National Consumers League renews call for legislation requiring child vaccinations

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February 11, 2019

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242 or Taun Sterling, tauns@nclnet.org, (202) 207-2832

Washington, DC—After a harrowing account in a February 6, 2019 Washington Post article about the galloping rate of measles because of state laws permitting parents to forego – for personal or religious reasons — safe and effective vaccines for their children, the National Consumers League (NCL) is renewing its call for passage of strict vaccination laws.

“Vaccinations are proven safe and effective. They prevent diseases like measles, polio, smallpox, influenza, and diphtheria which used to terrify parents and send communities into panic. Vaccines should be seen as a gift of modern medicine. When you decide not to vaccinate your child, you’re endangering your child and your community,” said NCL Executive Director Sally Greenberg.  

NCL supports laws that restrict exemptions. Greenberg continued: “Legitimate and well-documented health conditions should be the only reason to not vaccinate your children. The loophole of `personal preference’ or ‘religious exemptions’ has caused the “current epidemic and traffic in fear mongering and unfounded pseudo science. The link between autism and vaccines has been debunked time and again and yet anti-vaxxers persist in spreading bad information and contribute to the dangerous spread of deadly illnesses in their communities.”  

NCL commends California, West Virginia, and Mississippi for allowing only medical exemptions to vaccine requirements. In 2016, NCL honored Dr. Richard Pan, a California State Senator, for his brave leadership on vaccine laws. In 2015, he authored landmark legislation abolishing all non-medical vaccine exemptions, legally requiring vaccines for school-aged children, thereby restoring community immunity from vaccine-preventable diseases. In his acceptance speech, Dr. Pan remarked, “Consumers need accurate guidance on medications that can improve their health, especially vaccines which benefit both patients and the public. NCL has been a strong partner as we strive to combat misinformation about vaccines.”

Unfortunately, most states permit religious exemptions from vaccines, and 17, including Washington, Oregon, and Idaho, currently allow philosophical exemptions. As a result of this policy, 7.9 percent of children in Clark County, WA were unvaccinated. NCL applauds Washington state Representative Paul Harris (R-Vancouver), who has introduced legislation that would ban personal or philosophical exemptions from the measles vaccine. To see where your state stands on non-medical vaccine exemptions, please click here.

NCL’s stance on vaccines

NCL admires the work of health advocates like Dr. Richard Pan and countless others who understand the vital role that vaccines play in protecting our communities. Vaccines are among the safest and most effective public health measures we have. NCL calls on all states to strike non-medical vaccine exemptions. Because of vaccines, we have the luxury of not worrying that our children or our families will contract these once devastating diseases. The measles outbreak is a wake-up call. Our message to parents and adults alike: get vaccinated!

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About the National Consumers League

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

Why nutrition labeling on alcoholic beverages can reduce binge drinking – National Consumers League

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Shaunice Wall is NCL’s Linda Golodner Food Safety and Nutrition Fellow

Alcohol – like everything else we eat and drink – is best enjoyed in moderation. If consumed to excess, drinking alcoholic beverages can lead to addiction and increased risk of certain chronic diseases, but also weight gain, because these drinks are often dense in calories and devoid of nutrients.

One of the problems consumers face, however, is that there is virtually no information on the nutritional content in the alcoholic beverages they consume. NCL has been working to change this for more than 30 years, but progress on this front has been very disappointing. Does lack of a label cause binge drinking? Of course not, but evidence indicates that caloric and nutritional labeling encourages healthier choices when consumers read and understand the labels.  

What is binge drinking anyway? 
The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 grams percent or above. For men, it means consuming 5 or more drinks – and for women – it’s consuming 4 or more drinks in about 2 hours. 

A “drink” defined 
A “drink” refers to half an ounce of alcohol (e.g., a 12oz. beer, a 5oz. glass of wine, or a 1.5oz. shot of distilled spirits). 

The impact of alcohol consumption and binge drinking 

In 2015, the National Survey on Drug Use and Health reported that 86.4 percent of people in the United States aged 18 or older drank alcohol at some point in their lifetime. 

According to the U.S. Centers for Disease Control, binge drinking is the most common, costly, and deadly pattern of excessive alcohol use in the United States. More than one in six U.S. adults, or 38 million people, are binge drinkers, and they binge an average of four times a month.

