on the Affordable Care Act: The Value of Systemic Disruption

Shaffer on the ACA in the Amercan Journal of Public Health: The Value of Systemic Disruption

Abstract: It is important to recognize the political and policy accomplishments of the Patient Protection and Affordable Care Act (ACA), anticipate its limitations, and use the levers it provides strategically to address the problems it does not resolve.

Passage of the ACA broke the political logjam that long stymied national progress toward equitable, quality, universal, affordable health care. It extends coverage for the uninsured who are disproportionately low income and people of color, curbs health insurance abuses, and initiates improvements in the quality of care.

However, challenges to affordability and cost control persist.

Public health advocates should mobilize for coverage for abortion care and for immigrants, encourage public-sector involvement in negotiating health care prices, and counter disinformation by opponents on the right.

Tables summarize major changes in coverage, insurance company protections, and quality/affordability.

(Am J PublicHealth. Published online ahead of print February 14,2013: e1–e4. doi:10.2105/AJPH.2012.301180. It will appear in print in June, 2013,)

Presidential Debate: Ask About Women’s Rights Treaty/CEDAW

The third and final presidentail debate is scheduled for Monday, October 22, with a focus on foreign policy.

Please click here to ask moderator Bob Scheiffer to address women’s rights issues,  by asking the candidates about the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW), the Women’s Rights Treaty.

Presidential Debate Moderator: Ask About the Women’s Rights Treaty/CEDAW


While our nation has made undeniable progress in advancing women’s rights in recent decades, we still have a long way to go. One significant milestone on our way to equality will be the ratification of the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW), the Women’s Rights Treaty.
Women continue to be targets of sexual and domestic violence — at home and abroad. We are discriminated against in the workplace and elsewhere. Women in the U.S. and every other nation suffer from more poverty, less access to health care, less access to a livable wage, and barriers to equal education. The Women’s Rights Treaty/CEDAW is a valuable instrument for combating these wrongs. It embodies the basic democratic values of fairness and equal opportunity. Ratification does not require any federal appropriations. Moreover, women across the political spectrum support CEDAW’s ratification.

Click here to sign

Thank you!

Birth Control Covered – Aug. 1, 2012

Trust Women/Silver RibbonCampaign

Infographics – Please post on Facebook! And Like Us on our Facebook page.

Contraception Without Co-pays. See for more info
Contraception Without Copays! See for more info


Commentary on Contraceptive Insurance Mandate – by the Medical Care Section of the American Public Health Association by Ellen R. Shaffer, Arlene Ash, Mona Sarfaty, Medical Care, Volume 50, Number 7,  July 2012.  Excerpt:

Contraception is a fundamental health care service and a basic public health measure. The ability to plan, start, space, and discontinue bearing children has transformed everyday life for women, families, and communities. It has vastly enhanced women’s autonomy, professional and educational achievement, and emotional satisfaction and helped extend their life span.

Click here for Contraceptive Insurance by Shaffer et al.

Challenges in Congress and in the Courts

The House of Representatives continues to challenge contraceptive coverage:

A federal court in Colorado may issue a temporary injunction on the contraception benefit for a single private, for-profit company:

Women’s Preventive Services: Required Health Plan Coverage Guidelines, Health Resources and Services Administration (HHS)

Non-grandfathered plans and issuers are required to provide coverage without cost sharing for these services in the first plan year (in the individual market, policy year) that begins on or after August 1, 2012.

Type of   Preventive Service

HHS Guideline for   Health Insurance Coverage


Contraceptive methods and counseling.** All Food and Drug Administration   approved contraceptive methods, sterilization procedures, and patient   education and counseling for all women with reproductive capacity. As prescribed.
Well-woman visits. Well-woman preventive care visit   annually for adult women to obtain the recommended preventive services that are age and developmentally appropriate, including preconception and prenatal care. Annual
Screening for gestational diabetes. Screening for gestational diabetes. In pregnant women between 24 and 28  weeks of gestation and at the first prenatal visit for pregnant women at high risk for diabetes.
Human papillomavirus testing. High-risk human papillomavirusDNAtesting in women   with normal cytology results. Screening should begin at 30 years of age. Then no more frequently than every 3 years.
Counseling for sexually transmitted   infections. Counseling on sexually transmitted   infections for all sexually active women. Annual.
Counseling and screening for human   immune-deficiency virus. Counseling and screening for human   immune-deficiency virus infection for all sexually active women. Annual.
Breastfeeding support, supplies, and   counseling. Comprehensive lactation support and   counseling, by a trained provider during pregnancy and/or in the postpartum   period, and costs for renting breastfeeding equipment. In conjunction with each birth.
Screening and counseling for   interpersonal and domestic violence. Screening and counseling for   interpersonal and domestic violence. Annual.

* Refer to recommendations listed in the July 2011 IOM report titled Clinical Preventive Services for Women: Closing the Gaps concerning individual preventive services that may be obtained during a well-woman preventive service visit.

** Group health plans sponsored by certain religious employers, and group health insurance coverage in connection with such plans, are exempt from the requirement to cover contraceptive services. A religious employer is one that: (1) has the inculcation of religious values as its purpose; (2) primarily employs persons who share its religious tenets; (3) primarily serves persons who share its religious tenets; and (4) is a non-profit organization under Internal Revenue Code section 6033(a)(1) and section 6033(a)(3)(A)(i) or (iii). 45 C.F.R. §147.130(a)(1)(iv)(B).

