Vagina Talk: Let's Go Shopping For Health Insurance!

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Despite my obsession with health insurance, it was really only a few years ago that I realized it was a big deal. I was 22, a recent college grad and suddenly found myself with a part time job and no health insurance benefits. I did a little research on temporary plans and vividly remember seething at the computer screen as I saw the amount of money I'd have to pay for basic emergency care coverage. Little did I know, but in that moment my love affair with health insurance had begun. This obsession grew as I started working at a low cost community clinic and realized just how many people were un or underinsured. Every day I would witness a new story - a pre-existing condition that prevented them for getting health insurance, recently losing a job, a necessary prescription that wasn't covered in their plan or a high deductible that caused them to always pay out of pocket. But in the end it was always the same: people were forced to decide whether or not they could afford health care, causing many to forgo important preventative care and treatment. This shifted my whole world view. So much so, that when I went home to England for Christmas one year, I turned to my mother on the bus, and said in utter astonishment, "All of these people have health insurance just because they're British." At that moment, I really appreciated what it was like to live in a country where healthcare was viewed as a human right, and I knew I wanted that reality for both of my home countries.

That's why today is such an exciting day! As of today, October 1st 2013, Health Insurance Exchanges around the country are open for enrollment, inching us one step closer to an America where more people have access to health insurance. What are Health Insurance Exchanges you ask? Well, Health Insurance Exchanges are part of the Affordable Care Act. They're basically like a Travelocity/Expedia/Kayak for health insurance that individuals or small businesses can use to find the best insurance option for them. Over the next six months, individuals and small businesses will be able to start enrolling in health plans for 2014. If coverage is purchased by December 15th, health insurance benefits will begin January 1st, 2014!

Individuals will be eligible to buy insurance through these Health Insurance Exchanges if they aren't able to get insurance through their employer. The Exchanges will be a place where individuals can compare health plan prices, benefits and even learn whether they qualify for Medicaid or financial assistance. Since health insurance can be pricey, part of the Affordable Care Act involves tax credits to help make coverage more affordable. Tax credits will be available for people earning between the federal poverty level ($11,490/year for one individual) to four times that ($46,000/year for one individual). Subsidies are also available for individuals with incomes up to 250% of the poverty level ($29,000/year for one individual) to help cover the cost of copayments and deductibles. Individuals who earn up to 133% of the poverty level, will also now be available for Medicaid benefits for states that have expanded their Medicaid program.

In an ideal world, I wish that the Health Insurance Exchange was like a My Favorite Things Oprah episode, where we'd all just be sitting in a room screaming as Oprah yelled "And health insurance for you and you and YOU!" Unfortunately though, awesome things normally require us to put in a little bit of effort. But don't you worry because I've compiled a few resources to help make your health insurance shopping that much easier!

• HealthCare.gov - If you have questions, the best place to start looking for your answers is from the experts themselves. Health and Human Services have created a great website, with a nifty online tool to help you figure out your options. 
• Subsidy calculator: Want to know how much money you could save through Obamacare? Use this nifty calculator! 
• FAQs galore: The National Women's Law Center has an awesome list of FAQs that clearly explains all of the nitty gritty details of health insurance, Obamacare and almost all the logistics you'd want o know. 
• And if you're a visual/audio learner this one's for you!

Oh, and don't you worry. The Health Insurance Exchanges are still open today despite the government shutdown. Why the Republicans thought they could try for the 43rd time to repeal Obamacare and be successful is beyond me. In many ways today is a weird day. The shutdown is a blatant and sad reminder of how government sometimes doesn't work, but the launch of the Health Insurance Exchanges is proof of how government can really help their citizens. So let's celebrate the latter and remember that our right to healthcare is not a political bargaining chip. 

So there you have it friends. I wish you all a Happy October 1st and hope you celebrate this historic day. But don't forget - enrollment ends March 31st! 

P.S. This is my favorite tweet ever about the Affordable Care Act: 

Vagina Talk: Creepy Uncle Sam Spreading Lies About Obamacare

Have you seen the Creepy Uncle Sam video spreading lies about Obamacare through scare tactics? Did it make you want to scream and yell? Yeah, me too. 