In 2010, alcohol consumption cost America an estimated $249 billion in workplace productivity losses, health care expenditures, criminal justice costs, and other expenses — binge drinking was responsible for 77 percent of these costs, or $191 billion.  

Some nutritional consequences of binge drinking 
In 2018, a study funded by the National Institutes of Health found that young adults who frequently binge drink were more likely to have cardiovascular risk factors, including higher blood pressure, cholesterol, and blood sugar at a younger age than non-bingers. In addition to malabsorption of several nutrients in the gut, binge drinkers are at risk of malnutrition because alcohol contains calories that may substitute for those in more nutritious foods. Another more common consequence of binge drinking is weight gain, which in turn contributes to the nation’s obesity epidemic.   

The link between alcohol and obesity 

Researchers suggest a positive correlation between calories derived from alcohol and obesity. Alcohol also has an effect on hunger levels and food preferences.  

Alcohol cannot be stored in the body, however, its conversion to acetate in the liver and subsequent release into the bloodstream inhibits the amount of fat the body burns.  

The problem with binge drinking and misleading nutrition labels 

A pint of beer may contain as much as 200 calories – the same as a doughnut. Yet, in the United Kingdom, one study found that 85 percent of the population is unaware of or underestimates calories from alcohol. This problem is universal, and–in the United States–this is due in part to misleading nutrition labeling proposals by the U.S. Treasury Department’s Tax and Trade Bureau (TTB), which regulates and collects taxes on trade and imports of alcohol. 

Labeling of alcohol can reduce binge drinking 

As noted above, one strategy to increase awareness and reduce the risk of excessive alcohol use is to label alcoholic beverages with serving facts. Listing the ingredients alerts consumers to the presence of any potentially harmful or problematic substances while providing nutritional information–such as energy content–allows consumers to monitor their diets and makes it easier to maintain a healthy lifestyle.  

The impact that such a move could have was illustrated by a small experiment conducted in a UK pub, in which customers presented with caloric information consumed on average 400 fewer calories than those who had access to no such information.  

Obstacles for nutrition labeling of alcohol in the United States 

Labeling requirements for alcoholic beverages are woefully inadequate. The proposals offered by TTB are too little, and they don’t support public health.  

In 2003, a petition by several special interest groups (including NCL) to TTB, claimed that there were substantial disparities in the labeling requirements applicable to different kinds of alcoholic beverages. Wine and distilled spirits labels are required to reveal the beverages’ alcohol concentration – expressed as a percentage of alcohol by volume (additional proof-level statements are optional) – but labeling alcohol content on beer and other malt beverages is entirely optional. Only those alcoholic beverages that make nutritional claims, such as “light” or “lite” beers must disclose calorie content and certain nutrition information. 

There has been no rationale published by TTB for these differences.  

The National Consumers League’s petition  
NCL, the Center for Science in the Public Interest (CSPI), and 67 other organizations continue to advocate for mandatory content and nutritional labeling on all alcoholic beverages. While it may not eradicate binge drinking, consumers who want to consume alcohol in moderation deserve to know what’s in that drink. A label like the Nutrition and Supplement Facts on alcoholic beverages is long overdue.

NCL statement on drug importation legislation – National Consumers League

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January 14, 2019

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242 or Taun Sterling, tauns@nclnet.org, (202) 207-2832

Washington, DC—As the nation’s pioneer consumer organization, the National Consumers League (NCL) strongly supports consumer access to safe, effective, and affordable prescription drugs. 

However, NCL is concerned that new legislation, the Affordable and Safe Prescription Drug Importation Act (S.97/H.R. 447) and the Safe and Affordable Drugs from Canada Act of 2019 (S. 61), which would allow medicines to be imported into the United States from foreign countries, would open the U.S. market to a flood of counterfeit and/or substandard drugs, putting patient health and safety at risk.

Counterfeit medications made with deadly ingredients have been found in over 40 states across America, posing a significant public health threat. There is no way to ensure that drugs purporting to come from Canada actually come from Canada. A Food and Drug Administration (FDA) evaluation of non-FDA-approved imported drugs revealed that “while nearly half of imported drugs claimed to be Canadian or from Canadian pharmacies, 85% of such drugs were actually from different countries.” Allowing importation will only serve to exacerbate the challenge of preventing counterfeit drugs from reaching American patients.

