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Podcasts

- A Crow Story – Episode 053
  January 25, 2020Podcasts / Words of JenIn this episode, I share a short story that was based on actual events. Part of it was originally posted on Mastodon, and the rest was added after I started writing. I read “A Crow Story” on episode 053 of Words of Jen. If you enjoyed this episode please consider supporting me on PayPal.me. Thank you! http://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/woj053.mp3Podcast: Play in new window | DownloadSubscribe: Android | RSS...
- A Crow Story
  January 25, 2020Podcasts / Words of JenI started writing this story about crows on Mastodon. It is based on real life experiences that felt magical. The crows started visiting me in mid-September. Two crows came right up to my home to “bark” at me. Never seen anything like it before. I was at my computer, working on a piece of writing. The wall behind me has no window, and the window next to me is covered by blackout curtains. The two crows parked themselves at the corner of our mobile home and “barked” as loudly as they could. It sounded like they were pointing their voices at me, despite not having any way to actually see where I was. When I went to the window, the two crows moved from the corner of the mobile home and bounced into our driveway. It had been a long time since I’d been well enough to drive, yet another thing my chronic illness stole from me. We donated the car a while back, and the driveway had been empty ever since. One crow wandered off, but the other one stayed. Moved around in the alleyway, and kept coming back. Eventually, flew away, landed on a wire, and “barked” at me again. Was I supposed to follow them? I didn’t see any quest text… The whole thing seemed really strange, so I posted a little bit about it on social media. Surely, someone out there would tell me that this had happened to them, too… right? A friend asked, “Do you have ‘View low level quests’ enabled? You may have out-leveled the area already.” “That must be the problem!” I responded. I searched around, and finally found the button to view low level quests. Click! “I’ll be ready when the crows come back!” A stranger suggested that I should start feeding the crows. I’m in California, and I think we are not supposed to feed the wildlife. I’m also in a mobile home park where I don’t think feeding crows would go over very well. I feel like these two crows were either trying to warn me about something (no idea what) or have claimed me as one of their flock. I dunno. After thinking things over, I put a few handfuls of some really stale Cheerios outside on my driveway for the crows. I wonder if they will come back? The very next day, the crows came back. They ate some of the stale Cheerios I put in the driveway. When they were done, the “barky” crow cawed a “Thank You”. The two of them wandered around the alleyway for a bit, and then left. They seemed happy. Apparently, stale Cheerios are an acceptable tribute. What have I gotten involved in? Later that day, one of the crows returned. I could hear the crow making loud, but friendlier sounding, caw sounds. When I went to the window, I could not find the crow. It had to be nearby… but where? On instinct, I glanced up. There sat the crow, on my neighbor’s roof, “smiling” at me. My husband and I had a small flock of cockatiels. There were never more than six of them at any one time. Over the years, I learned to “speak bird”, for lack of a better way to say it. A bird that looks at you with one shining eye, while sitting all fluffy and relaxed – is smiling! I smiled back at the crow, who seemed very pleased with me. All the houses in the mobile home park are close together. I could see that this crow had one white feather near their shoulder. That made it really easy for me to spot this specific crow when they visited. Having done what they came to do, the crow with the white feather flew away. There was a large area of extremely tall trees across the road and beyond the car wash. For years, I’ve been unintentionally summoning spiders. I seem to have leveled up to crows. Or, one crow, anyway. About three days later, one of our cockatiels died. She was healthy, and eating, and interacting with our other birds. The change from healthy, to very clearly not, was shocking. She was right around the maximum age for a cockatiel lifespan, and sometimes birds just… stop. My husband and I took turns holding her as she slept on our chests, beneath our hands, warm and safe, and getting her head petted. And then, she was gone. In my grief, I remembered hearing some old story about crows acting as a portent of death. Were the crows trying to warn me about this? When I fed them, it was because the weather was starting to get cold, and I thought they were hungry. Now, I worried that by giving them something they considered valuable, I had unwittingly made some sort of bargain. What have I done? Time passed by, and my husband and I started feeding the crows. Not every day. We didn’t want them to become dependent upon us. Wild creatures need to be able to fend for themselves. I considered what we were giving them as “treats”. The two crows returned shortly after my husband put out the last of the stale Cheerios. They came right into the driveway and started loudly cawing. When I looked out the window, I saw one crow picking up Cheerios from the driveway, with the other one standing by and watching over the first. The second crow turned, looked right at me, and cawed again. It was as though they wanted me to know that they, and their companion crow, were enjoying the Cheerios. Crows are not picky eaters. There were times when they landed in the alleyway and strolled right over to another neighbor’s bird feeders. Often, I would look out the window and find some crows sitting on the wire, facing toward my home. Or, they would be on top of the telephone poles, scanning the horizon. Once, we gave the crows popcorn that I failed to finish eating the night before. The wind blew it all across the alleyway. Soon, there were several crows landing, and running after the popcorn. There was a small flock of maybe six or seven crows, who seemed to think chasing windblown popcorn was a wonderfully entertaining game! My husband threw a small handful of almonds into the driveway, on more than one occasion. We learned that crows love almonds! They clearly didn’t want to share the almonds with any other crows. A strange thing started happening. Two crows, the one with the white feather and their companion, started sitting on the stone fence at the front of the mobile home park. They stayed there for what seemed like a long time. I’d never seen crows do that before, especially in an area where lots of people come and go. I have chronic illnesses, and often am too sick to leave the house. My husband and I went outside one day, just for a short time, to play an app game that requires walking. We slowly walked up to the crows who were on the stone fence. They watched us pass by, very close to them, and did not move or fly away. On the way back, we could see the two crows were still there. I was having a hard time walking, and breathing, that day. Did the crows notice that I am sick? Is that even possible? There was a day when my husband I and walked to the nearest bus stop so I could go to a doctor’s appointment. One crow, up on a telephone pole, started cawing to the other crows in the area. Then, it started flying and following me to the bus stop. A second crow arrived, and they both sat on the wire directly above me. One of them had a white feather. These were my crows! Or, I was their person. They were watching over me. I remembered, many years ago, when I was in college, and had gotten lost on campus. I could not remember how to get to the building that my class was in. Panicking, I took a moment to close my eyes, to still my breath, and to focus. When I opened my eyes, a big, black, crow was staring down at me from the roof of one of the buildings. It flew down and found a closer perch. I remember looking into the crow’s eyes, and thinking, “I am lost.” The crow … did they just nod their head at me? I must have seen that wrong. The crow made one quick caw, and started flying, circling back to make sure I was following them. So, I followed. From the air, the crow led me down paths that I hadn’t walked before. Suddenly, the crow stopped flying. They perched themselves on a rooftop, right over the doorway of a building… that turned out to be the one my class was in. “Thank you,” I thought at the crow, as I passed beneath them and opened the heavy door to the old building my art class was in. No one asked why I was late. That crow couldn’t possibly be one of my crows. We met decades ago, and half a country away from where I was now standing. This pair of crows was new to me. There was a day when I discovered that I was allergic to the blackberries that I had been eating. We decided to give what was left to the crows. My husband scattered the blackberries outside, and I went to take some allergy medication. The pair of crows arrived. They looked extremely pleased with the food we offered them. Both crows were “smiling” at us, as they leisurely walked around, pickup up blackberries. We didn’t see the crows much after that. I thought that maybe the reason was that the weather had started getting a bit colder, and more windy. Once in a while, one of the crows would come sit somewhere outside and “bark”, and wait for me to find them. Later, my husband and I noticed that we were hearing what sounded like a crow that was screaming at the top of its lungs. This happened multiple times a day, for many days. We assumed that this was just an especially angry crow. I wondered why the crows were staying away. They seemed very pleased by the blackberries, and didn’t seem to need any more food from us right now. Maybe this behavior was seasonal. One day, I woke up to the sound of a screaming crow. It was loud enough to wake me up from a deep sleep – and I am a very sound sleeper. Not quite awake, I stumbled out of bed and found my husband standing in front of the open door of our home. Outside, there were some crows, standing at the corner of our mobile home, like they did the first time we met. Two were doing insistent “barking” noises. The other one just kept screaming. Upon spotting me, the two larger crows hopped over to the edge of our stairs. They looked up, giving us “smiling” eyes again. One of them had a white feather. The other crow gently nudged the screaming one, who got a bit quieter for a minute. They looked at me expectantly, patiently waiting for me to understand. Oh! Suddenly, I knew. The screaming crow was their baby, who was now just old enough to fly over here for a visit. They were introducing their offspring to my husband and I, their people. It was a beautiful moment that didn’t last long. Baby crow was making signs that indicated it wanted to be fed. Parent crows walked with the baby crow down the alleyway, and out of the mobile home park. The took flight from the sidewalk and returned to the grove of very tall trees. One day, a while later, I saw two crows chasing a hawk out of the mobile home park. They tag-teamed the hawk, tiring it out. The hawk eventually sat on the top of a telephone pole. The two crows took turns poking at the hawk until it decided to fly away. After removing the hawk, the two crows flew to back to the wires, perched, and looked over at me as I stood next to the window. I hadn’t been able to go outside for a long, long time. My crows were still watching over me. A Crow Story is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on PayPal.me. Thank you!...

Diablo III

- Season 19: Softcore Greater Rifts
  March 1, 2020Diablo III / Diablo VideosWith Season 19 coming to an end, I realized that I won’t have time to get my Hardcore Barbarian through much more of the Season Journey. My Softcore Barbarian seemed like a better choice, but I still didn’t have enough time to complete the entire Season Journey. I blame this on my allergies, which have been terrible since the end of January when Spring pollen season started. In this video, My Softcore Barbarian ran through a couple of Greater Rifts. She got a few Legendary Gems, which I started leveling up. My intention was to get back into the game and make at least one more video before Season 19 ended, but this turned out to be the last one. More to come when Season 20 starts! Season 19: Softcore Greater Rifts is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on PayPal.me. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/Season_19_Softcore_Greater_Rift_5.mp4Podcast: Play in new window | DownloadSubscribe: Android | RSS...
- Season 19: The Darkening of Tristram Through Level 8
  February 14, 2020Diablo III / Diablo VideosIn this video, my Hardcore Barbarian continued through a few more levels of The Labyrinth. This content is part of The Darkening of Tristram event, which is only available in January. My Barbarian started out at Level 57. My goal was to get him to Level 60. This video starts where the previous one left off – right in front of the entry to Labyrinth Level 7. I quickly learned that Ares the Hardcore Barbarian was not properly geared up for this, and probably should have hit at least Level 60 before attempting it. Some near death experiences were had. In this video, my Barbarian goes through The Halls of the Blind. It is my favorite part of The Darkening of Tristram event (and the original Diablo game). It starts with a creepy poem. By the end of this video, Ares the Barbarian was Level 58. Season 19: The Darkening of Tristram Through Level 8 is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on PayPal.me. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/Season_19_Darkening_of_Tristram_Level_8.mp4Podcast: Play in new window | DownloadSubscribe: Android | RSS...

