Many survivors of domestic and sexual violence are recipients of health care made possible by the Patient Protection and Affordable Care Act (ACA, or sometimes known as “Obamacare”), which supports programs such as our Oregon Health Plan and Federally Qualified Health Centers, as well as other public funding programs that make possible health care for people in need.

However, even as the future is unclear, there are actions you can take right now to take charge of your health and help advocate for the survivors of domestic and sexual violence with whom you work.

Since November, people across the United States are signing up for health care through the exchanges at record rates.  No matter your income status or situation, open enrollment for health insurance runs through January 31, 2017. The coverage you sign up for today is a contract for your health care in 2017.

Whatever may happen, new health insurance rules will not effect this year.  Thus, it is still a good idea to enroll eligible survivors in the Oregon Health Plan or on the exchanges.  Key points for advocates and survivors remain in 2017:

  • Domestic violence is a health issue.  Thus, domestic violence screening and counseling are core preventive health services.
  • Although the deadline for many people is January 31, survivors of domestic violence are exempt from the restricted enrollment periods, and can sign up for the Oregon Health Plan at any time.  (More below.)
  • Survivors do not need to provide documentation of abuse or violence to qualify.  
  • Domestic violence is no longer a pre-existing condition for insurers.  
  • Survivors who are married to their abusive partner have the ability to sign up for their own insurance and claim the appropriate tax subsidy as long as they have separated (Learn more here).
  • In Oregon, thanks to OCADSV and partner advocacy in 2015, survivors who are receiving care under their abusive partner’s healthcare insurance policy (private health insurance such as Moda, PacificSource, Providence, etc.) may still access confidential services by submitting the Oregon Request for Confidential Communication form here: http://tinyurl.com/ORPatientPrivacy (Learn more here.)
  • With tax season upon us, and with 1 in 20 Oregonians still uninsured, we know that many people will need to pay a penalty for a lack of healthcare insurance in 2016.  Survivors of domestic violence qualify for a “hardship exemption” from this penalty.  (Learn more here.)

We recommend advocates take the time to work with a community partner to the Oregon Health Plan to assist in navigating enrollment issues for survivors of domestic violence.  Community partners include trained navigators who are staff members of organizations such as IRCO, Urban League, Outside In, NARA, and many other organizations across the state of Oregon.  You can find them online (by zip code, make sure to search for “Community Partner (P)”) here: http://healthcare.oregon.gov/Pages/get-help.aspx . Contact Sarah Keefe at OCADSV if you have further questions about this process.

Healthcare: Past, Present and Future

Please click here to learn more about the ACA and potential changes.

Thanks to the ACA and Oregon leadership, Oregon was able to increase the number of Oregonians covered under the Oregon Health Plan (Oregon’s Medicaid program) from around 586,000 Oregonians in 2013 to over 1 million Oregonians last year.  This expansion is what is likely most at risk in the coming years.  Hundreds of thousands of lives here in Oregon may now lose access to health care, which becomes more and more expensive with each year.

Now, around 1 in 4 Oregonians are enrolled in the Oregon Health Plan (Medicaid).  In rural parts of the state, as much a many as 2 in 5 Oregonians are on OHP.  Low-income Oregonians are now able to access health care and preventive health services that ultimately improve health and reduce health system costs.  Access to the Oregon Health Plan (Medicaid) especially impacts low-income families, as Medicaid funds 1 in 2 babies born in Oregon.  Thanks to the ACA and the Medicaid expansion, there’s no longer a lottery system for health care in Oregon: everyone who qualifies for Medicaid can enroll in the program. In the past, you had to win a drawing for healthcare enrollment if you could not afford private insurance or your employer did not offer it.

There are also efforts in the legislature to improve access this year, specifically for children and youth in Oregon, as highlighted by Governor Brown last week.

We know that we can rely on our current healthcare system status quo for 2017.  What is uncertain is what changes will occur in 2018 and onwards.  Whether in one, two, or more years, the current political plan for how to reshape Medicaid and other services will likely mean a reduction of services that will affect vulnerable populations most, such as survivors of domestic violence, unless we actively organize to protect this care.

Federal support of public health and health care programs are critical especially for low-income survivors of domestic and sexual violence, such as public funding programs like Title X family planning dollars.  Six in 10 women who seek contraceptive care at a Title X site consider it their only source of medical care in a year.  With likely federal funding cuts looming in the next administration, these safety net programs are as important as ever.