Every head of Health and Human Services and the FDA for the last 18 years has refused to certify the safety of drug importation. FDA Commissioner Gottlieb recently stated that 86 percent of the packages FDA inspectors seized in 2017 contained counterfeit or sub-standard drugs. NCL fears that authorizing importation would expose consumers to unknown risks and undermine the security of the U.S. pharmaceutical supply chain.

Rather than considering misguided importation proposals, NCL encourages Congress to strengthen our drug supply chain and pursue other strategies to ensure the affordability and accessibility of safe and effective prescription drugs.

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About the National Consumers League

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

Make a New Year’s resolution to get vaccinated against shingles

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Nissa Shaffi

Shingles (herpes zoster) is caused by the varicella zoster virus (VZV), the same virus that causes chickenpox. Once a person recovers from chickenpox, the virus lays dormant in the body’s nerve cells, while the host remains asymptomatic. While scientists are not sure what causes the virus to reactivate in the form of shingles, it can present in individuals who are elderly or those who have compromised immune systems in general, due to medication or health conditions.

Shingles is a painful rash that usually develops on one side of the body, often the face or torso. The rash consists of blisters that typically scab over in seven to 10 days and clears up within two to four weeks. Even long after the rash has healed, shingles can lead to long-term complications in the form of postherpetic neuralgia (PHN)—severe nerve pain— at the site of the rash.  Although shingles is not contagious, VZV can spread from a person with active shingles to cause chickenpox in someone who has either never had chickenpox or has never received the chickenpox vaccine. The virus spreads through direct contact with the blisters, and a person is not infectious before the blister phase.

The only way to lower the risk of developing shingles is to get vaccinated. The Centers for Disease Control and Prevention (CDC) recommends that healthy adults 50 years and older get two doses of the new shingles vaccine called Shingrix to protect against the disease. The new vaccine is administered in a two-dose series, and the second dose is administered two to six months following the first dose. According to the CDC, it is imperative that patients complete the vaccine series as it provides greater protection than its predecessor Zostavax, which is a single-shot vaccine.

According to reports, a surge in demand for the shingles vaccine following the recommendations has led to a national shortage, leaving consumers searching far and wide for available doses. While news of the vaccine shortage is certainly unfortunate, the silver lining in this situation is that patients are taking proactive measures to protect themselves from illness.

NCL strongly advocates for the use of vaccines as a safe and effective preventive public health measure to protect against debilitating illnesses. A survey conducted by NCL in 2014 revealed that due to prevalent anti-vaccine rhetoric, nearly 33 percent of American consumers are misinformed about the benefit of vaccines. Vaccines are essential to public health as they protect vulnerable populations with diverse health needs. Adults and children who are not able to receive vaccines due to certain conditions rely on the general population for protection against disease, also known as herd immunity.

Consumers should feel at ease knowing that while shingles is a serious condition, your odds of developing the disease before the shortage ends are low. The CDC recommends that consumers call their local pharmacies or use Vaccine Finder to find their nearest available dose. If Shingrix is unavailable in your area, the CDC recommends that consumers 60 and older get the Zostavax vaccine.

If you have gone more than six months since your initial dose, the CDC states that you do not have to start the vaccine course over, but should instead promptly get the second dose to ensure maximum immunity. If you have already received your first dose of the vaccine, you can sign up for text, voice, or email reminders for your second dose. For more information on the causes and risk factors associated with shingles, please click here.

Texas v. United States – How consumers can protect themselves amid threats to the Affordable Care Act

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Nissa ShaffiLast week a federal judge in Texas, Justice Reed O’Connor, ruled that the Affordable Care Act (ACA) is unconstitutional. The case against the ACA is being led by Texas Attorney General Ken Paxton on behalf of a group of 18 Republican state attorneys general, two governors, and two individual plaintiffs.

The lawsuit argues that because the individual mandate penalty has been repealed (effective 2019), it would render the entire ACA invalid, as the entirety of the law relies on the mandate. The lawsuit makes the claim that the absence of an individual mandate penalty would mean that the entire ACA would be unconstitutional.