Book Reviews

- Drinking Closer to Home – by Jessica Anya Blau
  November 22, 2019Book Reviews / fictionAnna, Portia, and Emery – three siblings who are now adults, have returned to their parent’s home. Their mother, Louise, is in the hospital after suffering what has been described as a “massive” heart attack. The siblings are there to be able to visit their mother at the hospital, and also to provide emotional support for their father. Drinking Closer to Home is about a quirky family, each with their own unique problems. It is about living through situations that I would consider to be neglect, and somehow, being able to come together as a family during difficult times. The title of the book comes from a family story that involved the sibling’s mother when she was a tiny baby. It is the punchline of what, to me, is obviously an instance of severe neglect. I think this small part of the book is what makes the rest of it comprehensible. The members of this family have learned to find humor in situations that were neglectful, dangerous, and emotionally scarring. It is their way of coping. For example, the year that Anna was eleven, Portia was eight, and Emery was three, Louise told the girls that she had decided to quit being a housewife. Anna would be in charge of cooking, and Portia would be in charge of taking care of Emery. No one cleaned the house, and the backyard (including the pool) fell into disrepair. This was not a temporary situation! The book jumps around between the present – with chapters titled “Day 2” that mark time passing while Louise is in the hospital, and the past, with years as chapter titles. My impression is the the majority of the book comes from the viewpoint of one of the siblings. Portia is very pregnant with her second child, and has just gone through a divorce. She is co-parenting her first child with her ex-husband, and missing her daughter. And now, she is also very worried about her mother. Anna is an addict, who has gotten things mostly under control. (She has started eating too much red vines candy while visiting with her mother at the hospital). There is a lot of trauma in her past, in part, due to her own unfortunate choices. Anna is married, but isn’t necessarily monogamous. Emery brought his boyfriend, Alejandro, with him to his parents house. The two are an established couple, and they want to have children. This puts Emery into an uncomfortable position. How does one ask their sisters for their eggs at a time when their mother might be dying? Then, there’s Louise, who has been smoking for decades. The doctors want her to quit, but she’s not interested. Of course, she can’t smoke while she’s at the hospital, especially while recovering from a heart attack and very weak. Louise has her own issues with her parents, and also with her husband, Buzzy’s, parents. Buzzy has his own secrets to deal with. One reason I like this book so much is because the characters are vibrant and resilient. They find a way to keep going, despite using less than advantageous coping mechanisms. Overall, family honestly is very important to all of them. They manage to come together when times are tough. Another reason is because some of it reminds me of my own dysfunctional family. My mother never officially declared she decided not to be a housewife anymore – but that’s what her actions amounted to. Some of my family members were/are hoarders, and the house was never clean. In my case, my family is very toxic, and I needed to separate myself from them. So, I guess what I’m trying to say is that Drinking Closer to Home provides me with an satisfying story that allows me to imagine what it would be like if my family was able to overcome their issues and become functional. Drinking Closer to Home – by Jessica Anya Blau is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on PayPal.me. Thank you!...
- Stories for Nighttime and Some for the Day – By Ben Loory
  October 25, 2019Book Reviews / fictionStories for Nighttime And Some for The Day is, as you may have guessed, a book of short stories. One of them could probably fit into a single Tweet! Each short story feels like a parable or a fable. I got the feeling that there was a lesson in each one, if only I could puzzle out what it was trying to tell me. This imaginative collection of stories refuses to hand the reader an obvious answer about what it all means. One of my favorite short stories in the book is called “The Octopus”. It is about an octopus who lives in an apartment. His landlady brings up his mail. All of this is presented as though it is a perfectly normal occurrence. There is a letter from his two nephews, who live in the ocean. The nephews want to come visit, and upon arriving, want their uncle to take them around the city. He wasn’t expecting they would want to do that, and is largely disappointed by having to be a tour guide. When it is time for the nephews to return to the ocean, the octopus needs to make a decision. Should he go back to his apartment, or is it time for him to return to the ocean? My take on this story is that it is about that moment when you look back upon your life, and a big decision you once made… and decide to abandon it in favor of returning to the life you had before. Your understanding of the story may be entirely different from mine. That’s the beauty of the stories in this book! Another story that caught my attention is called “The Book”. A woman buys a book only to find that all of the pages are blank. The bookstore will not let her return it or exchange it. This makes the women irrationally angry at the book. She begins complaining about the book, and her complaints … go viral, so to speak. She unintentionally makes the book even more popular than it would have been had she decided to just forget about it. Years ago, I used to work in a big chain bookstore. Every so often, someone would come in to complain about a book that was currently rising in popularity (or was, at that moment, a best seller). Catholics came in to complain about The DaVinci Code (by Dan Brown) to insist that it was blasphemous and should be removed from the shelves. Confused people, who believed that if their children read the Harry Potter books they would actually learn magic, complained about those books being in the children’s section. The result was always the same. The complaints caused more people to become curious about whatever the controversial book was. In other words, I can relate to this particular short story from personal experience. Other stories in the book are not so dreamy. There are some rather terrifying stories that are creepy and confusing. I didn’t need to know what those stories were about to feel a visceral shiver as I read through them. I found the story about martians being treated as “the help”, and another story about an alien spaceship and two people who fell in love with each other, to be fascinating. Overall, reading these short stories reminded me of when I was a child and exploring the world inside of a new book with wonder and acceptance. Stories for Nighttime and Some for the Day – By Ben Loory is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on PayPal.me. Thank you!...

World of Warcraft

- Meipo the Mage
  November 20, 2019Adventures of Meipo / World of WarcraftMeipo is my brand new little Mage in World of Warcraft. This is my favorite screenshot of her. In this blog, I have some highlights as I leveled her up. These screenshots were taken between November 5, 2018, and November 18, 2019. The reason I created Meipo the Mage was so that I could play World of Warcraft with a friend of mine. He and I both play Dungeons & Dragons together. He made a WoW character based on his D&D character a while ago. Originally, we were thinking that my Kobold, Meepo, should be a Goblin in WoW. But, that would mean we’d be in opposing factions, and unable to play together. So, the WoW version of my D&D character is a Gnome. I’m kind of bummed that it wasn’t possible to spell her name the same way. Who knew Meepo was such a popular name? I settled for an alternative spelling. Meipo’s hair is green because she is based on my green Kobold. We played together a little bit, and then both got busy. My first goal was to get Meipo to Level 50 – which is where my friend’s Gnome was at. 50 Quests Completed Level 10 Meipo became a Fire Mage. Her D&D counterpart, Meepo is a Sorcerer who used the Fire Bolt cantrip often. (She also used Lightning, but that doesn’t seem to be a Mage option in WoW). Meipo fought Mangeclaw. This is the end of a short quest chain, and it took me a few times before I was able to kill the polar bear. If I remember correctly, the reward is Mangy Gloves (which are white, like MangeClaw). Meipo got her first Cooking Award. Meipo earned the 25 Fish achievement while fishing in Ironforge. The requirements on this one are lax. It counts fish, and sickly fish, and whatever garbage your character accidentally fishes out of the water. Meipo used a Rat Catcher’s Flute on the rats in the Deeprun Tram. The Enthralled Deeprun Rats followed her to the quest giver. Her D&D counterpart would have cast Friends on them instead! I really like the fireball effects in World of Warcraft. Meipo earned the Explore Dun Morogh Achievement. Miepo earned the 5 Daily Quests Completed achievement. I was working on her Cooking and Fishing Skills because I figured it was an easy way to gain some XP (experience points). Here’s a scenic view in the Valley of Kings area in World of Warcraft. World of Warcraft celebrated its 14th Anniversary between November 16, and November 30, 2018. Players who logged in during that time got a special email. From: The WoW Dev TeamSubject: WoW’s 14th Anniversary!Wow. Yet another year has gone by for WoW!We wanted to thank you for continuing to play World of Warcraft with us. So here’s an Anniversary Gift to go with your adventures!The WoW Dev Team The letter included an Anniversary Gift Package. Inside was 200 Timewarped Badges, a Celebration Package item to increase experience and reputation gain by 14% for 1 hour, and a “Letter from the Timewalkers” which directed players to either Stormwind or Orgrimmar. It also includes a quest called The Historian. This required Miepo to go to Stormwind and find Historian Llore. He asks the player a lore question. The reward for getting it right is Overturned Corgi Goggles. It is a toy that you can find in your Toy Box. Anduin Wrynn, Corgi King of Stormwind! Corgis everywhere! The Overtuned Corgi Goggles are fun to play with. Meipo the Mage experienced her first Winter Veil. She is too low level to do most of the holiday quests. But, she did get to open some presents. He Knows If You’ve Been Naughty: Open one of the presents underneath the Winter Veil tree once they are available. At Least You’re Being Careful: Proud owner of the 2018 Vintage Winter Veil gift, the Toy Armor Set. 100 Quests Completed Achievement Progress: The Road to Thelsamar This is what Meipo was wearing when she was Level 19. The Old Gnome and the Sea: Successfully fish from a school. 