Some Important Details

This preventive services provision applies only to people enrolled in job-related health plans or individual health insurance policies created after March 23, 2010. If you are in such a health plan, this provision will affect you as soon as your plan begins its first new “plan year” or “policy year” on or after September 23, 2010.

Top things to know about preventive care and services:

  • Grandfathered plans: If your plan is “grandfathered,” these benefits may not be available to you.
  • If you have health coverage from a plan that existed on March 23, 2010 — and that has covered at least one person continuously from that day forward — your plan may be considered a “grandfathered” plan. Grandfathered plans can lose their grandfathered status if they make certain significant changes that reduce benefits or increase costs to consumers.
  • Network providers: If your health plan uses a network of providers, be aware that health plans are required to provide these preventive services only through an in-network provider. Your health plan may allow you to receive these services from an out-of-network provider, but may charge you a fee.
  • Office visit fees: Your doctor may provide a preventive service, such as a cholesterol screening test, as part of an office visit. Be aware that your plan can require you to pay some costs of the office visit, if the preventive service is not the primary purpose of the visit, or if your doctor bills you for the preventive services separately from the office visit.
  • Questions: If you have questions about whether these new provisions apply to your plan, contact your insurer or plan administrator. If you still have questions, contact your state insurance department.
  • Talk to your health care provider: To know which covered preventive services are right for you — based on your age, gender, and health status — ask your health care provider

What is a Grandfathered Health Plan?

Fact Sheet: Keeping the Health Plan You Have: The Affordable Care Act and “Grandfathered” Health Plans

Health Reform.Gov explains that some health plans were “grandfathered” when the ACA was passed in on March 23, 2010, to accommodate people who wanted to keep the health care they had.  A federal regulation allows plans that existed on March 23, 2010 to innovate and contain costs by allowing insurers and employers to make routine changes without losing grandfather status.  Plans will lose their “grandfather” status if they choose to significantly cut benefits or increase out-of-pocket spending for consumers – and consumers in plans that make such changes will gain new consumer protections.  This Fact Sheet describes the changes that would cause plans to lose their grandfathered status.  It is estimated that 90% of plans eventually will convert by 2014.

NWLC Fact Sheet: “Contraceptive Coverage in the Health Care Law: What Happens on August 1, 2012?”

NWLC Resource: “How To Find Out If and When Your Health Plan Will Begin Covering Women’s Preventive Services with No Co-Pay”

Brochure: How the Health Care Law is Helping Women and Their Families

Poll: By Hart Research for Planned Parenthood and National Women’s Law Center about attitudes towards contraceptive coverage.


Recommended Twitter hashtags: #trstwmn   #NoCoPay    #Aug1 If there’s space: #herhealth    #worryfreesex    #mybodymyvote

Sample Tweets:

#worryfreesex No birth control co-pays starting Aug 1, just get the right partner #trstwmn

Your life, your decision: plan/start/space/stop having children. No more contraceptive co-pays Aug 1 #NoCoPay

Contraception: basic & necessary for public health, free Aug 1 #herhealth Contraception: basic & necessary for women’s health, free Aug 1 #trstwmn #herhealth Decide it, live it: contraception free from co-pays Aug1 #Aug1 Women’s work, life, schooling, & happiness are tied to contraception — free > Aug 1 #trstwmn

Contraception: covered by insurance & co-pay free starting Aug 1 #trstwmn #herhealth

Reproductive rights & contraception go together. No co-pays starting Aug 1  #trstwmn #herhealth

We fought for this: no co-pays on contraception starting Aug 1 #trstwmn #herhealth

Bishops hate it, women love it: co-pay free contraception on Aug 1  #trstwmn #herhealth

Contraception coverage in health insurance IS health care. No co-pays start on Aug 1 #trstwmn #herhealth

Time to double down the fight for women’s health and reproductive rights #trstwmn #herhealth Full coverage for contraceptive health care: good for women, good for families #trstwmn #herhealth When we fight we win: No co-pays starting Aug 1 #trstwmn #herhealth I trust women & I vote #2012 or #GOTV2012  #trstwmn #herhealth I trust women & I will vote #2012  #trstwmn #herhealth

Religious Coalition for Reproductive Rights – I’m a Fan of Birth Control! Support the reliigious freedom of women who use birth control. Help show that religion in America is gloriously diverse and no one set of beliefs about contraception or anything else can dominate our laws and policies.

Center for American Progress: Go to our Twibbon page and add your Free the Pill icon to your profiles:

Sample tweet:#FreeThePill: Birth control is covered w/no co-pay! TY #Obamacare. Add your #Twibbon: @CAPcongress #fem2

National Council for Jewish Women(NCJW): Questions? Contact Amy Cotton,

Coalition to Protect Women’s Health Like Us on Follow us on Twitter

Join Us: Trust Women Month


Join the effort of many organizations, all of which support reproductive rights and justice during the “Trust Women Month” – January 22 through February 22 in celebration of the 28th anniversary of the historic Roe v. Wade decision that legalized abortion on January 22 . Please wear a silver ribbon to show your support, spread the word and take action.

The Silver Ribbon Campaign proudly presents Walk For Choice SF, an event to show that we support reproductive justice, rights and health, and to kick off Trust Women Week (January 20 to 27).

The event will begin on Friday, January 20, at 6 PM in Justin Herman Plaza.

At 6:30 PM, we’ll be at 2nd & Market St. where we will be asking everyone to whip out whatever internet accessible devices you have and join the Online March For Reproductive Justice.

We encourage participants to wear reflective or glow-in-the-dark materials, or wear glow sticks for safety and so that we stand out. Also, be sure to proudly show your Silver Ribbons!