While this news is disheartening, it is important for consumers to know that the ACA is still the law of the land. The ruling is currently at the federal district court level and is going to be appealed, led by California Attorney General Xavier Becerra, representing a group of 17 attorneys general in other states. Attorney General Becerra described the ruling as an “assault on 133 million Americans with preexisting conditions and the 20 million Americans who rely on the ACA’s consumer protections for healthcare.”

Although the federal deadline for open enrollment has passed, there are some states that have their own individual exchanges, with extended open enrollment deadlines:

NCL encourages residents of these states who are not enrolled in a marketplace plan to take advantage of these extended deadlines. You can also see if you qualify for a Special Enrollment Period, which allows individuals to sign up for health insurance outside of the Open Enrollment Period if they have had changes in certain life events. If you qualify for Medicaid or the Children’s Health Insurance Program (CHIP), you can apply at any time.

So take heart consumers. NCL believes strongly that this ruling–which comes from a right-wing Texas judge–is overbroad and will be reversed on appeal.

The need for increased funding for Alzheimer’s research

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Nissa ShaffiOn November 28, in collaboration with Biogen and Eisai, The Hill hosted Preparing for a Treatment – Alzheimer’s Diagnosis and Care, which featured Senator Ed Markey (D-MA) and Senator Thom Tillis (R-NC), along with experts throughout the memory care and Alzheimer’s space. Senators Markey and Tillis discussed the vital need and urgency in funding for Alzheimer’s research and the need for a bipartisan effort towards a cure.

Senator Markey stated that more than five million Americans currently live with Alzheimer’s, and by 2050 that figure could triple to 16 million. Alzheimer’s remains one of the most underfunded and underdiagnosed chronic illnesses, despite having devastating effects equivalent to that of cancer or diabetes. Senator Markey reminisced on the Apollo moon landing in the ‘60s, recalling that the journey to the moon was an impressive feat for our nation and that we must now venture into the journey of the mind, a similarly vastly unexplored area.   

Senator Tillis emphasized the importance of continued development of new treatments for Alzheimer’s. He warned against disengaging in collaborative efforts with pharmaceutical companies on account of a few bad actors, as diminished engagement with pharmaceutical and biotech companies could have devastating effects on risk–taking and innovation.  

Experts from the panel agreed with the Senators that there is a great need for increased research in the biotechnology, pharmaceutical, and primary care spaces. The panelists stated that Alzheimer’s is currently the only disease that has no cure, methods of prevention, or strategies to slow down progression. However, there have been significant advancements made in the detection of Alzheimer’s in the form of amyloid positron emission tomography (PET) scans.  

Amyloid PET scans allow physicians to detect the development of amyloid plaques, which are clumps of insoluble plaques in the brain that destroy connections between nerve cells. These images can afford physicians the ability to detect Alzheimer’s in patients 10-15 years before a diagnosis, potentially transforming primary care delivery and forging a path towards prevention.   

The panelists also discussed the Bold Infrastructure for Alzheimer’s Act (S.2076), which would expand the public health infrastructure to support patients, caregivers, and communities in the Alzheimer’s space. Additionally, the bill would require greater reporting and analysis of state and national data on cognitive decline, caregiving, and health disparities. Introduced by Senators Susan Collins (R-ME), Shelley Moore Capito (R-WV), and Catherine Cortez Masto (R-NV), S. 2076 now enjoys 57 bipartisan co–sponsors, including Senators Markey and Tillis.     

The National Consumers League supports efforts such as S. 2076 that would make strides in addressing Alzheimer’s disease. NCL is also proud to be a partner in WomenAgainstAlzheimer’s We Won’t Wait Campaign, which seeks to unite women in a widespread effort to define Alzheimer’s as the 21st Century’s primary economic justice issue and health crisis for women. The Campaign promotes advocacy, education, and action on five key pillars: public funding, sex-based research, economic justice, diagnosis and treatment, and brain health. 

Gray market erectile disfunction medications pose risk to consumers

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Did you know the vast majority of online pharmacies are illegitimate? A review by the National Association of Boards of Pharmacy (NABP) found that only 2.4 percent of online pharmacies comply with U.S. pharmacy laws and practice standards. This alarming statistic sheds light on the growing threat of illegal, online pharmacies – a component of the gray market – to consumer health. While many online pharmacies may present themselves as a legal, safe, and/or cheaper option, purchasing medicines from these websites could come at the cost of safety and security if consumers do not take the appropriate precautions. 