50 Fish: Fish up 50 items. Meipo reached Level 20! Giddy Up!: Learn the Apprentice Riding Skill The Gnome racial mounts are fun, and bouncy, and hard to take seriously. I didn’t have to buy one for Meipo because I already had one. (My Gnome Death Knight bought it a long time ago.) It didn’t take long for me to switch over to a faster mount. I think it got updated since the last time I used it. Or, maybe I just forgot. The spots look cool, and it feels like Miepo is riding a dinosaur. Miepo was killing creatures for a quest when Lord Condar attacked. She managed to kill it before it could kill her. It didn’t drop anything special. Miepo bought a Common Grey Shirt at Ironband’s Excavation. She got a few more transmog items from finishing a quest there. Wise Man’s Belt Whispering Vest Meipo is wearing the Solstice Robe. It might be the most colorful thing she has found to wear (so far). It is also a transmog item. Solstice Robe The Seer’s Fine Stein dropped from a fox in Loch Modon. Meipo got attacked by Ashtail, a fox-like creature that had the ability to disappear into a puff of smoke. Ashtail dropped the Simple Robe of the Aurora. It is a transmog item. Fashionista: Chest: Collect 100 chest slot appearances. Meipo did not collect all of those herself. The achievement is one that takes into account all of the transmog items that your characters pick up. Meipo is wearing the Simple Robe of the Aurora. Achievement Progress: The Axis of Awful Achievement Progress: The Farstrider Lodge Miepo earned the Explore Loch Modan achievement while riding along on a Skystrider mount piloted by a Gnome named Ando. The way to finish the Twilight Threats Achievement, and complete the Loch Modan Quests Achievement, is to turn in a quest at Algaz Station. Meipo got a Bright Belt from a Leech Stalker. The Bright Belt is a transmog item. There is a quest that leads the player into Thelgen Rock to pick up an item. Doing so causes Torrention to appear. It is a huge water elemental type creature. The player doesn’t have to kill Torrention. It just stands there until the player attacks it. Kill Torrention, and it drops a Floodsurge Core – which begins a quest. Turn in the quest, and you get a Floodsurge Coat. Achievement Progress: Slabchisel Survey Miepo got Marblebeard’s Shrug – her very first shoulders! She was Level 25. Marblebeard’s Shrug is a transmog item. Miepo got the Wand of Infectious Dementia from Captain Stoutfist in Menethil Harbor. At Level 26, Meipo learned a fire shield skill. Meipo got the Cursed Eye of Paleth by completing quests involving the ghosts of soldiers and marines. It is a transmog item. Achievement Progress: The Flooding of Menethil Meipo got Steelbrow’s Old Robe. It goes nicely with her hair and eyes. So do the Merchant Marine Sandals she got from somewhere. Steelbrow’s Old Robe is a transmog item. The Merchant Marine Sandals are also a transmog item. A Simple Re-Quest: Complete a daily quest every day for five consecutive days. Lunch Lady: Learn 25 cooking recipes. I went back to Thelsalmar and finished the Explorer’s League quest. It is the one where you pick up a book and run around looking for scrolls. Torren Squarejaw: You located all of our documents! We can’t thank you enough for the help…we’d all but given up hope. It seemed sure that the Dark Irons would be able to act upon all of this information soon. It’s good to know that they’ll left blind in their attacks for quite a while yet. To thank you for all of your efforts on our behalf, we would like to offer you a gift. An artifact really… something we recovered from one of our digs. You have the appreciation of all of the Explorers’ League. The gift is a Star Shooter wand. It leaves a trail of glowing stars behind Meipo when she runs! The Star Shooter is a transmog item. Meipo fought Horrorjaw Achievement Progress: Engineers and Archaeologists A Dragonmaw Whelpstealer dropped a Demon Band ring for Meipo. The Floodlily Robes come from Ferilon Leafborn as a reward for completing a quest. It is a transmog item. Rethiel the Greenwarden is huge! If you look closely, you can see Miepo the Gnome by one of his feet. Relthiel the Greenwarden can be found in Greenwarden’s Grove. Level 30! It has been a long time since I took a low-level character across the Thandol Span for the first time. When I did it before, I was in a party with my husband. He went over the Span without me, because I was doing a pet battle. Neither one of us knew that entering the Thandol Span would start an event. I didn’t mind missing it at the time. It was nice to see this event from the start this time around. Thargas Anvilmar: Balgaras?! And the others… you were all dead! What foul trick is this? Calamoth Ashbeard: Your petty triumphs have been futile. The power of the Twilight’s Hammer is absolute! Calamoth Ashbeard: Rejoice, for you shall be the first to die. We will sweep across Khaz Modan and burn all to ash. Thargas Anvilmar: I don’t care how many times I have to kill you… I’ll take you all on to save this land! Shilah Slabchisel: Aye, and so will we! Calamoth Ashbeard: What luck! The offerings throw themselves upon the altar! Calamoth Ashbeard: ATTACK! LET NONE SURVIVE! Thargas Anvilmar, Shilah Slabchisel, Forba Slabchisel, and Captain Stoutfist: FOR KHAZ MODAN! The bad guys explode, and the battle ends. Achievement Progress: Wardens of the Wetlands Achievement Earned: Wetlands Quests The Khaz Modan mantle is a transmog item. Achievement Earned: Explore Wetlands Explore Wetlands: Explore Wetlands, revealing the covered areas of the world map. The quests involving Quae and Kinelory are fun. Read the quest text closely, and it is clear that they are a couple. Turn in the finished quest chain from Quae and Kinelory, and you get the Stormgarde Surcoat. It is a transmog item. Finish the quest where you kill Otto and Falconcrest – and bring back their heads – and you get the Demon-Trafficker’s Belt. It is a transmog item. I don’t remember which quest rewards the player with the Dustfall Bracers. It is a Transmog item. Meipo got the Scaled Cloak of the Fireflash from a spider. It is a transmog item. There is a quest in Faldir’s Cove that requires players to swim underwater and find Elven Gems. Players can use the Goggles of Gem Hunting to make the underwater gems glow. Achievement Progress: Faldir’s Cove The reward for completing the Faldir’s Cove quests is O’Breen’s Dress Robes. I went to Stormwind, temporarily abandoning the quest chain I had been working my way towards around Refuge Pointe. I thought the Noblegarden event was still going on, but it turned out it ended the day before. Meipo could use a bigger bag. The one I wanted to buy required a higher reputation with Stormwind than Meipo had. So, I started doing some Stormwind related quests. Meipo earned the Journeyman Cook Achievement after buying a bunch of recipes off of a vendor who was on the upper floor of an inn. Talk to Little Adeline in the Flower Shop in Stormwind. She will ask you if you like flowers. There is an option for players to click “Yes”. Little Adeline will drop flower petals on the player. Meipo collected Stormwind Balloons for a little Draenei girl who lost them. The tiny girl gets carried away by the balloons, and seems to be enjoying the journey. Meipo got some quests that required her to kill Kobolds (and take their candles while collecting gold dust). Somehow… that just seemed wrong. Kobold Candle – “You took it.” The Kobold Candle is a reward for completing the “I TAKE Candle!” quest. The quest giver is Jimb “Candles” McHannigan at Fulbrow’s Pumpkin Farm. It is the only reward offered to Mages. Other classes may get something else. Meipo went to The Darkmoon Faire for the very first time and got a fancy Darkmoon Top Hat. She got to ride a pony! Meipo also got to ride a Murloc on a Carousel. It matched the colors of her outfit and her hair. Going Down?: Fall 65 yards without dying. Meipo earned this Achievement at The Darkmoon Fair, after getting shot out of a rocket. She accidentally closed the parachute way too early and failed to land on the target. Meipo got the Well-Stitched Robe from Sara Timberlain. The Well-Stitched Robe is a transmog item. The Red Linen Sash, and the Red Linen Shirt also come from Sara Timberlain. Both are transmog items. The Elastic Wristguards come from Marshal McCree. It is a transmog item. Meipo earned the Fashionista: Talbard Achievement when she bought a Stormwind Talbard. The Stormwind Talbard is a transmog item. 250 Quests Completed: Complete 250 quests. Aw, Isn’t it Cute?: Obtain one of the Children’s Week reward pets through questing. Meipo earned Speedy. Meipo got the Simple Blouse of the Aurora from Fedfenel (after she killed him). It is a transmog item that apparently shows up as “Simple Blouse”. Explore Elwynn Forest: Explore Elwynn Forest, revealing the covered areas of the world map. Meipo fought Hogger. This wasn’t as exciting a battle as it was the first time I did this (on another, much older, character). A mini event happens right before the battle ends. In it, an NPC (non-player character) mentions taking Hogger to the Stormwind Stockades, and something about King Varian Wrynn. At the time Miepo went through this part of the game, King Anduin Wrynn was on the Stormwind Throne. I wish the mini event could have been updated to reflect current content. The Crime Scene Tape is a belt that comes from Lieutenant Horatio Laine. It is a transmog item. The Urchin’s Pants are a transmog item that come from Deputy Ranier. Farmer Saldean gives the player Harvester Boots… …and it shows up as Watched Watcher’s Slippers in Appearances. Meipo earned the Crime Scene Investigation Achievement. Meipo got the Sentinel Hill Surcoat from Marshal Gryan Stoutmantle. Meipo earned the Golden Sunshine Cloak after completing the Westfall Stew quest. Salma Saldean (at Saldean’s Farm) is the quest giver. Mages get this cloak as a reward. Other classes might get something else. The Mystic Riverpaw Wand comes from Captain Danuvin at Sentinel Hill. Legwork Trousers come from Marshal Gryan Stoutmantle at Sentinel Hill. The Torchlight Wand is one of the two rewards players can choose after completing The Coastal Menace quest. The quest giver is Captain Grayson, a pirate ghost who stands in front of the lighthouse. The Captain Sanders’ Hidden Treasure quest is optional. Players who finish it receive a Silver Bar, Captain Sanders’ Shirt, Captain Sanders’ Booty Bag, and Captain Sanders’ Sash. Captain Sanders’ Sash is a transmog item. Captain Sanders’ Shirt is also a transmog item. Meipo got the Curved Dagger from Mama Celeste at Fulbrow’s Pumpkin Farm. It is a transmog item. Meipo obtained the Sylverian Dreamer mount. She hasn’t learned the flying skill yet. That’s ok, because this beautiful dragon can run! Honorable Medallion: Enter a Battleground or Arena and Learn the spell Honorable Medallion. I honestly have no idea what triggered this Achievement. I don’t remember taking Meipo into a Battleground or Arena. She’s standing in Stormwind, and has never gone into the Stormwind Stockade. Flame Warden of Eastern Kingdoms: Honor the flames of Eastern Kingdoms. Meipo hit Level 39 shortly before earning this Achievement. I find that the holiday events are really good for leveling up characters. Meipo received a letter from The WoW Dev Team. It was about WoW’s 15th Anniversary! Every player who logged into WoW during the anniversary celebration got this letter on all of their characters. Wow, yet another year has gone by for WoW! We wanted to thank you for continuing to play World of Warcraft with us. So here’s an Anniversary Gift to go with your Adventures! We hope that you will join us for a very special celebration in the Caverns of Time! The WoW Dev Team The letter contained an Anniversary Gift. It included 25 Timewarped Badges, a Celebration Package that increases all Experience and Reputation gains by 15% until the celebration ends, and an Invitation from the Timewalkers, which begins a quest. Meipo was too low a level to start that quest. The Anniversary Gift included Lil Nefarian. The Anniversary Gift also included an item that was an incredibly appropriate one for Meipo (who is based on one of my Dungeons & Dragons characters). The Celebration Firework can only be used during the Anniversary Celebration. It can be used over and over again! Meipo found a shiny! The Evidence Collection Gloves are from Captain Alpert in Moonbrook. I’m not sure if they are a transmog item or not. I like to stop and take screenshots of the scenery in World of Warcraft whenever I find a nice view. Meipo hit Level 40 somewhere in Stromguarde Keep. I was unable to get a screenshot of it because it happened while she was in battle. Level 40: Reach Level 40. WoW’s 