UPDATE, JANUARY 2015: Whether you're on Medicaid or an insurance plan you purchased through Kynect, the Affordable Care Act makes all FDA-approved contraceptives available to you without a co-pay. If you've been charged a co-pay for any contraceptives, you should file a complaint! If you're a Medicaid patient, call Member Services at 1-800-635-2570. If your insurance is through Kynect, call the Kentucky Dept. of Insurance at 1-800-595-6053. by Clare Gervasi, KHJN volunteer This little essay is intended to inform you about the Kentucky health exchange, called Kynect (pronounced “connect”), and how we Kentuckians can access health insurance through the system and even find out if we are eligible for Medicaid. Furthermore, this piece includes information about how to get the kinds of reproductive and contraceptive care we need through Kynect and Medicaid. This essay also includes my own reflections on the Affordable Care Act and how it affects individual Kentuckians, especially women, from a first-person perspective. To begin, here is a little about me and the US health care system: I am a white cis woman in her early 30s. I live in Louisville and am a life-long US citizen. I have a graduate degree and come from an educated, middle class background. I am a birth doula and have long experience dealing with the health care system (especially reproductive health) as an advocate as well as a patient. I have been interacting continuously with Medicaid since 2010, when I became pregnant and subsequently became a mother to a child who has health insurance through Medicaid. I have been interacting with the Kynect Exchange system since March of this year, when I first signed up for health care under the new Affordable Care Act (ACA). So when I tell you this next part, I want you to understand the full frustration of what I mean: accessing health insurance information through Medicaid, its managed care organizations, and Kynect is like trying to break into Fort Knox. If neither my educational, racial, or class privilege, nor my professional experience, can save me confusion or time or money in navigating our health care exchange and managed care companies, what is required to succeed in getting the information an insurance user needs to be healthy? As someone who lived most of her 20s without health insurance, except for a brief period when I had insurance through my graduate school program, I was very excited about the passage of the ACA (commonly called Obamacare). The concept of the “health insurance exchange,” the centerpiece of Obama’s legislation, promised essentially a free market shopping experience, and rendered all of us who need health care (read: every living human) “consumers” in a “health care marketplace.” Through this state-run marketplace, called Kynect in Kentucky, we consumers could “shop” for the best health insurance plan for us. Obamacare provided free benefits agents, called “Kynectors,” to help us if we desired professional consultation in making our choice. We were supposed to access this marketplace online or by phone and to shop around as pleasantly as if we were surfing amazon.com or walking through the grocery, comparing prices and contents and making the best selection for ourselves and our families. Yeah, that all sounds like an improvement over the pre-Obamacare days... But the ease and pleasantness so touted by Governor Beshear and even the Obama administration, as they hold up Kentucky’s state exchange as a model for the nation, have not been my experience as a user or an investigator. If the appeal of state-run exchanges is greater transparency in shopping for options, Kynect and Obamacare have a long way to go. An ideal free market shopping experience includes clear pricing among competitors, so that consumers can make the best decision in their own best interest. It also guarantees privacy and freedom while shopping. I don’t have to tell Amazon my personal information to see how much it costs to order lightbulbs from them, for example. The Kynect exchange and the companies I dealt with in doing this research, Anthem and Humana, were anything but transparent or respectful of privacy. I spent many hours on the phone with both corporations, who refused to tell me almost any concrete, financial information unless I gave them my name, birth date, social security number, and phone number. That is a far cry from the free market. In sum, although attempting to access information about contraceptive care was a time-consuming, murky, and generally user-unfriendly experience for me, here is a run-down of some of what I did manage to find out for Medicaid users seeking contraceptive care: Here are some important notes to remember when deciding what care and coverage are best for you:
1. To find out whether or not a drug is covered, you can refer to this formulary, which is occasionally updated. Here is the most recent one as of the date of publication of this chart: http://www.anthem.com/Exchangedruglist4.pdf. You can always find the updated forumlary by clicking on the form “Anthem Select Drug List (4-Tier)” in the forms library on Anthem’s website: https://www.anthem.com/health-insurance/customer-care/forms-library 2. To find out whether or not a drug is covered, you can use this search tool on the Humana website. It will tell you which Tier the drug falls under if it is covered, and will also tell any dispensing limits associated with the drug. Here is the link to the search: http://apps.humana.com/UnsecuredDrugListSearch/Search.aspx 3. With the pill (“oral contraceptives”), there are so many different brand names and generics that these copays may or may not apply to your specific choice of drug. Look up your prescription in the formularies listed above to see if your drugs are covered. If they are listed as “Tier 1” drugs, then the copays listed above are true. If not, they may cost more or not be covered at all. If you are looking for more information, here are some useful tools:
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Última noticia, enero 2015: Por el Acto del Cuidado de Salud Asequible (en inglés, Affordable Care Act, ACA o "Obamacare"), si tienes seguro de Medicaid o de un plan que compraste en el Kynect, tienes derecho a todos los métodos anticonceptivos sin copago. Si te han cobrado un copago por cualquier medicamiento anticonceptivo, deberías formular una queja. Si tienes Medicaid, llame al Member Services a 1-800-635-2570. Si tienes seguro que compraste en el Kynect, llame al Kentucky Department of Insurance a 1-800-595-6053. Por Clare Gervasi, voluntaria de Kentucky Health Justice Network Este ensayo intenta informarte del intercambio de salud en Kentucky, el que se llama Kynect (pronunciado ‘co-nek’), y también informarte cómo nosotros los de Kentucky podemos inscribirnos en el seguro médico por el intercambio y averiguar si somos elegibles para Medicaid. Es más, este blog incluye información sobre cómo obtener por Kynect y Medicaid los tipos de cuidado anticonceptivo y reproductivo que necesitamos. Este ensayo también contiene mis reflexiones sobre el Acto del Cuidado de Salud Asequible y cómo les afecta a los de Kentucky individualmente, las mujeres en particular, desde una perspectiva personal. Para empezar, un poco sobre yo y mi relación con el sistema de salud en EEUU: soy una mujer cisgénero (cisgénero es una persona cuya identidad se ajusta a su sexo asignado al nacer; es decir, una persona no transgénero), de ascendencia europea. Tengo 32 años. Vivo en Louisville y soy ciudadana estadounidense desde el nacimiento. Tengo maestría y soy de una familia educada de la clase media. Soy doula (una doula trabaja como asistente a la madre y su familia durante el parto) y tengo larga experiencia en manejar el sistema de salud (en cuanto a la salud reproductiva en particular) como defensora y paciente también. Hace desde 2010 que interactúo continuamente con Medicaid, cuando me encontré embarazada y al cabo me convertí en madre a un niño quien tiene el seguro médico por Medicaid. En cuanto al sistema Kynect, hace desde marzo de este año (2014) que interactúo con este intercambio, cuando me inscribí en el seguro médico bajo el nuevo La Ley Federal de Cuidado de Salud Asequible (Affordable Care Act, o ACA). Entonces, cuando te cuento la parte siguiente, quiero que entiendas la completa frustración en lo que digo: el proceso de ganar acceso a la información sobre el seguro médico por Medicaid, sus organizaciones de ayuda coordinada, y Kynect es como intentar a asaltar Fort Knox--se siente imposible. Si ni mi privilegio educacional, racial, de clase, ni mi experiencia profesional, me podían ahorrar el tiempo o el dinero, ni evitar la confusión en manejar el intercambio de seguro médico y las compañías de ayuda coordinada, pues ¿qué se requiere para tener éxito en obtener la información que necesita un usuario del seguro médico para ser sano? Yo viví sin el seguro médico por la mayor parte de la veintena, salvo un período breve cuando lo tenía por mi programa de estudios posgrados. Por eso, la adopción en 2010 de la Ley de Cuidado de Salud (la apodada Obamacare o Obamacuidados) me hizo mucha ilusión. El concepto del “intercambio de seguro médico,” el fundamento legislativo de la administración del Presidente Obama, nos prometió básicamente una experiencia como “consumidor” de la salud