Medications for erectile dysfunction (ED) – which affects 24 percent of men in the United States over the age of 18 – are among the most commonly sold medications on the gray market. Due to a number of factors including the stigma some consumers experience around sexual health conditions and treatments, many patients suffering from ED don’t talk to their doctors or have prescriptions filled. This creates an environment where consumers may instead seek out unsafe, illegitimate online pharmacies to get these prescription medicines.

In accordance with our mission to ensure all Americans have access to safe, effective medicines, the National Consumers League (NCL) partnered with Bayer to develop a white paper, Increased Consumer Risk from Erectile Dysfunction Medication Advertised and Sold on the Gray Market, to analyze the possible dangers consumers face by purchasing ED medications from illegal online pharmacies. NCL presented the paper’s findings in November at the Alliance for Safe Online Pharmacies (ASOP) Global Foundation’s Spotlight on Illegal Online Drug Sales Research Symposium in Washington, DC.

Based on the research, the white paper recommends five concrete policies to improve consumer safety, including:

  • Enhancing consumer awareness about the gray market and promoting health literacy;  
  • Encouraging healthcare providers to talk about the risks of illegal online pharmacies with their patients;  
  • Supporting collaborative law enforcement actions to combat illegal sales on the gray market; 
  • Increasing access to ED medicines by making them available over-the-counter, with robust consumer education and information programs; and
  • Adding to the body of evidence on the dangers of the gray market.     

To learn more about the research and the dangers of the gray market, read the full white paper here.

Seven groups join chorus of elected officials, organizations in challenge of U.S. State Departments decision regarding ubiquitous health termsSeven groups join chorus of elected officials, organizations in challenge of U.S. State Departments decision rega

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November 15, 2018

The Honorable Michael R. Pompeo
Secretary of State U.S. Department of State

Dear Mr. Secretary,

The undersigned groups are deeply concerned by reports from several sources that the U.S. Department of State is considering a proposal to prohibit U.S. diplomats around the world from using the terms “sexual and reproductive health” and “comprehensive sexuality education.” This proposal is counterproductive, banning widely accepted language that has been in use for decades. We strongly oppose any such change.

The term “sexual and reproductive health” encompasses a broad array of issues affecting both women and men, including pregnancy, prepartum and postpartum care, maternal and perinatal health, perimenopause and menopause issues, puberty issues, pap smears and cervical cancer testing, contraception, abortion, Ebola, Zika, stillbirths, female genital mutilation, infertility, adolescents and sex education, testing and treatment of sexually transmitted diseases including GC and Chlamydia (both on the rise according to the Centers for Disease Control) and HIV prevention, testing and treatment, posttraumatic stress syndrome, depression related to hormone changes, and importantly, violence against women.

The United States has tremendous influence around the world in promoting better health outcomes for all of the world’s citizens. Efforts to change or control the language and restrict the use of certain words that U.S. diplomats are permitted to use is unwise as we believe that by prohibiting the terms “sexual and reproductive health” and “comprehensive sexuality education” will undo decades of global progress for women’s access to healthcare and basic human rights.

We are committed to lifting the stigma related to sexual reproductive health communications, especially between women and their healthcare providers. Sexual health issues are very common for both sexes, with about 7 in 10 women having experienced a sexual health issue and 15-20% of men having described some kind of sexual problem when meeting with their healthcare provider.

Reproductive health is specific to reproductive processes, functions, and the reproductive system across all stages of life. Sexual and reproductive health issues are frequently preventable or treatable, yet a multitude of barriers often stand in the way of women and men discussing their concerns with a healthcare provider, leaving them to suffer in silence. Among those barriers is the culture of embarrassment or stigma that already exists in discussions about sexual and reproductive health.

Breaking down barriers that hinder or prevent conversations about sexual and reproductive health requires support and education at many levels. We believe the U.S. Department of State’s proposal to prohibit the terms “sexual and reproductive health” and “comprehensive sexuality education” will only hurt, not help, the progress that has been made and hinder ongoing efforts to further break down barriers.