15th Anniversary: Logged in during WoW’s Anniversary. Meipo has become a terrifyingly effective Fire Mage! rThe purpose of going to Stomgarde Keep was to collect the Stromgarde Badges that were taken by enemies after they killed Alliance soldiers. The player must bring the badges to Captain Nials in Refuge Pointe. Captain Nials: Privates Horus, Tilling, Rockwell… Captain Nials: Tormil, Gamlor, Shefferd, Cowry… Captain Nials: So many lost. And so many more we must lose before this battle ends. Captain Nials: Thank you for these badges, Meipo. I will send news to the families of the deceased. Captain Nials gave Meipo the Slippers of Sorrowful Tidings. I don’t remember if they are a transmog item or if they are not. Time for a rest! A Witherbark Fisher dropped a Shimmering Stave of the Aurora. The Shimmering Stave is a transmog item. Part of a chain of quests that Meipo was working on involved killing Kobolds. It was a different group of Kobolds than the one she had to kill before. Again, this just felt wrong! Meipo was now strong enough to kill two raptors at the same time. One of the raptors dropped the Silver-Thread Amice shoulders. I have no idea how the raptor obtained this item, nor why it was carrying it around. The Silver-Thread Amice is a transmog item. Meipo hit Level 41 while fighting Cresting Exiles. Meipo found Boros, a giant bug that was a level higher than she was, and an Elite. It was somewhere in Dabyrie’s Farmstead. Meipo killed Boros! She didn’t have a quest for this, so there’s a chance she might have to return someday and kill him again. Meipo fought Kor’gresh Coldrage in Bolderfist Hall. She has a quest for that. Success! Next, Meipo fought Phalanax, a Level 42 elite. She did not have a quest for this one. She needed something to do while waiting for her hearthstone cooldown to finish so she could turn in a quest. Phalanax dropped the Elder’s Cloak of the Aurora. The Elder’s Cloak of the Aurora is pretty. The Horned Stilletto of the Aurora is a transmog item. Back to Stromgarde Keep to complete more quests! Miepo fought, and killed, Foulbelly. He dropped the Brigade Breastplate of the Quickblade, which is mail. Miepo cannot use it. Meipo also fought, and killed Or’Kalar. It was an interesting battle, because Or’Kalar’s Stomp causes knockback. I’m not sure what gender Or’Kalar identifys as, but they are wearing the skimpy type of chest armor that is typically assigned to female characters. Meipo hit Level 42 standing in front of Apprentice Kryten. He gives players a quest that requires them to obtain three objects that are inside the tower behind him. The quest must be turned in to Skuerto, who is in Refuge Point. It requires Trelane’s Phylactery, Trelane’s Orb, and Trelane’s Ember Agate. The reward is Trelane’s Leggings. Meipo was tasked with grabbing three of Trelane’s things. Those things seem really valuable, and were somewhat guarded by ogres. This brings up a question. How did Skuerto obtain Trelane’s Leggings? It seems like that item would have been in the tower with Trelane’s other possessions. Maybe some other adventurer brought Trelane’s Leggings to Skuerto, shortly before Meipo turned in the other items. Or, maybe Skuerto was ran out of bag space while in the tower, and decided to use his hearthstone to get back to Refuge Point. Achievement Progress: Refuge Pointe Miepo made friends with Trained Razorbeaks by feeding them. She got the Gryphon Down Scarf, which is a transmog item. Meipo hit Level 43 in Drywhisker Gorge. Geomancer Flintdagger is a Level 43 elite. He dropped the Twilight Robe, which is a transmog item. Meipo looks like a little kid who dressed herself for the first time. The best thing to do while flying is to take screenshots of the scenery. In this one, Meipo is flying over part of Arathi Highlands. Fast and Furious: Learn the Journeyman Riding Skill. Players must be at least Level 40 to purchase the Journeyman Riding Skill. Meipo was Level 43, and finally got around to buying it. 10 Cooking Awards Meipo made a fishing buddy! She was fishing in Stormwind, and this NPC (non-player character) walked over and started fishing next to her. Miepo needed to kill Fozuk to get the Rod of Order. This is one small part of a long quest chain. Fozuk drops the Rod of Order. It is a quest item. Players cannot equip it. Characters who have the mining profession can mine Fozuk. A Plains Creeper dropped the Dwarven Magestaff of the Fireflash. This is what the Dwarven Magestaff of the Fireflash looks like. The Dwarven Magestaff is a transmog item. The quest chain involves a fight with Thenan. Characters who have the mining skill can mine Thenan, too! Miepo released Princess Myzrael. The process was sparkly and shiny. Princess Myzrael is a Level 43 elite who is much bigger than either Fozuk or Thenan. Princess Myzrael drops the Eldritch Bracers. Players cannot mine her. That said, she does spawn a couple of large beings (that look similar to Fozuk and Thenan). You can mine them. Meipo hit Level 44 at the same time she completed this quest chain. The Eldritch Gloves are a transmog item. Arathi Highlands Quests: Complete the Arathi Highlands storylines listed below. Explore Arathi Highlands: Explore Arathi Highlands, revealing the covered areas of the world map. Miepo earned the 100 Fish Achievement in Hillsbrad Foothills. Hillsbrad Foothills is pretty! Meipo stands before Jintha’ Alor, ready to embark upon a bunch of quests that involve killiing the Trolls that dwell within it. Gan’dranda seemed very confident about fighting Miepo. He did not survive the battle. The reward for completing this quest is Theresa’s Bracers. I don’t know if this is a transmog item. Dron Blastbrew gives players a quest to go kill some peaceful, lovely, turtles. It makes me uncomfortable. The reward for this quest is Nat Pagle’s Extreme Angler, a fishing pole that Meipo is not yet big enough to use. The thing I found interesting about this item is that players no longer need to carry around a fishing pole in order to go fishing. There was a time when that was necessary – but not anymore! In addition, there used to be a series of quests that involved Nat Pagel. It’s been a while since I ran a character through them, and I’m assuming those quests are still in the game. Dron Blastbrew then gives players a quest to kill the Direglob and bring him back a sample of it. There is a lovely little quest that requires players to do nothing more than pick up bottles of alcohol that ended up along the shoreline. Meipo fought The Reak at Skulk Rock. He is a Level 46 elite. It is the only slime that is this color. The rest are green. The Reak drops the Lord’s Cape of the Fireflash. The Lord’s Cape of the Fireflash is a transmog item. Meipo hit Level 45 while fighting with a Green Sludge. The Direglob is huge and terrifying! This battle did not go well. The Direglob beat Miepo up, and then swallowed her. She ended up making the “corpse run”. I took this screenshot of The Hinterlands just because it was pretty. One more try! This time, I used a Rough Stone Statue, which was able to heal Meipo for a little while. The Direglob ate the statue, but that didn’t immediately stop the statue from healing her. Next, the Direglob ate Miepo (again). It is possible to fight The Direglob from inside it. Meipo nearly killed The Direglob, and would have succeeded, if it wasn’t for that pesky Green Sludge that joined the battle. It was time to go back to Jinta’Alor and finish up some of those quests. Maybe it would be easier to fight The Direglob after Meipo leveled up some more. Meipo hit Level 46 after turning in a quest to Fraggar Thundermantle. Fraggar Thundermantle gave Miepo the Necklace of Evil Faces. It is not a transmog item because it is jewelry. He also gave Meipo the Sandals of Tainted Blood as a reward for a different quest. A Vilebranch Wolf Pup dropped the Durable Bracers of the Fireflash. I don’t remember if it is a transmog item or not. There stands Miepo, getting ready to harass Ongo’longo. The goal is to make him angry enough to break his chains and run over some Trolls. His bright green color reminds me of The Hulk. Off he goes! The reward for completing this quest is the Blood Drinker Staff. It is a transmog item. Meipo hit Level 47 in Jintha’ Alor. Meipo fought Morta’gya the Keeper. She drops the Tablet of Shadra, which the player needs for a quest. The reward for completing this quest is the Leggings of Secret Rituals. It is a transmog item. Miepo completed the Jintha’ Alor quest chain. After leveling up a little more, Meipo returned to fight The Direglob again. As before, The Direglob swallowed her. Success! Meipo gave the Direglob Sample to Dron Blastbrew. He gave her the Wand of Oomph. Meipo has now completed the Stormfeather Outpost quests. The Wand of Oomph is a transmog item. The next quest chain comes from Gilda Cloudcaller at Quel’Danal Lodge. But first… Meipo went back to Stormwind to buy the Reagent Bank. One of the bags she carries is for mining supplies, only. She was also carring a bunch of gems, stuff for cooking, and cloth. The Reagent Bank opened up a ton of bag space for her. Miepo hit Level 48 while turning in a Fishing quest. Meipo killed a lot of big spiders, and found the Eye of Shadra at Agol’watha. The reward for this quest is the Shadraspawn Mantle. For whatever reason, it comes up as Surlis’ Mantle in the Appearances Tab. The Fang of Shadra is inside a little container and is easy to find. The next quest is to kill Qiaga the Keeper and collect the Shell of Shadra. The reward is the Gown of the Last Priestess. Meipo fought Qiagra the Keeper at the Alter of Zul, and got the Shade of Shadra. Gown of the Last Priestess is a transmog item. A lovely view of The Hinterlands. The next quest is to summon Shadra, a gigantic spider. The player needs to go to Shadra’ Alor and use the Idol of Shadra at the Southwestern, Nortwestern and Eastern Temples. Meipo earned the Explore The Hinterlands Achievement. Eastern Temple Northwestern Temple Southwestern Temple Shadra is a gigantic spider that crawls out of the lake. Miepo was able to stand back, throw lots of fire spells at Shadra, and kill her. This quest chain sends the player to Aerie Peak to speak with Gryphon Master Talonaxe. The reward for killing Shadra the Venom Queen is the Veil of Aerie Peak. Meipo got the Quel’Danil Lodge Achievement and the Hinterlands Quests Achivements at the same time by turning this quest. This is what the Veil of Aerie Peak looks like. The Veil of Aerie Peak shows up as the Darkcleric’s Veil in the Appearance Tab. I have no idea why that is. Meipo hit Level 49 while turning in a Cooking quest. Next, Meipo went to Western Plaguelands. She stopped there at some point, picked up a few quests, and didn’t bother to actually work on them. One of the quests required Meipo to collect Shaggy Black Bear flanks. The reward for this quest is Grant’s Signet. Next, Meipo started working on the Battle for Andorhal quests. Most of them come from (and are turned in to) Thassarian or Lurid. Meipo killed Dessicated Spearmen and Opengut Behemoths. She also fought Desiccated Magus enemies. The reward for turning in the War Machine’s quest is Dried-Up Bracers. The Dried-Up Bracers are a transmog item. Rattlegore is a Level 50 elite. Rattlegore died in an awkward position. Meipo fought Araj the Summoner from a distance. It worked really well! Breaking the Phylactery was a little tougher because the skeletons that Araj summoned wanted to come over and attack. Meipo hit Level 50! My goal with this blog post was to continue it until Meipo hit Level 50. It took a while to get her there, and the WoW 15th Anniversary experience buff helped speed that along. I’m not retiring this character, though! Upcoming blogs in the “Adventures of Meipo” series will appear when she levels up more. Meipo the Mage is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on PayPal.me. Thank you!...