en “el mercado libre.” En otras palabras, la legislación nos convirtió de humanos con necesidades universales en “consumidores” que escogen lógicamente la mejor oferta para proteger nuestra salud. Por este intercambio manejado por el estado, el que se llama Kynect en Kentucky, nosotros consumidores pudiéramos “ir de compras” para hallar el mejor plan de seguro médico para nosotros. Obamacare nos ha proveído profesionales que son navegadores gratuitos--en nuestro estado se llaman “Kynectors”--para ayudarnos si deseáramos apoyo profesional en navegar nuestras opciones. Debiéramos acceder a este mercado en línea o por teléfono y comparar planes y precios tan afablemente si navegáramos en amazon.com o camináramos por el supermercado, para seleccionar la mejor ganga para nosotros y nuestras familias. Claro, todo eso parece mucho mejor que los días antes de Obamacare… Pero la facilidad y amabilidad tan publicitadas por el Gobernador Beshear y aún la administración de Obama, mientras ponen en el candelero el intercambio de Kentucky como modelo para la nación, no he experimentado ni como usuaria ni como investigadora. Si el encanto de los intercambios manejados por los estados es que haya más claridad en comparar opciones para comprar, aún les queda un largo camino a Obamacare y Kynect. Una experiencia ideal en el mercado libre incluye precios transparentes entre competidores, para que los consumidores puedan tomar la mejor decisión para actuar en su interés personal. Es más, una experiencia ideal garantiza la privacidad y la libertad mientras estamos comparando. Por ejemplo, no tengo que dar a Amazon.com mi información personal para ver cuánto cuesta comprar las bombillas de varias fabricantes. Sin embargo, el intercambio Kynect y las compañías con las cuales interactué para llevar a cabo esta investigación, Anthem y Humana, eran cualquier cosa menos transparente o respetuosas de privacidad. Pasé muchas hora hablando por teléfono con las dos corporaciones, quienes se negaron decirme información específica con respeto a las finanzas a menos que yo les diera mi nombre completo, fecha de nacimiento, número de la seguridad social, y número de teléfono. Eso es años luz al mercado libre. En resumen, aunque consumió mucho tiempo, y era un proceso oscuro y no fácil como usuario en general, aquí te comparto a ti lo básico que quise encontrar en cuanto al cuidado anticonceptivo para las usuarias de Medicaid en Kentucky: Aquí hay unas notas importantes para tomar en cuenta cuando estás decidiendo cuál cuidado y cobertura son los mejores para ti:
1. Para averiguar si está cubierto o no un medicamento particular, puedes referirte a este formulario, el cual se actualiza de vez en cuando. Aquí tienes el más reciente a partir de la publicación de esta gráfica: http://www.anthem.com/Exchangedruglist4.pdf. Siempre puedes encontrar el formulario actualizado por hacer clic en el archivo llamado “Anthem Select Drug List (4-Tier)” en la biblioteca virtual de formularios en el sitio web de Anthem: https://www.anthem.com/health-insurance/customer-care/forms-library 2. Para averiguar si está cubierto o no un medicamento particular, puedes utilizar esta herramienta de búsqueda en el sitio web de Humana. Te informará a ti a cuál nivel pertenece el medicamento (si está cubierto). (“Nivel” en los formularios de medicamentos se dice “Tier” en inglés, y se pronuncia “tir.”) También, la herramienta de búsqueda te informará si haya límites en la cantidad de dicho medicamento que se puede dispensar dentro de un periodo. Aquí tienes el enlace para la herramienta de búsqueda: http://apps.humana.com/UnsecuredDrugListSearch/Search.aspx 3. En cuanto a la píldora (“los anticonceptivos orales”), hay tantas marcas y tantos medicamentos genéricos diferentes que no se sabe en todos casos si los copagos en esta gráfica son aplicables a la píldora específica que prefieres. Busca tu receta en los formularios arriba para ver si tus medicamentos están cubiertos. Si están categorizados bajo “Tier 1” (”Nivel 1”), entonces los copagos en esta gráfica son correctos. Si no, es posible que cuesten más, o quizás no estén cubiertos en absoluto. Si estás buscando más información, aquí tienes unas herramientas útiles:
What do reproductive justice, burlesque, and fire-eating have in common? (Yes, you read that correctly!) Here's what: A fundraising event that will change lives: Kentucky Health Justice Network’s third burlesque show, “Peek-a-Boo!” WHEN: Friday, November 7, 2014 Doors open and seating begins at 8pm, show at 9:30pm. WHERE: The Cure Lounge 1481 S. Shelby St., Louisville, KY 40217 WHAT: an evening of fabulous entertainment including burlesque, dancing, fire eating, and fun, with all proceeds benefiting Kentucky Health Justice Network's programs WHO: You, your friends, your co-workers, and all the fabulous reproductive justice advocates in your life! Please note this venue is ages 21 and over. TICKETS: $10-20 sliding scale at the door. RSVP on Facebook here. Thanks to our fantastic event sponsors:
The Cure Lounge Carla Wallace Theiss Law Offices, PLLC Planned Parenthood Advocates of Indiana and Kentucky Kentucky Religious Coalition for Reproductive Choice ACLU of Kentucky Indy Feminists Rootbound Farm Colin Maloney Fairness Campaign Judi Jennings Want to support the event even more? Sponsorships of this event are a great way to show your organization or group's support for the cause, and come with perks like free tickets and drinks and your name on the event program. Click here for sponsorship information! by Caitlin Willenbrink, chair, Kentucky Health Justice Network board of directors and chair, Kentucky Religious Coalition for Reproductive Choice board of directors
This article is cross-published in Kentucky Religious Coalition for Reproductive Choice's Fall 2014 Voice for Choice newsletter. This year, constitutional amendments to define personhood as beginning at conception will be on the ballot in two states, North Dakota and Colorado. These fetal personhood measures are a dangerous tactic that national anti-choice organizations are undertaking as a strategy to undermine abortion rights, but the effect of the policy would be much more widespread than that. Personhood measures undermine the bodily autonomy of pregnant people and all people and create situations where a citizen could be criminally prosecuted for a miscarriage, in vitro fertilization, or even using emergency contraception. Unfortunately, we do have case studies of the implications of fetal personhood policy, even though no state has yet adopted such a measure. Bestowing fetuses with personhood through policies like fetal harm laws can and has lead to pregnant people losing basic human rights as a result only of their pregnancy. Alabama’s “Chemical Endangerment of a Child” law was written to give the state power to prosecute parents who knowingly expose their children – to deter people from bringing children to places where controlled substances are produced or distributed, such as methamphetamine laboratories. But since it was enacted, more than 100 women who became pregnant and tested positive for a controlled substance have been arrested. Some have experienced pregnancy losses, but the majority have continued their pregnancies to term and given birth to healthy children. Recently, a similar bill passed in Tennessee to authorize the criminal prosecution of pregnant people who use drugs. A related case arose recently in Montana, where a woman who was 12 weeks pregnant was arrested for having a positive drug test. Leaving aside the tenuous research that links drug use with poor pregnancy outcomes, as well as our own judgments on pregnant people who experience addiction, from these cases we can see how laws like these, and the treatment of a fetus as having equal rights as the person carrying it, have proven time and again to lead to the less-than human treatment of pregnant people. People who experience addiction – especially those who are also pregnant – deserve support and treatment, not shame and imprisonment. In many cases, it’s led to medical interventions being forced on, or refused to, a pregnant person. In the high-profile case of Savita Halappanavar in Ireland, who suffering from a miscarriage at about 17 weeks pregnant. When she sought medical attention and treatment, her requests an abortion were refused – she was told that due to her fetus retaining a heartbeat and her life not appearing to be in physiological danger, abortion was not legal. Savita went into septic shock due to the fetal remains in her uterus, and her condition deteriorated rapidly. She died a few days later of organ failure and cardiac arrest. However someone feels about abortion, we should be able to agree that criminalizing a pregnant person and applying a law differently to them simply because they are pregnant is wrong. Kentucky Health Justice Network, together with the Kentucky Religious Coalition for Reproductive Choice, is opposed to any such personhood measure, and we are demonstrating that opposition by standing with organizations who challenging these measures on the ground. North Dakotans Against Measure 1 (www.ndam1.org) are lobbying against the amendment in that state, and in Colorado, a wide swath of reproductive justice organizations is coming together the NO on 67 campaign (www.voteno67.com). These measures