Reactions to "Repeal and Replace" of the ACA for You, Your Family, or Friends!

As policymakers battle for the fate of the Affordable Care Act on Capitol Hill, individuals, families, and children find themselves caught in the crossfire. The Affordable Care Act has given over 20 million people access to health care coverage. Now high-risk pools and exclusion of coverage based on preexisting conditions may return.

Has the ACA changed the life of you, your family, or friends? Do you have a story to tell? Let your voice be heard!

Name

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* 1. Name

Date

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* 2. Date

Phone Number

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* 3. Phone Number

Email

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* 4. Email

What city do you live in Wisconsin?

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* 5. What city do you live in Wisconsin?

Did the Affordable Care Act help you or a loved one secure health coverage?

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* 6. Did the Affordable Care Act help you or a loved one secure health coverage?

What do you want others to know?

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* 7. What do you want others to know?

ABC for Health and/or its HealthWatch Wisconsin project can use my recordings and/or statements for the following purposes: publicity, media outreach, educational uses and purposes, contact with elected officials, and posting online or in other electronic formats, including use through any webcasting media to HealthWatch Wisconsin.

By clicking "Yes" below, I acknowledge the receipt of this document and give permission to ABC for Health and HealthWatch Wisconsin to reproduce my story for educational and publicity purposes in perpetuity without further consideration from me.

I understand my story may be made available on the Internet and will be accessible to anyone with an internet connection. I will need to notify ABC for Health if any changes to my situation occur that will impact this permission, or if I would like to retract my testimonial, to the degree that it can be retracted, once it is online.
I give permission for You to Share My Story.

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* 8. I give permission for You to Share My Story.

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