- WoW Classic: Odds and Ends
  November 2, 2019World of Warcraft / World of Warcraft ClassicVaca and Neverlast had picked up plenty of quests, and even started working on a few of them. The time had come to finish up as many as possible and turn them in. This involved a whole lot of running around, which can tire out any Tauren. We weren’t expecting the scenery to temporarily become just as discombobulated as we were feeling. My Tauren Warrior, Vaca, recently hit Level 10. She was ready to take her Beatstick and use it on whatever monsters the quest givers pointed her and her Druid friend Neverlast at. Vaca and Neverlast have gotten into a habit of picking up a whole lot of quests, and then slowly working through them. That’s not a bad thing. It happens a lot in games like Classic WoW. The first thing to do was talk to Pakwa the Bag Vendor in Thunder Bluff. Vaca had two empty slots that bags are supposed to go in. She could only afford two Small Brown Pouches. Bag space is super important in WoW Classic. Part of the reason is that there are so many quests that require players to keep items in their bags until they have the opportunity to turn in the quest. The other reason is because it is much harder to obtain bags in WoW Classic than it is in WoW Retail. The next thing to do was try and finish The Venture Co. quest that we got from Morin Cloudstalker. We needed to kill 14 Venture Co. Workers and 6 Venture Co. Supervisors. Picking off the Workers was pretty easy. Most of them were teeny tiny Goblins. Others were Ogres, but much smaller than the ones in Retail WoW. The Supervisors were trickier. They mostly stayed inside the little huts, doing nothing, until they got targeted by a player. The “big bad” of the group was an Ogre named Enforcer Emilgund. He was Level 11 and an Elite (with a fancy portrait frame). Vaca was still Level 10, and this fight was a bit difficult for her. Fortunately, Neverlast’s healing skill kept Vaca alive. I cannot remember if we got any good loot from killing Enforcer Emilgund. He wasn’t part of The Venture Co. quest, but he seemed important. At some point, we would turn in a quest that he was connected to and maybe get a nice reward from whomever the quest giver happened to be. We were somewhere around The Golden Plains, on the edge of the prairie, when the drugs began to take hold. There were times when the scenery simply refused to adhere to the laws of physics. Azeroth had turned into a surrealist painting. Eventually, it would catch up and fill itself in. I’ve no idea why this was happening, but figure it had something to do with playing WoW Classic on a Mac. A while ago, we picked up a quest called Dwarven Digging from Baine Bloodhoof. He wanted Vaca and Neverlast to collect 5 Prospector’s Picks from the Dwarven dig site. To do this, we had to kill many Dwarves. It moved pretty fast, and I failed to take screenshots of it. We did finish the quest, though. All we needed to do now was return to Baine Bloodhoof in Bloodhoof Village. Baine Bloodhoof: Hello, Vaca. Do you have the Broken Tools? The dwarves’ digging will enrage the kodos of Mulgore. This defilement must be stopped! Turning in the quest gave Vaca just enough experience points to hit Level 11. She was pretty close to leveling before turning in the quest. While they were still in Bloodhoof Village, Vaca and Neverlast spoke with Skorn Whitecloud. He’s the one that told them about Ghost Howl. They figured Skorn Whitecloud would want to know that Vaca and Neverlast had encountered, and killed, Ghost Howl. Perhaps it will make Skorn feel better that his nemesis is no longer out there, roaming around. Time to do some cooking! Warriors need food, especially after a difficult battle. But, the main reason I decided Vaca should pick up Cooking was because I find games with virtual food to be amusing. This is likely because I have a ton of food allergies. I’m very limited in terms of what I can safely eat in real life, but video game food is always safe! Next, we worked on a quest called Preparation for Ceremony. It requires players to obtain 6 Azure Feathers and 6 Bronze Feathers. These items can only come from certain kinds of Harpies. We quickly learned that Harpies are tough! They like to hang out around the big trees, spaced just enough apart from each other so that players end up fighting more than one at a time. Sister Hatelash is a Level 11 elite that decided to try and kill us. We did not need to kill her for the quest we were working on. But, she gave us no choice in the matter. Together, Vaca and Neverlast were successful. There were now more players in this area, working on the same quest that we were. We were all going to have to take turns and wait for the harpies to respawn. We handed the feathers we collected to Eyahn Eagletalon, in Thunder Bluff. He now had enough of them to make a headdress that his brother could use in a ceremony. Thunder Bluff seemed like a good place to stop for the night and rest, after all that running around. WoW Classic: Odds and Ends is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on PayPal.me. Thank you!...

Out of Spoons (Chronic Illness)

- A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Four
  January 21, 2020health insurance / Out of SpoonsImage by Clker-Free-Vector-Images from Pixabay 2020 marks the fourth year of the Donald Trump Presidency. His administration, and the Republicans in Congress, are still trying to destroy Obamacare. They are also going after reproductive health care, Medicaid, Medicare, Social Security Disability, the ablity for LGBTQ people to recieve health care, and the ability for undocmented children to be covered by Medicaid. The Guardian reported that President Trump was impeached on December 19, 2019, when the House of Representatives voted 230-197 to approve a first article of impeachment. This blog post, like the ones that preceded it, has the “receipts” about every bad thing the GOP and Trump tried to do to American’s health care. (It also includes the good things that Democrats – and occasionally some Republicans – did to protect our healthcare.) If you would like the full story, you may want to start with the blogs I’ve written about this topic so far. They include: A Timeline of the GOP’s Attempts to Destroy Obamacare – Part One A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Two A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Three A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Three – Continued January 2020 January 1, 2020: Speaker Nancy Pelosi tweeted: “For six years, Americans of every age have been protected against health insurance discrimination if they have pre-existing conditions. Now, Trump and Republicans are trying to tear away those protections. #ProtectOurCare” January 2, 2020: The New York Times posted an article titled: “It Looks Like Health Insurance, but It’s Not. ‘Just Trust God,’ Buyers Are Told.” It was written by Reed Ableson. From the article: …More than one million Americans, struggling to cope with the rising cost of health insurance, have joined such groups, attracted by prices that are far lower than the premiums for policies that must meet strict requirements, like guaranteed coverage for pre-existing conditions, established by the Affordable Care Act. The groups say they permit people of common religious or ethical belief to share medical costs, and many were grandfathered in under the federal health care law mainly through a religious exemption.These Christian nonprofit groups offer far lower rates because they are not classified as insurance nd are under no legal obligaition to pay medical claims. They generally decline to cover people with pre-existing illnesses. They can set limits on how much their members will pay, and they can legally refuse to cover treatments for specialities like mental health……The main requirement for membership is adherence to a Christian lifestyle. And the alternative sharing plans keep flourshing, especially now that the Trump administration has relaxed rules to permit alternatives to the A.C.A. that don’t provide such generous coverage.But state regulators in New Hampshire, Colorado, and Texas are beginning to question some of the ministries’ aggressive marketing tactics, often using call centers, and in some cases people who joined them were misled or did not understand how little coverage they would recieve if they or a family member had a catastrophic illness……Because the groups are not technically considered insurance, they operate with no government oversight. “Regulators haven’t been willing to assert any control or regulatory authority over these plans,” said Katie Keith, who serves as a consumer representative to the National Association of Insurance Commissioners and teaches health law at Georgetown University. “They feel their hands are tied. At the end of the day, it’s not insurance.”Families who have joined the groups recount winding up with medical bills not covered by the ministries, with no legal way to appeal decisions to reject coverage for care. Some groups ask their members to push hospitals and doctors to write off their bills rather than use members’ money to pay their expenses… January 2, 2010: The Hill posted an article titled: “More than 200 Lawmakers urge Supreme Court to ‘reconsider; Roe v. Wade”. It was written by Nathaniel Weixel. From the article: More than 200 members of Congress want the Supreme Court to “reconsider” the landmark abortion case Roe v. Wade.Led by Minority Whip Steve Scalise (R-La.), 166 House Republicans and 39 Senate Republicans signed an amicus brief calling the right to an abortion “unworkable.”Two Democrats, Rep. Collin Peterson (Minn.) and Rep. Daniel Lipinski (Ill.), also signed onto the brief. Lipinski has come under fire for his anti-abortion stance, and is being targeted in his upcoming primary by a progressive Democrat……The lawmakers were writing in support of a Louisiana law that would require doctors who preform abortions to have admitting privileges at a nearby hospital, a requirement that critics say is designed to force abortion clinics to close.The Supreme Court is set to hear oral arguments challenging the law in March. If upheld, the restrictions could leave the state with just one abortion provider… There is a PDF of the Amici Curiae mentioned in the above article. Here is a list of the members of Congress who signed it in support of Louisiana’s abortion law, and in an effort to overturn Roe v. Wade. U.S. Senate (by State): Arizona: John BoozmanArkansas: Tom CottonFlorida: Marco RubioIdaho: Mike Crapo, James E. RischIndiana: Todd Young, Mike BraunIowa: Jodi Ernst, Chuck GrassleyKansas: Jerry Moran, Pat RobertsKentucky: Rand PaulLouisiana: John Kennedy, Bill Cassidy, M.D.Mississippi: Cindy Hyde-Smith, Roger F. WickerMissouri: Roy BluntMontana: Steve DainesNebraska: Deb Fischer, Ben SasseNorth Carolina: Richard Burr, Thom TillisNorth Dakota: Kevin Cramer, John HoevenOhio: Rob PortmanOklahoma: James M. Inhofe, James LankfordPennsylvania: Pat ToomeySouth Carolina: Tim ScottSouth Dakota: Mike Rounds, John ThuneTennessee: Marsha BlackburnTexas: John Cornyn, Ted CruzUtah: Mike Lee, Mitt RomneyWisconsin: Ron JohnsonWyoming: John Barrasso, Michael B. Enzi House of Representatives (by state): Alabama: Robert B. Aderholt (04), Mo Brooks (05), Bradley Byrne (01), Martha Roby (02), Mike D. Rogers (03)Arizona: Andy Biggs (05), Rick Crawford (01), Paul A. Gosar, D.D.S., (04), French Hill (02), Debbie Lesko (08), Gary Palmer (06), David Schweikert (06), Bruce Westerman (04), Steve Womack (03)California: Paul Cook (08), Doug LaMalfa (01), Kevin McCarthy (23), Tom McClintock (04), Colorado: Ken Buck (04), Doug Lamborn (05), Doug Lamborn (05), Scott Tipton (03)Florida: Mario Diaz-Balart (25), Neal Dunn, M.D. (02), Matt Gaetz (01), Brian Mast (18), Francis Rooney (19), John Rutherford (04), Ross Spano (15), W. Gregory Steube (17), Michael Waltz (06), Daniel