June 26, 2017 The Honorable Mitch McConnell Senate Majority Leader United States Senate S-230, U.S. Capitol Washington, D.C. 20510 The Honorable Charles Schumer Senate Minority Leader United States Senate S-221, U.S. Capitol Washington, D.C. 20510 Dear Majority Leader McConnell and Leader Schumer: On behalf of the nation’s leading domestic and sexual violence advocates and survivors, we strongly urge you to oppose the Better Care Reconciliation Act. Victims of violence need access to health care over their lifespans that is affordable and inclusive of mental and behavioral health services. Repealing the ACA and drastically reducing Medicaid coverage, as the BCRA does, will likely cause tens of millions of people to lose their health insurance. The most vulnerable women and youth who have experienced violence or trauma, including domestic violence, sexual assault, and child abuse, would be among those disproportionately impacted. Domestic violence and sexual assault are unplanned crises with long- term consequences. It is unreasonable to assume someone will know to choose a health plan based on the expectation she or he will become a victim of crime or violence. The BCRA will allow insurers to sell plans that cover very little -- potentially leaving a victim with a huge medical bill after an attack --- or make comprehensive health insurance so expensive that it’s unaffordable. We should be helping all survivors by making insurance more affordable, accessible and comprehensive, not less. Medicaid coverage, including the Medicaid expansion, is particularly important for survivors of violence because they are more likely to be suffering from chronic pain and other chronic health conditions that require continuous screening and services. Many are also struggling with mental, emotional and behavioral health consequences of their abuse, and those services may now no longer be covered. We also remain concerned that as a result of the new continuous care requirement, victims of sexual assault and domestic violence could still face higher premiums as a consequence of their abuse. Victims of domestic violence who leave an abuser or are forced to leave their employment and relocate with limited resources could easily find themselves paying much higher premiums or going without any care at all. According to the Centers for Disease Control and Prevention, one out of four women in the United States has experienced severe physical violence by an intimate partner during her lifetime, with 70 percent of victims first experiencing abuse before the age of 25. Nearly 23 million women have 1 been the victim of rape or attempted rape in their lifetime, with 40 percent experiencing the assault before the age of 18. We ask you not to turn your back on victims. Protect their access to health care to make sure that they have a pathway to healing, safety and well-being. Sincerely, National Organizations Asian Pacific Institute on Gender Based Violence Break the Cycle California Coalition against Sexual Assault (CALCASA) Casa de Esperanza: National Latin@ Network Futures without Violence Institute for Science and Human Values Jewish Women International Legal Momentum, the Women's Legal Defense and Education Fund National Alliance to End Sexual Violence National Center for Victims of Crime National Center on Domestic and Sexual Violence National Clearinghouse for the Defense of Battered Women National Coalition Against Domestic Violence National Domestic Violence Hotline National Network to End Domestic Violence National Organization of API Ending Sexual Violence National Resource Center on Domestic Violence Praxis International SAFE, Inc. Service Women's Action Network (SWAN) Sewa-Aifw (Asian Indian Family Wellness) The Genieve Shelter UltraViolet US Women and Cuba Collaboration Women of Color Network, Inc. Woodhull Freedom Foundation YWCA USA State Organizations Alabama One Place Family Justice Center Alaska Tundra Women's Coalition Alaska Network on Domestic Violence and Sexual Assault The LeeShore Center 2 Women In Safe Homes Arizona Arizona Coalition to End Sexual and Domestic Violence Alice's Place, Inc. Sharon Manor Transitional Housing Central Phoenix Inez Casiano NOW Eve's Place Arkansas Serenity Inc. California California Partnership to End Domestic Violence Center for the Pacific Asian Family Alliance for Community