What if we lose coverage? Share your story!
Did you recently get health insurance? Has having health insurance helped you? How would losing insurance coverage impact your life?

Our new president-elect has said he will repeal the Affordable Care Act (Obamacare), which will significantly impact the way people get health care – we at Raising Women's Voices want Washington to understand why health coverage is important to so many people in the US.

We are collecting stories to help protect health coverage. We will share your stories on social media to advocate for the health care we need. Please fill out the form below to make sure your voice is heard!

For questions, comments, or concerns, please contact Cindi Azuogu - cindi@mergerwatch.org. To find more about what we do, go to http://www.raisingwomensvoices.net

We want to hear from YOU!

1. Do you have health insurance? *
2. What kind of insurance do you have?
Select all that apply
3. If the Affordable Care Act is repealed, how will it affect you? *
Select all that apply
4. Please tell us more about the way you might be affected.
Your answer
5. Have you had any other experiences with health insurance that you'd like to share?
Your answer
6. How old are you? *
Please select the category that contains your age
7. Can we follow up with you about your story? *
Your contact information will be kept confidential.
8. What is your name? *
First and last name preferred, please.
Your answer
9. Where do you live? *
City and state, please.
Your answer
10. What is your email address? *
Your answer
11. What is your phone number? (optional)
Your answer
12. Can we publish your story online? *
Stories that use a real name are more likely to convince lawmakers and help our cause.
13. How did you hear about RWV’s If I Lose Coverage story collection campaign? *
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