Webster (11), Ted S. Yoho, D.V.M (03)Georgia: Rick W. Allen (12), Earl L. “Buddy” Carter (01), Doug Collins (09), A. Drew Ferguson IV (03), Tom Graves (14), Jody B. Hice (10), Barry Loudermilk (11), Austin Scott (08)Idaho: Russ Fulcher (01), Mike Simpson (02)Illinois: Mike Bost (12), Larry Bucshon, M.D. (08), Rodney Davis (13), Adam Kinzinger (16), Darin LaHood (18), Daniel W. Lipinski (03), Greg Pence (06), John Shimkus (15)Indiana: James R. Baird (04), Jim Banks (03), Jackie Walorski (02)Iowa: Steve King (04)Kansas: Chuck Fleishmann (03), Roger Marshall, M.D. (01), Steve Watkins (02)Kentucky: Andy Barr (06), James Comer (01), Hal Rogers (05)Louisiana: Steve Scalise (01), Michael Johnson (04), Ralph Abraham M.D. (05), Garret Graves (06), Clay Higgins (03), Maryland: Andy Harris, M.D. (01)Michigan: Jack Bergman (01), Bill Huizenga (02), Paul Mitchell (10), John R. Moolenaar (04), Tim Walberg (07),Minnesota: Tom Emmer (06), Collin C. Peterson (07), Pete Stauber (08),Mississippi: Jim Hagedorn (01), Steve Palazzo (04)Missouri: Sam Graves (06), Vicky Hartzler (04), Trent Kelly (01), Billy Long (07), Blaine Luetkemeyer (03), Jason Smith (08), Ann Wagner (02)Montana: Greg Gianforte (AL)New York: Peter T. King (02), Lee Zeldin (01New Jersey: Mike Simpson (02), Christopher H. Smith (04)Nebraska: Don Bacon (02), Jeff Fortenberry (01), Adrian Smith (03)North Carolina: Ted Budd (13), Virginia Foxx (05), George Holding (02), Richard Hudson (08), Patrick McHenry (10), Mark Meadows (11), Gregory F. Murphy, M.D. (03), Mark Walker (06)North Dakota: Kelly Armstrong (AL), Dan Bishop (09), David Rouzer (07),Oklahoma: Tom Cole (04), Kevin Hern (01), Markwayne Mullin (02),Ohio: Troy Balderson (12), Steve Chabot (01), Warren Davidson (08), Bob Gibbs (07), Anthony Gonzalez (16), Bill Johnson (06), Jim Jordan (04), Doug LaMalfa (01), Robert E. Latta (05), Michael R. Turner (10), Brad Wenstrup, D.P.M. (02)Pennsylvania: John Joyce (13), Fred Keller (12), Mike Kelly (16), Daniel P. Meuser (09), Scott Perry (10), Guy Reschenthaler (14), Lloyd Smucker (11), Glenn “GT” Thompson (15)South Carolina: Jeff Duncan (03), Ralph Norman (05), Tom Rice (07), William Timmons (04), Joe Wilson (02)South Dakota: Dusty Johnson (AL)Tennessee: Tim Burchett (02), Chuck Fleishmann (03), Mark E. Green M.D. (07), Phil D. Roe, M.D. (01), John Rose (06), Texas: Jodey C. Arrington (19), Brian Babin, D.D. S. (36), Kevin Brady (08), Michael C. Burgess, M.D. (26), Michael Cloud (27), K. Michael Conaway (11), Dan Crenshaw (02), Bill Flores (17), Louis Gohmert (01), Lance Gooden (05), Kay Granger (12), Pete Olsen (22), John Ratcliffe (04), Chip Roy (21), Van Taylor (03), Randy Weber (14), Roger Williams (25), Ron Wright (06)Utah: Rob Bishop (01), John R. Curtis (03), Chris Stewart (02)Virginia: Ben Cline (06), Denver Riggleman (05), Rob Wittman (01)Washington: Dan Newhouse (04), Cathy McMorris Rogers (05)West Virginia: David B. McKinley, P.E. (01), Carol D. Miller (03), Alex X. Mooney (02),Wisconsin: Glenn Grothman (06), F. James Sensenbrenner (05), Brian Steil (01)Wyoming: Liz Cheney (AL) January 2, 2020: Emily’s List tweeted: “Abortion is under attack. Today, 207 members of Congress signed on to a briefing asking the Supreme Court to take up the issue of whether two crucial cases protection abortion – Roe v. Wade and Casey v. Planned Parenthood – should be “reconsidered and, if appropriate, overruled”. Emily’s List followed that tweet with another tweet: “The threat to abortion is here. It is real. It is urgent. That’s why it is so important to elect pro-choice Democratic women up and down the ballot across the country. Every single election.” January 2, 2020: Planned Parenthood Action tweeted: “Public: we support Roe v. Wade. 207 Anti-abortion politicians: hey SCOTUS, “if appropriate, overrule” what the people want. New year, same nonsense. January 3, 2020: Speaker Nancy Pelosi posted a press release on the Speaker’s official website titled: “Pelosi Statement on House Seeking Expedited Supreme Court Ruling on GOP’s ACA Lawsuit”. From the statement: Speaker Nancy Pelosi released the following statement as the House of Representatives filed a petition for a writ of certiorari in Republicans’ Texas v. U.S. lawsuit, asking the Supreme Court to act swiftly to uphold the Affordable Care Act in the face of the GOP’s effort to strike down the whole law. Last month, the 5th Circuit Court of Appeals had sided with Republicans and given instructions to the District Court to redetermine how much of the law to strike down, almost certainly delaying a final ruling into 2021 or later.“Everyday that Republicans’ anti-health care lawsuit is allowed to endure is a day that American families will be forced to live in uncertainty and fear. Unless the Supreme Court acts, families will continue to face needless disruption in their coverage and premiums, states will be unable to plan for the future and protections for people with pre-existing conditions will remain in peril.“The Trump Administration and its GOP allies want to delay judgement on the disaster they have sought to unleash on the health care of the American people, but there is no legal or practical justification for doing so.“The Supreme Court should hear this case now and recognize Congress’s clear intent to preserve protections for people with pre-existing conditions and other benefits and protections of the Affordable Care Act.” The writ of certiorari mentioned in the Speaker’s above statement can be viewed (as a PDF) here. January 3, 2020: New York Attorney General Letitia James posted a press release on her official website titled: “Attorney General James Seeks Supreme Court Review Of ACA Case”. From the press release: New York Attorney General Letitia James and a coalition – which includes 19 additional states and the District of Columbia – today filed a petition asking the U.S. Supreme Court to review a recent decision by the U.S. Court of Appeals for the Fifth Circuit in Texas v U.S. The decision affirmed a lower court’s ruling that the individual mandate of the Affordable Care Act (ACA) is unconstitutional, yet refused to rule on the validity of the rest of the ACA – calling into question whether the remaining provisions of the statute could still stand, including those that protect and provide coverage to Americans with pre-existing conditions. Because this decision causes uncertainty that may harm the health of millions of Americans – in addition to doctors, clinics, patients, and the healthcare market – Attorney General James and the coalition are petitioning the Supreme Court to take up the case and resolve it before the end of the court’s current term in June.The lawsuit – originally filed by a Texas-led coalition and supported by the Trump Administration – argued that Congress rendered the ACA’s individual mandate unconstitutional when it reduced the penalty for noncompliance with the law to $0. The plaintiffs further argued that the rest of the ACA should be held invalid as a result of that change. A coalition of attorneys general – that included New York – defended the ACA in its entirety, supported by a bipartisan group of amici, including scholars, economists, public health experts, hospital and provider associations, patient groups, countries, cities, and more. The Fifth Circuit held the individual mandate to be unconstitutional, but declined to further rule on the validity of the ACA’s remaining provisions. The court instead sent the case back to the Northern District of Texas to determine which provisions of President Obama’s signature health care law are still valid.Today’s petition makes clear that states, patients, doctors, hospitals, employers, pharmaceutical companies, and more will be impacted by the looming uncertainty caused by the Fifth Circuit’s decision. It asks the Supreme Court to review the case this term. The petition also highlights the important advancements in health care access made under the ACA, including: More than 12 million Americans now receive health coverage through the ACA’s Medicaid expansion;Nearly nine million individuals nationwide receive tax credits to help subsidize their health insurance coverage through individual marketplaces;Millions of working families rely on high-quality employer-sponsored health insurance plans;Important protections prohibit insurers from denying health insurance to the 133 million Americans with pre-existing conditions, like diabetes, cancer, or pregnancy, or from charging individuals higher premiums because of their health status; andNearly $1.3 trillion in federal funding has been dedicated to keeping Americans healthy and covered, which includes spending through Medicaid expansion and public health dollars. Filing today’s petition with Attorney General James are the attorneys general of California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Iowa, Massachusetts, Michigan, Minnesota (by and through its Department of Commerce), Nevada, New Jersey, North Carolina, Oregon, Rhode Island, Vermont, Virginia, Washington, and the District of Columbia, as well as the governor of Kentucky. January 3, 2020: California Attorney General Xavier Becerra posted a press release on his official website titled: “Attorney Genreal Becerra Leads Coalition Seeking Supreme Court Review of ACA Repeal Case”. From the press release: California Attorney General Xavier Becerra today, leading a coalition of 20 states and D.C., filed a petition to the U.S. Supreme Court seeking review of the Fifth Circuit’s recent decision in Texas v. U.S. The decision held the individual mandate of the Affordable Care Act (ACA) unconstitutional and called into question whether the remaining provisions of the ACA could still stand, including those that protect and provide coverage to Americans with pre-existing conditions. Because this decision causes uncertainty that may harm the health of millions of Americans, as well as doctors, clinics, patients, and the healthcare market, Attorney General Becerra and his coalition are petitioning the Supreme Court to take up the case and resolve it before the end of the Court’s current term in June.“While the Trump Administration fights to strip access to healthcare, our coalition moves forward to defend it – because a pre-existing medical condition should never again disqualify you from receiving affordable healthcare”, said Attorney General Becerra. “This dangerous repeal case jeopardizes the lives of our families, neighbors, and millions of Americans who rely on the ACA for their healthcare. We’ll continue to fight because our communities are healthier when everyone can access affordable care – whether that means gaining coverage from Medicaid expansion or by staying on a parent’s health insurance. We’re asking the Supreme Court to swiftly resolve this repeal lawsuit for the sake of saving lives and ending uncertainty in our healthcare system.”… January 3, 2020: Law.Com posted an article titled: “Donald Verrilli Returns to SCOTUS to Defend Obamacare”. It was written by Jacqueline Thomsen. From the article: The U.S House of Representatives and a Democratic group of state attorneys general on Friday placed the issue of the Affordable Care Act before the Supreme Court again, asking justices to review an appellate court decision that struck down the health care law’s individual mandate as unconstitutional.Alongside their petitions for writ of certiorari filled with the court, both the state officials and the House separately asked the justices to take up the matter on an expedited basis and schedule oral arguments for this spring.If the Supreme Court agrees to follow that schedule, that means an opinion could come down just months ahead of the 2020 presidential election, placing healthcare at the heart of the political debate……And the House’s petition, signed on by former Solicitor General Donald Verrilli, who previously defended the Affordable Care Act before the Supreme Court, said the Fifth Circuit ruling “has created an intolerable situation”… January 7, 2020: New York Attorney General Letitia James posted a press release on her official website titled: “Attorney General James Fights To Stop Restrictions On Women’s Reproductive Rights From Taking Effect”. From the press release: New York Attorney General Letitia James, along with a coalition of 19 additional attorneys general from around the nation, today filed a multistate amicus brief in support of a lawsuit that seeks to protect a woman’s right to safe and legal abortion care without the burdensome restrictions imposed by Arkansas laws. The brief – filed in support of the plaintiffs in Little Rock Family Planning Services v. Leslie Rutlidge, now before the Eighth Circuit Court of Appeals – supports the last surgical abortion clinic in Arkansas as it challenges four state laws that would restrict the ability for women in Arkansas to access abortions by banning abortions after 18 weeks and otherwise restricting women’s access to reproductive care.