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2024 Reproductive and Sexual Health Rights and Access Agenda

Today, we live in a country where millions have been stripped of their reproductive freedom and autonomy. At least 22 states have banned or severely restricted abortion since the Supreme Court overturned Roe v. Wade, and more than 58% of individuals with the capacity for pregnancy live in a state that is hostile to abortion. People living in those states in need of abortion will face significant barriers trying to access that care – the cost of that care when they lack health care coverage, traveling hundreds of miles, while needing to take time off from work and find childcare. For some those barriers will be insurmountable, and they will be forced to either self-manage their care, or remain pregnant, placing their health and wellbeing at risk.  

Even when Roe was in place, the right to abortion was and still is in name only for far too many. Decades of tenacious efforts by anti-abortion policy makers led to the enactment of over 1,380 abortion restrictions since the landmark decision in 1973. Restrictions that deterred, delayed, and denied many from exercising that constitutional right. Restrictions that are built upon and operating within our country’s legacy of racism and discrimination, and thus disproportionately impact Black, Latino, Indigenous and other people of color, young people, disabled people, and people experiencing poverty.  

The attacks on our bodily autonomy are unrelenting. In addition to banning abortion, policy makers across the country are passing legislation that limits access critically needed gender-affirming care, and information that will help young people make informed decisions about their bodies and relationships and to feel seen and accepted for who they are.  

As we boldly reimagine the post-Roe future it is incumbent upon us to be innovative – to build a system of policies and care that is anchored in equity – where everyone can truly access the sexual and reproductive health care and information they need. To fight not just for the right to abortion, but for policies that at the core effectuate that right and advance equality and justice for all.  

 

Strengthening Access through Increased Medicaid Reimbursement for Sexual and Reproductive Health Care.  

If New York is going to be a true access state, it must ensure providers are adequately reimbursed for the care they provide. A decade of stagnant Medicaid reimbursement and inflation factors mean providers are significantly unreimbursed compared to what it costs them to deliver care today. Other access states, like California, Oregon and Illinois have all recently increased reimbursement for reproductive and sexual health care services – through rate increase supplemental payments on key abortion and reproductive health care services. The FY2024 enacted budget included an increase to the reimbursement for procedural care but did not increase the rate for medication abortion care. Abortion by medication is over 60% of the abortion care provided by Planned Parenthoods in NY – for some it is over 70%. Increasing Medicaid reimbursement for this service will provide much needed sustained funding, as providers invest in their infrastructure to grow capacity and increase access to sexual and reproductive health care services across the state. The Governor and Legislature must enact a FY25 budget that increases Medicaid reimbursement for medication abortion.   

 

Sustained Grant Funding for Reproductive and Sexual Health Care   

Unfortunately, the stark reality of millions losing access to abortion care is not just a crisis of today but will be a crisis we are facing for years to come. Prior to Governor Hochul’s historic investment of $35m in access and security funding for abortion providers, there had been no intentional investment in abortion access. This reality coupled with insufficient reimbursement rates and rising costs of delivering care, has throttled the ability of providers to grow their capacity to meet the present need, and invest in their infrastructure to enhance their delivery of care. Before the fall of Roe, New York’s abortion care infrastructure was at or near capacity. As we face the mounting pressures of access to abortion care drastically dwindling across the country, continued grant investment is paramount to addressing the challenges of uncompensated care, provider training and capacity, facility enhancements, and the need for practical support to ensure access to care for all.  

The State must increase these grant funds and enact the Reproductive Freedom and Equity Program (A.361 González-Rojas/S.348 Cleare) – legislation that would create a sustained funding mechanism through the NYS Department of Health to provide grants to support the operational and programmatic needs of abortion providers and abortion funds – to ensure they can address the growing need for care in New York. This program will allow non-profits who support patients with ancillary costs such as transportation, child care, and housing to submit applications for grant funding.    

The State must also continue to invest in the Comprehensive Family Planning and Reproductive Health grant. This program facilitates affordable access to a range of critical services like birth control, cervical cancer screening, sexually transmitted infection testing and treatment, and more for New Yorkers with low incomes, serving more than 252,000 individuals in 2021. However, decades of stagnant funding has made it challenging for providers to deliver care to all who need it. 2022 was the first year in over a decade when providers experienced an increase in their family planning grant funding, however, this increase still fails to meet the needs of providers as they seek to respond to the demand for care in their communities.  