If you're lucky enough to have not seen this video, it's a new ad campaign by Generation Opportunity to convince people to "opt out" of Obamacare. It follows a young female going to get an annual with her new insurance and a nurse judgmentally asks her about her signing up for Obamacare. If that isn't bad enough, once the woman is ready for her exam a creepy Uncle Sam comes in and... you get to the picture. Basically it's as unsubtle as you can be about not wanting the government in your exam room. 

This is wrong on so many levels. First of all, Obamacare is not about the government coming into your exam room or getting in-between you and your doctor. Doctors aren't suddenly going to be working for the government, and the government isn't going to be telling you what tests or procedures you can and cannot get. If anything, Obamacare has enacted provisions to make more preventative and routine tests covered by insurance. 

And more importantly, you don't "sign up for Obamacare." You sign up for health insurance. Not just any health insurance, but private health insurance, mostly through insurance carriers most people already use. This is the main component of Obamacare: increasing access to health insurance. Obamacare is HELPING people get insurance by providing cheaper options, offering subsidies and expanding Medicaid coverage. BIG DIFFERENCE. Last time I checked, being able to have health insurance is a good thing. 

If that isn't bad enough, the fact that they made this ad focus on the annual exam is so twisted. They are deliberately playing into the confusion surrounding forced restrictions on women's health to make it seem like Obamacare is the one mandating all these impositions. It's actually pretty ironic as Ilyse Hogue, President of NARAL sums up perfectly, "This ad is brought to you by the same people who force Uncle Sam between our legs when it comes to reproductive health. It's un-American to mandate forced ultrasounds, restrict abortion care, and deny contraception coverage while trying to trick students into forgoing Obamacare, which will help them get preventative care and end gender discrimination in insurance coverage."

Listen, I know Obamacare isn't perfect. Health insurance is still going to be expensive, and mandating health insurance is going to feel like a burden for some people and businesses. But the truth of the matter is that our healthcare system is broken. We spend far more on healthcare costs than any other developed country and we are embedded in an employer based health insurance system that makes our health benefits tied to market successes, while also leaving out large segments of the population who work part time, don't work, are retired, students or self-employed. For the time being, Obamacare is the best option we have to start trying to fix our broken system. 

It is time for health care in the United States to be seen as a human right, and not a privilege. In 2012, 84 million people in the United States were uninsured or underinsured. How can we call the United States one of the greatest nations on Earth, if we fail to provide a basic human right to so many of our citizens? The fact that starting January 1st, 2014 millions of people will be able to access health insurance and then go to the doctor and access necessary health care is amazing. So Creepy Uncle Sam, you may have your scare tactics but that doesn't deter my excitement and optimism for Obamacare. I cannot wait to celebrate the day someone tells me that it's their first time at the clinic because they now have health insurance thanks to Obamacare. What a wonderful thing! 

Vagina Talk: Nobody Puts Plan B Behind the Counter!

Congratulations world! Plan B One Step is now available over the counter for people of all ages! That means no more asking a pharmacist for it - you'll now be able to find it on a shelf in the pharmacy like any other drug. YIPPEE!!

It's been a long time coming, a hard fight and there are a lot of people to thank. Emergency contraception has been around for decades, but the actual brand Plan B first became available in 1999 and required a prescription. Since 2003, there's been a long fight to get Plan B available over the counter. This debacle has been wrought with political ideologies and motives overriding proven science and evidence that shows that access to emergency contraception is safe and necessary in preventing unintended pregnancy. Finally in 2006, Plan B became available over the counter for people over the age of 18. That age restriction changed to 17 in 2009, and over the last few months there has been a flurry of court challenges, rulings and FDA guidelines that have paved the way for Plan B to finally become available over the counter for people of all ages. Hurrah! (Side note: it can get a little confusing since the terms emergency contraception and Plan B tend to be used interchangeably but it's important to remember that Plan B is only one brand of emergency contraception.)

