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Sponsored by:

Susan Dentzer
President and CEO, NEHI
Opening Remarks
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Our Topic Today

Coverage and access

to womens health
services is critical for
women and their
families. The
Affordable Care Act
expanded these for
millions.
Coverage and access to these services has led to improved
health outcomes and has contributed to long-term economic
stability and well being of families
Coverage and access helps to spur innovation in creating new
and better products and services
Women need broad access to these products and services from
the high-quality providers who have the willingness and capacity
to serve them such as Planned Parenthood health centers

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Recent Innovations In
Womens Health Services

Full-field digital
mammography --
exceptionally sharp images
with lower recall rate
Long-acting reversible
contraceptives
Cell-free DNA screening -
non-invasive prenatal testing
alternative to amniocentesis
and CVS - tests for fetal
biomarkers in mothers blood
no added risk of
miscarriage or fetal harm
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Our Speakers Today

Stephanie Glover, Adam Sonfield, Sonya Borrero,

MPA MPP MD, MS

National Guttmacher University of

Partnership for Institute Pittsburgh
Women & Families
@NWPF @Guttmacher @CWHRI

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Click to add title

Women's Health, Innovation,

and the Economic Stability of
Families
Stephanie Glover
Health Policy Analyst February 15, 2017
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Click tousadd title
About

The National Partnership for Women & Families is a nonprofit,

nonpartisan advocacy group dedicated to promoting fairness in the
workplace, reproductive health and rights, access to quality health
care, and policies that help women and men meet the dual demands
of work and family.

More information is available at

www.NationalPartnership.org.
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ClickAffordable
The to add title
Care Act (ACA)

The greatest advance for womens health in a

generation:
Historic coverage gains
Robust coverage protections
Access to preventive services without cost-sharing (including birth
control)
Current context: facing a full-fledged attack on
womens health and well-being

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Click to add
Historic coverage
title gains

ACA provides greater access to coverage and

financial help to make care more affordable for
women and families
9.5 million previously uninsured women have
gained affordable, comprehensive health coverage
The uninsured rate among African-American women fell seven
percent and the uninsured rate among Latina women fell nine
percent between 2012 and 2014,
ACA supports economic security by giving women
and families one less thing to worry about as they
try to make ends meet

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Click to coverage
Robust add title protections

Women cant be charged more just because of their

gender
Prior to the ACA, 92 percent of the best-selling plans on the individual
market charged women higher premiums simply because of their gender
Being a woman is no longer a pre-existing condition
The ACA ended outrageous, predatory practices that allowed insurers to
refuse to cover women who had pre-existing conditions (such as breast
cancer, Cesarean sections and medical treatment due to domestic
violence)
Women have guaranteed access to a defined set of
benefits through their insurance
Includes coverage of maternity and newborn care, prescription drugs,
mental health services and more

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Click to to
Access add
preventive
title services

Fifty-five million women now have preventive services

covered without cost-sharing
Includes well-woman visits; gestational diabetes screening; HPV testing;
counseling for sexually transmitted infections; counseling and screening for
HIV; screening and counseling for intimate partner violence; breastfeeding
support, supplies, and counseling; and contraception.
Because of the ACA, women saved more than an
estimated $1.4 billion in out-of-pocket costs on the birth
control pill alone in 2013
Prior to the ACA, only 15 percent of women had coverage for oral
contraception with no out-of-pocket costs
Women no longer have to choose between filling their
birth control prescription and filling their gas tank

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Fighting a full-fledged
Click to add title
attack on womens health

Womens health and economic security are under

attack from efforts to
Repeal the ACA
Restructure Medicaid
Defund Planned Parenthood

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For more
Click information
to add title

Contact me: Follow us:

Stephanie Glover
Health Policy Analyst
sglover@nationalpartnership.org

www.facebook.com/nationalpartner
ship

Find us: @NWPF

www.NationalPartnership.org

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 The Importance of
Protecting the
Reproductive Health
Safety Net
Adam Sonfield, Senior Policy Manager

February 15, 2017

GUTTMACHER INSTITUTE 2017

 Medicaid is an essential source of
U.S. health coverage
74 million enrollees in
48%
Medicaid and CHIP

20% of U.S. population 31%

27%
(vs. 14% for Medicare) 20%

12.9 million women of

reproductive age

Women aged 1544 covered by Medicaid or CHIP

CHIP = Childrens Health Insurance Program

Guttmacher Institute 2017 15

 Guttmacher Institute 2017 16
 Medicaid is central to publicly funded
family planning
Required coverage