This is the time to ensure the State’s continued investment in this critical program meets the realities that providers face as they strive to expand access to these vital services throughout NYS. The FY25 NYS budget must provide a 4% increase to the Family Planning Grant  

  

Ensuring Comprehensive Sexuality Education for all New York Youth. 
Information is power. When young people have the tools they need to make healthy decisions about their bodies and their relationships, they have a brighter future.  

Comprehensive sexuality education has been shown to improve health outcomes and benefit our youth. Unfortunately, there is no consistent requirement for this education in New York, creating a patchwork system where not all kids receive this education and in some cases are not receiving accurate information. PPESA supports legislation (A.4604 González-Rojas) requiring comprehensive, medically accurate, culturally, age and developmentally appropriate sexuality education in publicly funded K-12 schools statewide. Your ability to access this vital information should not be dependent upon your zip code.    

     

Continuing to Combat Maternal Mortality and Expanding Access to Doula Services.  

Rates of maternal mortality in this country and state are unacceptably high – particularly for Black women. It is estimated that 84% of maternal deaths are preventable. Over the past few years New York has taken many important steps towards combating maternal mortality, and we must continue to pursue policies and investments that support safe and healthy pregnancies and births for all pregnant people. This support includes, but is not limited to: 

  • Increase Oversight of Changes to Maternity Services (A.8205 McDonald/S.7740 Webb): Access to maternity care remains essential to preventing adverse health outcomes related to pregnancy and eliminating health disparities in the face of a national maternal health crisis. Unfortunately, not all New Yorkers have equal access to such care, with residents of rural areas experiencing maternity care deserts. Meanwhile more populated areas of the state face threatened closures of maternity wards which will leave pregnant people without timely access to care, as demonstrated by the recent proposal to close Burdett Birth Center in Rensselaer County. Despite this current reality, proposed changes to the delivery of maternity services are not subject to a full review by the Public Health and Health Planning Council. This legislation would require a full review of any addition, decertification, or changes in the method of delivery of maternity services by a general hospital to better ensure that the State’s hospital system is responsive to the needs of its pregnant people. 
     

  • Insurance Coverage for Doula Care (S.380 Cleare): Doulas assist and support pregnant people before, during, and after childbirth by providing emotional and informational support. The assistance of a doula has been shown to reduce the length of labor for pregnant people, the number of cesarean sections and episiotomies, and improve the physical and mental health of the birthing person. Unfortunately, not all New Yorkers can afford the cost of doula services, and without any insurance coverage for this care it can be completely impossible to access. We support legislation to require health insurance companies to provide coverage for doula services so any pregnant person can access the support they need throughout and following their pregnancy. 

 

Ensuring Transparency and Access to Sexual and Reproductive Health Care and Gender Affirming Care.  

PPESA supports legislation surrounding hospital transparency that would offer patients the tools they need to determine whether the hospital in their area provides the care they seek prior to admission (A.733-A Rozic/S.1003-A Hinchey). In addition, this would give New York the tools to identify regions in the state where particular types of care are unavailable and to understand the impacts of such gaps on communities and individuals statewide.  

Further, when hospitals choose to implement policy-based exclusions on care, it can operate to limit both communications between health care practitioners and their patients regarding treatment options and the types of care they can provide, as well as the provision of those services. We support legislation (A.5297 Paulin/S.6616 May) that would prohibit hospitals from preventing practitioners from communicating accurate and comprehensive information about a diagnosis or medically accepted course of treatment or preventing delivery of a medically accepted course of treatment for pregnancy-related complications or miscarriage management. 

  

Health Care Access for Immigrant Communities: Everyone’s health depends on access to care and coverage. Hundreds of thousands of New Yorkers cannot enroll in health insurance because of their immigration status. The Essential Plan for All (A.3020-A González-Rojas/S.2237-A Rivera) will make access to affordable care a reality for undocumented New Yorkers by establishing a state funded Essential Plan program for immigrants whose status makes them ineligible for other state and federally funded coverage. PPESA stands with the #Coverage4All campaign in calling for passage of the Essential Plan for All to ensure coverage for all New Yorkers.