So why are we celebrating that as of today, August 1st, Plan B is available over the counter for people of all ages? Because it's a big freaking deal. The reason why we have been fighting for this long is because access to emergency contraception is really important. In the United States half of all pregnancies are unintended. There are a multitude of social and systematic reasons why half of all pregnancies are unintended (which I promise to write more about one day), but apart from addressing those underlying issues of reproductive injustice and inequality, increasing access to better health care and services is one way to fix this problem. In an ideal world, everyone would have access to comprehensive reproductive and sexuality education, and birth control that was 100% effective. Sadly, that's not the world we live in. So instead, access to emergency contraception offers a viable alternative to prevent unintended pregnancy because it's a back up plan people can use when their Plan A fails. Because let's be honest, accidents happen no matter how prepared we are.

But there's a lot of misconception about Plan B and emergency contraception out there, so let's take a few moments to debunk some pretty common myths.

1. Plan B is NOT THE ABORTION PILL. Say it with me! Plan B is not the abortion pill! (If you remember one thing from this post, please please please let it be that). Why isn't it the abortion pill? Well first of all, it's a totally different type of drug. Plan B is a high dosage of levonorgestrel, or a synthetic version of the hormone progesterone found in birth control pills. The abortion pill is a different drug called mifepristone or RU-486. Plan B is also not the abortion pill because it works in a totally different way, so much so that it won't affect an existing pregnancy. It works to delay ovulation by basically giving your body a high dose of hormones to confuse your natural cycle in a way that makes your ovaries say, "heeeyyyy wait a minute, maybe we shouldn't release our precious egg just yet." That's why the timing of when you take emergency contraception is so important because the sooner you take it, the higher chance you have of delaying ovulation. This gives you a higher chance of not getting pregnant since you're giving the sperm in your uterus time to die before an egg is released and they can go pounce on it. Because of the way it works, emergency contraception WILL NOT affect an existing pregnancy. See, there's even studies to prove it. 
2. Plan B can be taken up to 72 hours after unprotected sex. Like I said above, the earlier the better but you do have a window period, with some practitioners even saying you can take it up to 120 hours (5 days) later.  
3. While Plan B is awesome, it shouldn't be used as a regular form of birth control.This isn't because it's going to do anything terrible to your body (because again, it's basically just a high dosage of birth control hormones) but because if you really want to prevent pregnancy, the best way to do this is to be on a more effective and reliable form of birth control. 
4. Emergency contraception comes in a lot of shapes and pill sizes. On the one hand you have the type of emergency contraception made from levonorgestrel, like Plan B, Next Choice and Levonorgestrel. While they're all the same drugs, the most recent court ruling has only allowed Plan B One Step to be available over the counter. The other generic versions will still be available but will require a prescription for those under 17. The other type of emergency contraception out there is called Ella. It's relatively new to the US market and always requires a prescription because it's an alternate drug and works a bit differently. 
5. It is safe to have Plan B available over the counter! The hormone in Plan B mimics progesterone, which unlike estrogen that's found in some birth control pills, doesn't have the same risk for blood clots or heart issues. Related to this, having emergency contraception available over the counter to all ages will not increase sexual behavior. Going back to the facts, while the teenage pregnancy rate in the US has been declining over recent years, we still have the highest teen pregnancy rates among developed countries so let's face it, teenagers are having sex. Having emergency contraception available over the counter will therefore hopefully give teenagers and adults access to more options to control their fertility and prevent unintended pregnancies. 

But while we celebrate today, remember the fight is far from over. Just because Plan B will now be available over the counter does not mean access is guaranteed. Plan B is still pretty pricey and cost is always going to be a factor. The good news is that theoretically the Affordable Care Act will cover Plan B through the women's preventative services requirements. I say theoretically because the thing about insurance is that if you want it to cover your medicine, you have to have a prescription for it. The name "emergency contraception" implies that for most people, when you need it, you don't have time to go to your doctor, get a prescription and then take your pill before the 72 hours are up (not to mention you really want to be taking it as soon as you can). So with that in mind, there's still a lot of work to do to try and work with clinics/doctors/practices to set up standing prescriptions that individuals with insurance can use when the need arises, as well as lead massive education campaigns to make sure that everyone knows what "coverage" means so they can access the care they need.

Either way, we have a lot to celebrate and be thankful for today! This is a huge step and I for one, am super excited to see Plan B One Step available over the counter at my local pharmacy.