“Roe v. Wade has been the law of the land for 47 years and despite attempts by politicians across the country to undermine this national precedent and assert control over women’s bodies, we will not go backwards,” said Attorney General James. “We will continue to be relentless in our defense of a woman’s right to choose, relentless in safeguarding women’s freedoms, and relentless in protection the ability for women to control their own bodies. Our coalition won’t allow Arkansas, nor any other state, to make it harder for women to exercise their constitutional right to an abortion. And we will continue to use every legal tool available to prioritize the health, safety, wellness, and rights of women.”In March of last year, the governor of Arkansas signed into law several bills intended to restrict a woman’s access to abortion services throughout the state. The laws would criminalize abortions performed after 18 weeks and impose additional undue burdens on a woman’s constitutional right to an abortion. The Little Rock Family Planning Services clinic argues that these laws would make abortion care unavailable and health care services less safe for women.In July, the U.S. District Court for the Eastern District of Arkansas granted a preliminary injunction and temporarily blocked the laws restricting abortion care from taking effect. The State of Arkansas appealed the decision to the Eighth Circuit Court of Appeals shortly thereafter.In the brief filed today, Attorney General James and the coalition of attorneys general argue that the Arkansas laws violate a woman’s constitutional right to choose under Roe v Wade. The coalition further argues that limiting or eliminating women’s access to safe and legal abortion leads to worse health and socioeconomic outcomes for women.In July, the U.S. District Court for the Eastern District of Arkansas granted a preliminary junction and temporarily blocked the laws restricting abortion care from taking effect. The State of Arkansas appealed the decision to the Eighth Circuit Court of Appeals shortly thereafter.In the brief filed today, Attorney General James and the coalition of attorneys general argue that the Arkansas laws violate a woman’s constitutional right to choose under Roe v. Wade. The coalition further argues that limiting or eliminating women’s access to safe and legal abortion leads to worse health and socioeconomic outcomes for women. The brief describes the different ways that states can promote women’s health without impeding women’s rights upheld by the U.S. Constitution. Today’s brief is just the latest action in a long list of measures Attorney General James has taken to protect women’s reproductive freedom. Last month, Attorney General James filed an amicus brief defending the right to maintain full and equal access to birth control guaranteed under the Affordable Care Act for tens of thousands of women nationwide… January 7, 2020: California Attorney General Xavier Bacerra posted a press release on his official website titled: “Attorney General Becerra Leads Multistate Amicus Brief Defending Women’s Reproductive Rights”. From the press release: California Attorney General Xavier Becerra today led a multistate coalition in filing an amicus brief in Eighth Circuit Court of Appeals in support of the plaintiffs in Little Rock Family Planning Services v. Leslie Rutledge, a lawsuit that seeks to protect a woman’s right to safe and legal abortion care. The multistate coalition supports the last surgical abortion clinic in Arkansas in its challenge to four state laws that would restrict women’s access to safe and legal abortion by banning abortion after 18 weeks and otherwise restricting women’s access to reproductive care.“We’re standing up to protect women’s rights,” said Attorney General Becerra. “No woman should be blocked from making health decisions about her body that she is entitled to under the Constitution. We will continue to fight to ensure that all women can access affordable comprehensive reproductive healthcare.”.. A copy of the brief is available here. January 7, 2020: HuffPost posted an article titled: “Trump Administration Quietly Goes After Disability Benefits”. It was written by Arthur Delaney. From the article: Some Americans could lose Social Security Disability Insurance benefits under a recent Trump administration proposal – a change that could affect thousands of people but that has recieved little attention since it was first floated in November.Under the proposed change, the government would look more closely at whether certain disability recipients still qualify as “disabled” after they’ve already been awarded those benefits. While recipients already have to demonstrate their continuing disability every few years, the proposal would ramp up the examinations, potentially running still-eligible beneficiaries out of the program.The extra reviews will help “maintain appropriate stewardship of the disability program,” the administration said in the proposal, arguing current rules fail to account fully for the possibility of medical improvement……Democrats and disability advocates said the proposed new regulation would only hurt disabled people, that it hasn’t been vetted and that the rule-making process should be delayed. More than 8 million of Americans recieve disability benefits based on past employment and a loss of wage income due to the onset of a severe disability……The regulation could affect hundreds of thousands of SSDI and Supplemental Security Income recipients, [Kathleen] Romig [senior policy analyst at Center on Budget and Policy Priorities] said, potentially ending benefits for tens of thousands. The administration didn’t estimate how many would lose benefits, but said the proposal would save over $2.6 billion over a decade.The rule would not take effect until sometime after the administration releases a final version, for which no date has been set – and as with other regulations the administration has issued without imput from Congress, a lawsuit could stop it……The draft rule would add a new category: medical improvement likely, as in likelier than possible, but not as likely as expected. Reviews would occur “approximately every two years,” as opposed to within 18 months for people with expected medical improvement and within three years for those with possible improvement. Overall, according to the administration, there would be 2.6 million more reviews, an 18% increase, at an anticipated cost of $1.8 billion – almost wiping out the $2.6 billion worth of savings on benefits… January 7, 2020: Senator Bernie Sanders tweeted: “10,000 Americans died waiting for Social Security Disability Insurance in 2017. Instead of addressing this crisis, Trump wants to make it harder for people with disabilities to get the help they need to get by. Unacceptable. We must protect and expand SSDI and SSI.” This tweet was the start of a short thread. January 7, 2020: Senator Bernie Sanders tweeted: “As president, I will reverse this disastrous rule on day one of my presidency. Together, we will guarantee every person with a disability the right to live in the community with dignity and independence.” January 9, 2020: Cal Matters posted an article titled: “Gov. Gavin Newsom to propose that California manufacture its own generic drugs”. From the article: In a bold strategy to drive down prescription drug prices, Gov. Gavin Newsom is proposing that California become the first state in the nation to establish its own generic drug label, making those medications available at an affordable price to the state’s 40 million residents.The proposal, part of the new state budget Newsom is expected to send to the Legislature on Friday, would authorize the state to negotiate contracts with drugmakers to manufacture selected prescriptions on behalf of California. Such a disruption of the pharmaceutical industry, proponents say, would leverage the state’s massive market to increase competition and lower generic drug prices nationally.The strategy is one of several the Democratic governor plans to recommend to lower the cost of health care for Californians. The administration released only a summary of the proposal on Thursday without the projected price tag, but indicated that it’s part of a multi-prong effort that includes strenghtening the state’s public option for health insurance and increasing drug pricing transparency.Newsom will also continue last year’s push to establish a single drug market for drug pricing, direct the state to ask for more rebates from drug manufacturers, and open a new health care affordability office sometime this spring… January 10, 2020: Sacramento Bee posted an article titled: “From housing to health care: Here’s what’s in Gavin Newsom’s $222 billion California state budget”. It was written by Sophia Bollag. For the purpose of this blog post, I am only including the parts of the budget that are related to health care. ..Newsom is also calling for a “once-in-a-generation” revamp of Medi-Cal to increase preventative health services, boost assistance for homeless people and improve mental health care.His plan would also steer nearly $700 million in addition money to the program.His budget would allow undocumented people over the age of 65 to enroll in Medi-Cal, provided they meet the program’s income requirements. That proposal builds on the current budget’s Medi-Cal expansion to undocumented young adults.The budget proposal also contains ambitious plans to cut prescription drug costs, including creating a state-owned generic drug label and a single drug purchasing market in California… January 10, 2020: Human Rights Watch posted an article titeld: “US: ‘Unailenable Rights’ Commission Risks Rights Protections.” From the article: The United States State Department’s Commission on Unalienable Rights risks calling for a dangerous downgrading of international human rights protections. On January 10, 2020, the Human Rights Watch executive diretor, Kenneth Roth, testified at the commission’s fourth open session.While the fundamental rights set out in the human rights treaties are clear, the Trump administration has taken issue with the rights they uphold, such as reproductive freedom, or the rights of LGBT people not to face discrimination. Human Rights Watch expressed concern that the commission’s exercise in identifying “unalienable” rights is the administration’s unilateral attempt to rewrite international law basd on its own beliefs.