purport to be only about abortion, but advocates conservative and liberal alike realize their destructive possibilities. In both states, the measures are very broadly and unclearly written, so in both states, organizations as wide-ranging as Planned Parenthood, the ACLU, bar associations, and even the AARP have come out in opposition to them. Learn more and get involved by following the above-mentioned campaigns and at National Advocates for Pregnant Women (www.advocatesforpregnantwomen.org). By Farah Ardeshir CLPP. Pronounced CLIP yet not meant to cut off, trim, pare, or curtail. But, it's funny because I would use all those adjectives to describe the manner in which we have recently seen civil rights and civil liberties cut off, trimmed, pared and curtailed. CLPP is the exact opposite. Civil Liberties and Public Policy Program, now you know it as CLPP, is a "reproductive rights and justice organization" who "for over 30 years, CLPP has been working to realize a world in which all people have the economic, social, and political power necessary to make healthy decisions about our bodies, families, sexuality, and reproduction." It's not just a conference where you hoard all the free event goodies, of course, that happens, but before you reach that point of geekery, you've officially put your cool face on because reproductive freedom heroines are roaming about, often standing nearly 2 feet from you in the 100 foot lunch line. If that isn't enough, you might be ogling over the food. I'm a foodster (made that up) who looks forward to rating their food because it doesn't taste like conference food. Check. It's definitely an event for dreamers. And it's most certainly a space for queers, for hip hop lovers, for femme queers, for friendly people, for dancers, for #LaverneCox lovers (wish she would be a keynote speaker), for Queen Bey disciples, and for anyone else you can think of that a) believes reproductive freedom is necessary to have a stake in for current and future earthlings and b) also believes it cannot truly be achieved without prioritizing immigrant rights, racial justice, trans justice, queer liberation, (dis)ability justice and c) in some way participates in that progress. I remember feeling the whole room swallow up the chatter when Monica Raye Simpson, Executive Director of SisterSong, stepped onto the stage during the open plenary and sang. Being a dreamer, I swelled up with a sense of unfettered optimism thinking that the entire room was echoing my little inner voice dialogue, "Wow, Monica, you are so brave up there. This is beautiful. Why doesn't Congress host stuff like this?" So, I'm taking this moment to spread the gospel. Here's what happened and what will hopefully happen when you go to CLPP: Colored Girls Hustle wipes the floor while the whole crowd claps along with them. Loretta Ross, founder of SisterSong, and Dázon Dixon Diallo, MPH, founder of SisterLove recount historical moments in the reproductive justice movement and share visions of what will come for the movement. Found a little trashed up piece of paper at the last moment and got it signed by Loretta. Word. Made some of the greatest fellow organizer and activist friends spread across the United States. Listened to Deborah Peterson Small lecture about Marxism, White Supremacist Capitalistic culture, and state-sanctioned criminalization of black bodies and pregnant bodies. All of my academic dream topics in one lecture. Purchased a zine that afforded me a great deal of emotional support called Transplants, Sowing the Seed of Gender in the Garden. You can find your own copy at drawnbloodpress@etsy.com. Foolishly sang in unison with a group of Bey lovers to the entire visual album. What can be better than that? Like I said earlier, I hope that Laverne Cox is a keynote speaker in the near future. I hope there is a kickball game because a body gets stiff after hours of sitting through lectures. I would love to see Autostraddle send a few journalists to CLPP with swag in tow. It would also be great if the seminar on how to work in the movement extended into a mini job fair for participants. For a lot of us, we travel a great distance to reach CLPP so making the most of it with a mini job fair would be smashing. Bon voyage, kids. It's not all daisies and daffodils. You're going to hear people say things you disagree with. You'll have long conversations about engaging your community in different ways and short conversations about where to find coffee, immediately. All in all, you'll think and criticize and create and envision and learn. RADICAL COLLABORATIONS IN OUR MOVEMENTS FOR JUSTICE |
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