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Women on the Front Lines of ACA Implementation

March 24, 2014

(Ellen Liu serves as director of women's health at the Ms. Foundation for Women.)

Headshot_ellen_liuWomen have a lot to celebrate this month. March is Women's History Month, and March 23 marks the fourth anniversary of the passage of the Affordable Care Act.

Over the past five years, the Ms. Foundation for Women has been funding outreach and advocacy efforts to ensure that women and women's health services are a central part of implementation of the ACA.

With nearly one in five women uninsured nationwide, the need for targeted outreach to women is undeniable. Low-income women, women of color, immigrant women, and young women are uninsured at substantially higher rates than the national average for all women.

Our work on the ACA has focused on ensuring that all women have access to preventive care, treatment, and services. We know that access to health care improves the well-being of women, resulting in greater financial stability, peace of mind, and lower rates of depression.

Given the proven benefits of health insurance, it has been especially important for the Ms. Foundation to address health equity and to support those who have the least access to affordable quality care. Through our Women 4 Health Care program, we have focused on the intersection of gender, race, and class, both by funding advocacy for inclusive, comprehensive health coverage and by targeting outreach to underserved women.

In the process, we have learned some valuable lessons about successful advocacy and outreach strategies. First, we have learned that we must engage at multiple levels to ensure that women are not left out. Our grantee partners have been active on various levels, serving on governance and administrative committees for their state exchanges; monitoring legislation that pertains to women's health; providing technical assistance to state exchanges to ensure they prioritize women, as well as strategizing about how best to reach women through outreach campaigns; and leading community efforts to link women and families to resources that can help them through the enrollment process.

Second, we have learned that we must invest in organizations that are trusted messengers within the communities that stand to benefit the most. The Ms. Foundation has invested in reproductive health, rights, and justice organizations that have a long history of working with African-American, Latina, immigrant, and youth populations, both in terms of grassroots outreach and policy and legislative advocacy at the state level.

Our grantees have been strong advocates for the essential women's health services that should be covered in state exchanges, from maternity care for dependents, to abortion, to birth control coverage. (Birth control coverage continues to be a source of controversy, with a challenge to its inclusion now pending before the U.S. Supreme Court.)

Often these organizations are the only ones at the table representing women's health, which makes their participation and voice even more critical.

Funding for these organizations has enabled advocates to engage directly with women and encourage them to enroll in state exchanges or link up to Medicaid enrollment. Through their on-the-ground organizing activities, these organizations have helped uninsured women overcome a range of obstacles, including health literacy challenges, language barriers, and complicated insurance industry jargon. Making the complexities of the ACA understandable for the average person has required an enormous person-to-person grassroots effort; indeed, this is at the heart of our grantees' efforts to make the ACA work for women. Needless to say, the impact of this grassroots organizing has been huge.

The engagement around the ACA also has provided an opportunity to educate women about their voting rights and increase their participation in the community as agents of change. Working on the ground in local communities, our grantees have been able to expand their base of support and build upon the trust and good reputations they already had.

Regrettably, healthcare reform has become a polarizing public policy issue, and more advocacy is needed to counterbalance the barrage of political attacks. Unfortunately, few funders actually engaged in the hard work of ACA implementation are focused on its impact on women, despite the fact that the ACA represents one of the most significant developments in terms of access to health care for women in a generation. Given the stakes, we need more engagement and dedicated funding for women and ACA implementation, not less.

Much remains to be done, and expanding access to healthcare coverage for immigrants is at the top of the list. The five-year waiting period immigrants are subject to before they can receive Medicaid coverage is a horrendous injustice and unsound policy. The exclusion from the ACA of immigrants who remain in the country under the Deferred Action for Childhood Arrivals (DACA) policy should be reversed. And the chilling effect on mixed immigrant-status families who are afraid to sign up for services for fear of deportation must be addressed.

We must increase advocacy efforts on behalf of Medicaid expansion — particularly in the Midwest and South — if we hope to substantially improve women's access to healthcare coverage. Because so many of the states that have rejected Medicaid expansion are states with some of the worst rates of healthcare coverage and health outcomes in the nation, it is essential that we expand support for women's health advocacy in those regions.

Lastly, philanthropy must make deeper investments in local and state organizations where critical budget fights and erosion of basic safety nets are ongoing, disproportionately affecting women. For this to happen, philanthropy must work to strengthen cross-issue alliances so that women's reproductive health and access to care is not seen as a politicized, narrow, and siloed issue, but rather as a central concern of broader movements, including economic justice and workers' rights, immigration reform, LGBTQ, environment, and civil rights. The nexus of women's health and ACA implementation is a strategic opportunity that philanthropy should be robustly and creatively investing in, shaping healthcare access and rights for generations to come.

Four years after the historic passage of the ACA, it is time for philanthropy to do more.

— Ellen Liu

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