When Title X clinics are defunded or cut, including providers such as county-level public health clinics (recent Oregon cuts to these programs include such counties as Washington, Wasco, Sherman, Gilliam, or Douglas Counties) or Planned Parenthood, there are severe health affects that are measurable at the population level. The death rate for pregnant women in Texas spiked from 18.6 deaths per 100,000 live births in 2010 to more than 30 per 100,000 in 2011 and remained over 30 per 100,000 through 2014.  This precipitous climb occurred at the same time that Texas slashed funding for Title X clinics. 

The U.S. is the only developed country in the world where maternal deaths increased between 1993 and 2013, according to the World Health Organization. The rate of maternal deaths rose from 18.8 per 100,000 live births in 2000 to 23.8 in 2014, an increase of 27%.  In a potential corollary to Texas, at the same time, we see unprecedented restrictions being sought on essential women’s health services at the state level.  

It is important for advocates and policy makers to understand and follow family planning and reproductive health issues, because for the health of survivors of domestic and sexual violence, there is growing evidence that you cannot separate relationship health from reproductive health and vice versa.

However, there is great reason for hope and further investment in family planning and other preventive health services that are essential for survivors of domestic and sexual violence. In Colorado, with the expansion of access to preventive health services, and investment of funding in birth control methods and education, the state decreased the teen pregnancy rate by 40 percent from 2009 to 2013, while their rate of abortions fell by 42 percent. This saved the state over $79 million in Medicaid spending.

If we’ve learned anything from other states such as Colorado and Texas, we know that access to family planning and safety net services are critical investments, especially for vulnerable populations that include many survivors of domestic and sexual violence.  Time will yet tell what is happening in counties that have cut or reduced their public health clinic or Title X or other safety net clinic services, such as Washington, Wasco, Sherman, Gilliam and Douglas Counties here in Oregon.

The dramatic reduction in Medicaid funding proposed by key policy makers at the federal level would be a return to a charity care model where the most vulnerable are reliant on Title X and other safety net providers who have been systematically underfunded (even here in Oregon, where some counties have cut or reduced their public health clinics, while facing provider shortages in their CCOs).  Hospitals and other urgent and emergency care providers in Oregon have transitioned their models away from charity care, and there may be unexpected consequences for providers if many of the newly enrolled, out of 1 in 4 Oregonians, no longer have access to Medicaid due to reduction or cancellation of the Medicaid expansion.

Vanessa Timmons, Executive Director of OCADSV, explained to me what it was like being an advocate for survivors of domestic and sexual violence, pre-Medicaid expansion.  “I remember for months constantly asking for donations so the survivor I was working with could get another few months worth of her life-saving prescription.  It was so hard for the survivor.  She never knew how many more months she’d be able to get by. It was exhausting.”

Even now, for some survivors in Oregon, our current system is failing them. One advocate tells me how disheartened she is working with survivors when there are no resources in her rural area for them, especially if they are undocumented.  There is so little she can do to help when a survivor is sick and there are no care options for them besides leaving the country and their family behind. For this advocate, survivor, and the survivor’s children, this is unacceptable.

It is clear that the U.S. Senate and House of Representatives plan to repeal the Affordable Care Act (ACA) which includes the Medicaid expansion and other funding for many health programs. Your experience working with survivors and connecting them to health services is an important perspective that can shape this process.  Please call (or write) your elected officials and others you have connections to and help educate policy makers of the affect the ACA rules have had on survivors and your work.  You can find how to connect to them here: https://www.senate.gov/senators/contact/ http://www.house.gov/representatives/find/  And here’s the Capitol switchboard, 202-224-3121

If we have learned anything, it’s that survivor voices are powerful.  Both in Oregon and at the federal level, protections for survivors of domestic and sexual violence have passed with near unanimous bipartisan support in the last year, both with last year’s Survivors' Bill of Rights Act at the federal level and Oregon’s 2015 law creating advocate certification and privilege in Oregon, and additional confidentiality for survivors.  With your help, this will continue!  Stay tuned for an upcoming announcement about our domestic and sexual violence Awareness Day set for February 22nd on the Capitol steps in Salem, OR.

If you have questions or would like to discuss any of the issues in this communication, please contact Sarah Keefe at [email protected] or 503-230-1951.