Transformations Alliance for Community Transformations CORA (Community Overcoming Relationship Abuse) California NOW South Asian Network Shepherd's Door Domestic Violence Resource Center NOW San Gabriel Valley /Whittier Asian Law Alliance Family Services of Tulare County Colorado Moving to End Sexual Assault Safehouse Progressive Alliance for Nonviolence The Arc of Aurora Colorado Coalition Against Sexual Assault Advocate Safehouse Project WSAT Colorado Coalition Against Domestic Violence Project Safeguard Deaf Overcoming Violence through Empowerment (DOVE) Renew, Inc. S.H.A.R.E., Inc. Clear Creek County Advocates Connecticut Meriden-Wallingford Chrysalis, Inc. Delaware Delaware Coalition Against Domestic Violence Community Legal Aid Society, Inc. People's Place SAFE 3 District of Columbia Survivors and Advocates for Empowerment, Inc. Bread for the City DC Coalition Against Domestic Violence DC Primary Care Association Asian/Pacific Islander Domestic Violence Resource Project Becky's Fund Florida Palm Beach County Chapter of National Organization for Women, Inc. Florida National Organization for Women West Pinellas National Organization for Women (NOW) Georgia Georgia Coalition Against Domestic Violence Hawaii Hawaii State Coalition Against Domestic Violence Hawaii Counseling and Education Center Idaho Southwest Idaho National Organization for Women Illinois Illinois Coalition Against Sexual Assault Illinois National Organization for Women Mutual Ground, Inc. Illinois Coalition Against Domestic Violence Indiana Prevail, Inc. Kosciusko County Shelter for Abuse, Inc. Indiana Coalition Against Domestic Violence Indiana National Organization for Women Iowa Iowa Coalition Against Domestic Violence YWCA Clinton Crisis Intervention Service Monsoon United Asian Women of Iowa Centers Against Abuse and Sexual Assault (CAASA) Healthy Kids School-Based Health Clinics Domestic Sexual Assault Outreach Center Monsoon United Asian Women 4 Kansas Kansas Coalition Against Sexual and Domestic Violence Jana's Campaign Kentucky Safe Harbor of NE KY SpringHaven, Inc Domestic Violence Program Barren River Area Safe Space, Inc. GreenHouse17 Kentucky Coalition Against Domestic Violence Louisiana Louisiana Coalition Against Domestic Violence Louisiana Foundation Against Sexual Assault Maine Maine Coalition to End Domestic Violence Family Violence Project New Hope for Women Next Step Domestic Violence Project Spruce Run-Womancare Alliance Safe Voices Family Crisis Services Caring Unlimited Maryland CHANA Maryland Network Against Domestic Violence Heartly House SARC, Inc. The Women's Law Center of Maryland, Inc. NewLifeServices Inc HopeWorks of Howard County Wurzbacher and Associates, Human Service Consultants Maryland Coalition Against Sexual Assault Massachusetts Jane Doe Inc., the Massachusetts Coalition Against Sexual Assault and Domestic Violence Saheli, Support and Friendship for South Asian Women Safe Passage Asian Task Force Against Domestic Violence Domestic Violence/Sexual Assault Program at Newton-Wellesley Hospital REACH Beyond Domestic Violence, Inc. The Network/La Red New England Learning Center for Women in Transition New Hope, Inc. 5 Massachusetts Alliance of Portuguese Speakers (MAPS) YWCA Northeastern Massachusetts YWCA Central Massachusetts Womanshelter/Companeras Michigan Michigan Coalition to End Domestic and Sexual Violence Catherine Cobb Safe House Bay Area Women's Center Relief After Violence Encounter - Ionia/Montcalm, Inc. Turning Point Child & Family Services of Southwestern Michigan, Inc. Women's Resource Center of Northern Michigan Hope Shores Alliance Mai Family Services SafeCenter Minnesota Minnesota Coalition for Battered Women Family Pathways Home Free Community Program Freeborn County Crime Victims’ Crisis Center Safe Avenues Friends Against Abuse Committee Against Domestic Abuse, Inc. (CADA) Hands of Hope Resource Center Breaking Free Fergus Falls Area NOW Minnesota NOW Foundation Tubman Pearl Crisis Center CADA Minnesota Coalition Against Sexual Assault Women's Shelter, Inc. Gender Violence Institute Mississippi Mississippi Coalition Against Domestic Violence Missouri Missouri Coalition Against Domestic and Sexual Violence National Organization for Women, Missouri National Organization for Women, Columbia Area Capital Area Missouri NOW 6 Montana Montana Coalition Against Domestic & Sexual Violence Safe Space Domestic Violence and Sexual Assault Program HAVEN Montana Chapter, National Organization for Women Nebraska Nebraska Coalition to End Sexual and Domestic Violence Nevada Nevada Coalition to End Domestic and Sexual Violence Pershing County Domestic Violence Intervention Woman To Woman Ministries New Hampshire New Hampshire Coalition Against Domestic and Sexual Violence New Jersey Northern New Jersey Chapter, NOW NJ Coalition to End Domestic Violence New Mexico New Mexico Coalition Against Domestic Violence Community Against Violence (CAV) Resolve (formerly IMPACT) New Mexico State National Organization for Women Albuquerque Sexual Assault Nurse Examiners Collaborative Enlace Comunitario Santa Fe National Organization of Women New York New York State Coalition Against Domestic Violence Vera House, Inc. VIBS New York State Coalition Against Sexual Assault Hope's Door My Sisters' Place, Inc. Safe Horizon Willow Domestic Violence Center Womankind (Formerly New York Asian Women's Center) Grace Smith House A New Hope Center, Inc. North Carolina Safe Alliance Families First, Inc. 7 Health Care Justice Fayetteville (NC) Chapter NOW NC Coalition Against Domestic Violence Carteret County Domestic Violence Program, Inc. The Outer Banks Hotline, Inc. Davie Domestic Violence Services & Rape Crisis Center Turning Point, Inc. NC National Organization for Women North Dakota CAWS North Dakota Ohio Ohio Domestic Violence Network Artemis Center Ohio Alliance to End Sexual Violence Jewish Family Service Association A.L.I.V.E., INC OneEighty Asian Services In Action Survivor Advocacy Outreach Program Oklahoma Native Alliance Against Violence Oregon Saving Grace: Imagine Life without Violence Oregon NOW (National Organization for Women) Pennsylvania YWCA Lancaster Pittsburgh Action Against Rape Southwest PA National Organization for Women Survivors, Inc. PPC Violence Free Network Victims' Intervention Program Network of Victim Assistance (NOVA) Your Safe Haven, INC YWCA York Women's Resources of Monroe County PA Coalition Against Domestic Violence Women's Resource Center Huntingdon House Sullivan County Victim Services Centre Co. Women's Resource Center Women Against Abuse 8 SAFE (Stop Abuse For Everyone) YWCA Carlisle Domestic Violence Services of Cumberland & Perry Counties Blackburn Center Pennsylvania Coalition Against Rape Puerto Rico Siempre Vivas Rhode Island RI Coalition Against Domestic Violence Sojourner House Women's Resource Center Domestic Violence Resource Center of South County Blackstone Valley Advocacy Center South Carolina SC Coalition Against Domestic Violence and Sexual Assault YWCA of the Upper Lowlands, Inc. Sistercare Cumbee Center to Assist Abused Persons Safe Harbor Safe Harbor People Against Rape South Dakota SDCEDSV Tennessee Tennessee Coalition to End Domestic & Sexual Violence Texas TX Association Against Sexual Assault Texas Council on Family Violence Vermont Vermont Network Against Domestic and Sexual Violence Virginia Virginia Sexual and Domestic Violence Action Alliance SARA Roanoke Loudoun Abused Women's Shelter Women's Resource Center of the New River Valley Shelter for Help in Emergency Sexual Assault Resource Agency Project Horizon, Inc. 9 The Haven Shelter and Services, Inc. YWCA South Hampton Roads Virginia NOW Choices, Council on Domestic Violence for Page Co., Inc. Madeline's House Washington Coalition Ending Gender-Based Violence Washington Coalition of Sexual Assault Programs King County Sexual Assault Resource Center Washington State Coalition Against Domestic Violence (WSCADV) SAGE Jewish Family Service of Seattle Washington State National Organization for Women Spokane Area National Organization for Women Cambodian Women Networking Association Kitsap Sexual Assault Center West Virginia West Virginia Coalition Against Domestic Violence Tug Valley Recovery Shelter Women's Resource Center Family Crisis Intervention Center Family Refuge Center Tug Valley Recovery Shelter Family Crisis Center, Inc. Wisconsin The Bridge to Hope Wisconsin Coalition Against Sexual Assault End Domestic Abuse WI AVAIL, Inc. Rainbow House Domestic Abuse Services The Bridge to Hope AVAIL Wyoming Wyoming Coalition Against Domestic Violence and Sexual Assault Advocacy & Resource Center FOCUS, Inc. Family Crisis Center Gillette Abuse Refuge Foundation Women's Self Help Center 10