For these reasons, we urge the Administration to abandon the proposal to prohibit the use of “sexual and reproductive health” and “comprehensive sexuality education.”

Thank you for your attention to our concerns about the damage this proposed prohibition of terms will have. The United States should be a leader in promoting sexual and reproductive health for men and women.

Sincerely,

Sheryl A. Kingsberg, PhD
Immediate Past President
The North American Menopause Society

Ms. Sally Greenberg
National Consumers League
Healthy Women International

Other Groups Endorsing this Request

American Medical Women’s Association
American Sexual Health Association
Healthy Women International
Society for the Study of Women’s Sexual Health
National Association of Nurse Practitioners in Women’s Health

What California is doing to lower maternal mortality

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Nissa ShaffiThe United States currently has the worst maternal mortality rate in the developed world, at 26.4 deaths per 100,000 live births, compared to 9.2 in the United Kingdom, 8 in France, and 5.5 in Australia. To put this in perspective, the United States currently has a higher maternal mortality rate than Saudi Arabia and Libya and is barely better than Mexico, Iran, and Russia. An even more devastating reality is the maternal mortality rate among black women, who are 243 percent more likely to die from pregnancy- or childbirth-related causes than women of any other race in America.

There is some good news amid these grim numbers. The state of California has successfully worked in collaboration with public and private healthcare stakeholders to decrease the maternal mortality rate to seven deaths per 100,000 live births.

In 2006, the California Department of Public Health (CDPH) and the California Maternal Quality Care Collaborative (CMQCC) worked together to assemble a multidisciplinary committee of clinical experts to investigate this epidemic. This committee’s focus was to determine the causes of maternal deaths and the demographics of women most affected, along with identifying opportunities to turn the numbers around.

Within the first two years of its launch, the committee was able to identify placenta accreta and preeclampsia (pregnancy-induced high blood pressure) as the two most preventable causes of maternal mortality.  Placenta accreta is a condition in which the placenta affixes to the uterine wall and fails to separate postpartum, which results in severe obstetric hemorrhaging. Upon discovering a correlation between the rise in cesarean sections (C-sections) and placenta accreta cases, the CMQCC sought to reduce the number of C-sections that were medically unnecessary.

Additionally, the CMQCC revamped California’s hemorrhage guidelines to help make childbirth safer for mothers in the state. As a result, California has created a state model that has resulted in a dramatic decrease in maternal mortality, while the rest of the country continues to experience an increase in rates.

California has set an example for the rest of the country. Other states would do well to take a page from its example and turn around this alarming trend of increased maternal fatalities. In addition, a bill currently being voted on in Congress, the Maternal Health Accountability Act (S.1112), would be a federal remedy to help address this issue. The bill would require states to monitor and assess pregnancy-associated deaths and develop appropriate measures to improve the quality of maternal care. We should all ask our members of Congress to help pass the Maternal Health Accountability Act (S.1112), a bipartisan bill that could potentially save countless lives and reverse the damaging trend of maternal mortality in the United States.

Healthcare Open Enrollment starts today

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Nissa ShaffiOpen Enrollment is back! From November 1, 2018 to December 15, 2018, consumers will be able to shop for insurance coverage options through the individual health insurance marketplace. Even if you are currently insured, you can still take advantage of the Open Enrollment period to compare plan options and select a plan that better suits your budget and needs.

The Centers for Medicare & Medicaid Services (CMS) recently announced that marketplace premiums have dropped by 1.5 percent nationally. With regard to pre-existing conditions, all marketplace plans sold through HealthCare.Gov are required to provide comprehensive coverage to consumers and cannot discriminate against enrollees on the basis of health status. In addition, when you apply for insurance via the marketplace, you will be able to determine if you qualify for a premium tax credit. To find out if your monthly income range qualifies for a premium tax credit, please click here.

The National Consumers League encourages consumers to seek coverage via the Affordable Care Act (ACA) compliant plans offered on the marketplace. These plans are required to cover the essential health benefits mandated by the ACA, ensuring that you have access to comprehensive care.

If you need assistance navigating the marketplace, you can find a healthcare navigator in your area to help in comparing coverage options that meet your needs. To find a navigator in your area, please click here. Most importantly, in order to have coverage that is effective by January 1, 2019, you must sign up by December 15, 2018.