No cost sharing

No coercion
75% of all public dollars
Free choice of providers
for family planning
Medicaid family planning
expansions

Guttmacher Institute 2017 17

 Guttmacher Institute 2017 18
 Medicaid is crucial for pregnancy-
related care
Required coverage for 68%
prenatal care, labor/delivery, 51%
postpartum care

Limited cost sharing

Higher income-eligibility levels

than for Medicaid generally

% covered by Medicaid

Guttmacher Institute 2017 19

 Multiple Lines of Attack
Eliminating the Affordable Care Acts Medicaid
expansion

Block grants and per capita caps

Expanded waiver authority for states

Guttmacher Institute 2017 20

 Inevitable Consequences
Fewer people insured under Medicaid

Less robust coverage and patient protections

Shifting costs to states, patients and providers

Less responsive to crises, rising costs, new technology

Easier to target reproductive health services and providers

Guttmacher Institute 2017 21

 Planned Parenthood: False Mantras
Planned Parenthood is a small part of the national
family planning effort

Federally qualified health centers (FQHCs) can

seamlessly pick up the slack

Reproductive health care offered by Planned

Parenthoods and FQHCs is interchangeable

Guttmacher Institute 2017 22

 Women can often obtain care more
quickly from Planned Parenthood

0.6
Same-day
appointments
0.6
0.4
0.2
Average 0.5
wait time
0.8

Evening or 0.8
weekend 0.6
hours 0.2

Health departments FQHCs

Planned Parenthood

Guttmacher Institute 2017 23

 Planned Parenthood sites are most likely
to take steps to facilitate contraceptive
method choice and uptake

Full range 93%

of methods 61%
offered 52%
Same-day 81%
IUD/implant 29%
insertion 25%
Pills 83%
dispensed 76%
on-site 34%

FQHCs Health departments

Planned Parenthood

Guttmacher Institute 2017 24

 Planned Parenthood sites serve a
particularly high volume of clients

% of sites serving 50+ contraceptive clients per week

Planned
Parenthood
66%

Health
departments
24%

FQHCs 17%

Guttmacher Institute 2017 25

 Guttmacher Institute 2017 26
Exploring the potential impact of
defunding Planned Parenthood:
Texas as a case study

Sonya Borrero, MD, MS

Associate Professor of Medicine
Director, CWHRI
University of Pittsburgh &
VA Pittsburgh
Planned Parenthood provides
critical reproductive health
services

High-quality, timely care for gender-specific cancer

screenings, STI testing/ treatment, contraceptive
care, and abortion services (at some sites)

Safety net for teens, low-income populations,

immigrants, and uninsured

In 2010, nearly 40% of the almost 7 million women

receiving contraceptive care from safety-net family
planning health centers were served at PP
 The case of Texas

On January 1, 2013, Texas became 1 st state to

enforce ban excluding PP from state-funded
Medicaid program

State argued that excluding PP would have no

adverse impact because there was an ample supply
of alternative providers

In 2011, Texas cut family-planning grants and

redistributed funds away from dedicated family-
planning providers led to closure of 82 clinics (1/3
were PP)
 Investigators used claims data from 2011-2014
to examine changes in contraceptive use 2 years
before and 2 years after the PP exclusion

Among women using injectable contraception,

rates of continuation and childbirth examined
pre and post exclusion
35% relative reduction

31% relative reduction

 Additional results

Women in counties with PP returning for on-time

injection decreased from 57% before exclusion to
38% after the exclusion

No change in number of claims for hormonal

contraceptive methods in either cohort of counties

Rate of childbirth in counties with PP saw an

increase of 27% among women using injectables

Stevenson A, et al: N Eng J Med, 2016

 Conclusion

The exclusion of Planned Parenthood affiliates from

the Texas Medicaid program had an adverse effect
on low-income women in Texas by the reducing
provision of highly-effective methods of
contraception, interrupting contraceptive
continuation, and increasing the rate of
childbirth covered by Medicaid

Stevenson A, et al: N Eng J Med, 2016

 Cost coverage is only one
dimension of access
Cost coverage alone does not ensure universal access
to the full range of contraceptive methods; especially
true for newer more invasive, but highly effective
methods (LARC)

Access to providers who are skilled in evidence-based

provision of contraceptive methods is critical, and not
always assured in other community-based clinics

Innovative service delivery and payment models are

required to ensure appropriate reimbursement and
stocking for LARC, which incur high up-front costs
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