“The US Government’s voice is needed on human rights, but it should be a voice that upholds the principled defense of all rights, not a pick-and-choose approach,” Roght said. “Repressive governments frequently justify their human rights violations by claiming that some rights are more important than others. If the Trump administration adopts its own selective approacth to human rights, it will only facilitate this classic excuse to evade the requirements of international rights law.”Secretary of State Mike Pompeo announced the formation of the commission in July 2019 to advice on the promotion of human rights in foreign policy. The commission has yet to announce the form of its final product or the role that open session testimony will have in shaping that final product. Though the commission’s meetings are open to the public, it has not provided any publicly available record or transcript of testimony.The commission’s first step should be changing President Donald Trump’s own approach to foreign policy and human rights, Human Rights Watch said.“As long as the president embraces autocrats and dictators, expressing envy of their ability to silence or compromise the democratically essential checks and balances on their authority, the US government will have little credibility on human rights,” Roth said. January 13, 2020: The U.S. House of Representatives Ways and Means Committee posted a press release titled: “Neal, Larson, and Davis Slam Harmful Draft Social Security Rule. From the press release: Today, Ways and Means Committee Chairman Richard E. Neal (D-MA), Social Security Subcommittee Chairman John B. Larson (D-CT), and Worker & Family Support Subcommittee Chairman Danny K. Davis (D-IL) released the following statement regarding reports of a draft Social Security Administration (SSA) rule that would narrow the eligibility criteria for Social Security and Supplemental Security Income (SSI) disability benefits:“Yet again, the Trump Administration is going out of its way to make life more challenging for the most vulnerable people in our country. The United States government has extremely stringent disability standards. In fact, fewer than four in 10 applicants are found eligible for Social Security disability benefits, even after all levels of appeal. This rule would further restrict eligibility, making it even harder for disabled people to access the essential income they’re qualified to recieve. We are particularly alarmed that news of this latest proposal comes on top of the Administration’s recent efforts to cut off benefits for severely disabled people whom the agency already found eligible.“Instead of working to strip disability benefits from people who qualify, the SSA should focus on its truly pressing problems. Resources should go toward cutting lengthy wait times on the phone and at field offices, eliminating benefit backlogs, and hiring personnel to improve the agency’s lacing services.“We strongly urge the Trump Administration to reject this curel proposed rule and reassess SSA’s priorities.” January 13, 2020: New York Attorney General Letitia James posted a press release on her official website titled: “AG James Stops Public Charge Rule From Taking Effect”. From the press release: New York Attorney General Letitia James issued the following statement after the United States Court of Appeals for the Second Circuit denied the Trump Administration’s efforts to immediately reverse a nationwide preliminary injunction on the president’s Public Charge Rule:“Today is a victory for the millions of immigrants in our state and in this country that have been sidelined, disrespected, and demeaned by the Trump Administration. Generations have come to this country with nothing more than a dream in their pockets, but the president’s Public Charge Rule is an egregious attempt to infringe upon the values of our nation. The court’s decision to enforce the preliminary injunction and block the president from expediting his plan to discriminate against communities of color is welcome news to millions across New York and this country. We remain committed to fighting against this misguided rule and will continue to pursue every legal took available to permanently stop it.”In August 2019, Attorney General James and a coalition that includes the attorneys general of Connecticut and Vermont, as well as the City of New York, filed a lawsuit challenging the Trump Administration’s Public Charge Rule, which aims to deny green cards to immigrants that use or have used government assistance programs. The program specifically targets immigrants of color, while putting these communities at risk, and would have short and long-term impacts on public health and the economy.In September, Attorney General James and the coalition filed a motion for a preliminary injunction to stop the rule from going into effect. After the court order the preliminary injunction, President Trump and his Administration filed to stay the order but were denied in their efforts today.The overall health and wellbeing of New York’s immigrant communities that use vital public benefit programs would be negatively impacted by the Public Charge Rule. Additionally, with the anticipated decline in Medicaid enrollment, individuals who would have otherwise had access to healthcare are at risk of living with undiagnosed and untreated conditions. Economically, impacted communities can be expected to experience increased poverty rates, housing instability, a reduced workforce, and an overall decrease in total economic productivity. January 13, 2020: Speaker Pelosi tweeted: “130 million Americans live every day with pre-existing conditions. They depend on knowing their health care, secured by protections in the ACA, is there when they need it. #ProtectOurCare” January 13, 2020: Senator Sherrod Brown tweeted: “The Affordable Care Act’s Medicaid expansion is our number one took to get Ohioans the addiction treatment they need – and President Trump wants to take it away. We must #ProtectOurCare.” The tweet included a link to a Washington Post article titled “Medicaid expansion may have saved thousands from overdose deaths”. January 13, 2020: Representative Vicente Gonzalez tweeted: “Our government should be fighting to ensure Americans have access to quality, affordable health care without facing discrimination based on their pre-existing conditions – not working to take it away from millions! #ProtectOurCare” January 13, 2020: Representative Bill Foster tweeted: “If @realDonaldTrump gets his way, families across the country will see their costs go up as they lose pre-existing condition protections. I’m fighting to #ProtectOurCare for the 314,000 residents of my district who live with pre-existing conditions. January 13, 2020: Representative Zoe Lofgren tweeted: “I’m fighting for people living with pre-existing conditions in CA-19 & all around the country. If the GOP’s Texas v US lawsuit strikes down the Affordable Care Act, millions of Americans will lose vital protections & access to care. We must #ProtectOurCare!” January 13, 2020: Representative Ted Lieu tweeted: “If Trump gets his way, families in #CA33 and across the country will see their health care costs go up as they lose pre-existing condition protections. We can’t let it happen. #ProtectOurCare”. Here are a few tweets from President Trump: January 13, 2020: President Trump tweeted: “Mini Mike Bloomberg is spending a lot of money on False Advertising. I was the person who saved Pre-Existing Conditions in your Healthcare, you have it now, while at the same time winning the fight to rid you of the very unpopular Individual Mandate… January 13, 2020: President Trump tweeted: “…and if Republicans win in court and take back the House of Representatives, your healthcare, that I have now brought to the best place in many years, will become the best ever, by far. I will always protect your Pre-Existing Conditions, the Dems will not! January 13, 2020: President Trump tweeted: “I stand stronger than anyone in protecting your Healthcare with Pre-Existing Conditions. I am honored to have terminated the very unfair, costly and unpopular individual mandate for you!” In the above tweets, President Trump is spouting propaganda. His words do not match his actions in the previous years regarding American’s health care. (For more details, read my previous blogs about the ways Republicans and Trump have been trying to take away American’s health care.) January 14, 2020: Senator Bob Casey tweeted: “If the ACA is overturned: Women lose protections against discrimination in health care settings. Insurance companies will be able to charge women more than men. Women lose essential protections for breastfeeding including vital workplace standards. #ProtectOurCare.” January 14, 2020: Senator Doug Jones tweeted: “Folks, I know there’s a lot going on right now, but we can’t forget about the nearly 1M Alabamians living with pre-existing conditions whose health coverage is under attack right now. We need to stand up to #ProtectOurCare.” January 15, 2020: The Star Tribune Editorial Board posted an Editorial titled: “Waiting game on the Affordable Care Act isn’t healthy”. From the editorial: Patients, seniors, doctors, hospitals, state lawmakers and voters are owed a swift answer from the U.S. Supreme Court about whether the Affordable Care Act (ACA) will survive the latest challenge to its existence. The court needs to remove the uncertainty hovering ominously over this landmark measure, one whose sprawling web of assistance programs consumers, hospitals and states have come to rely on for quality, accessible care.That the fate of the 2010 law is dependent on the courts for the third time in a decade is exasperating. Twice already, battles over the ACA’s constitutionality have been fought all the way to the Supreme Court. Twice, justices have upheld the law. Now, a third challenge, one that’s essentially a vanity project led by a headline-seeking Texas attorney general, is gaining ill-deserved momentum.The legal argument in this dubious Texas lawsuit is the flip side of the original 2012 Supreme Court challenge to the law. Back then, the ACA’s earliest opponents argued that the law was unconstitutional because it required people to buy insurance. The Texas AG now argues that the law is unconstitutional because Congress essentially gutted the purchase requirement in 2017 during an end-of-the year tax bill……The implications are enormous. Millions of Americans depend on the financial aid the law provides to buy private insurance. In Minnesota, the average household that applied for help through MNsure received $5,244 to buy coverage in 2020. That aid could be gone next year or in the future. The fate of the Medicare “doughnut hole” is equally uncertain, leaving seniors with frightening questions about how they’ll be able to afford medications… January 15, 2020: Senator Sheldon Whitehouse tweeted: “If Trump and the GOP succeed in overturning the Affordable Care Act, millions of Americans will lose coverage and access to life-saving prescription drugs. This is a fight for basic human rights. #ProtectOurCare”. January 15, 2020: America’s Health Insurance Plans posted a statement on their website titled: “AHIP Issues Statement Upon Filing an Amicus Brief with the Supreme Court Requesting Certiorari in TX v US”. From the statement: Matt Eyles, president and CEO of America’s Health Insurance Plans (AHIP), issued this statement as the association filed an amicus brief with the Supreme Court requesting certiorari in TX vs US and timely consideration of the validity of the Affordable Care Act (ACA):“Every American deserves affordable coverage and high-quality care. This has been – and always will be – our committment.“The district court’s original decision to invalidate the entire ACA was misguided and wrong. We urge the Supreme Court to grant certioari and remove the overhanging legal uncertainty that undermines the stability of coverage for nearly 300 million Americans, and that inhibits greater and faster progress to improve coverage and care for everyone.“As we indicated in our brief, returning this case to the district court on remand only delays what Congress has unmistakably indicated through its actions: that the ACA should continue in operation despite its zeroring out of the mandate. We are confident that the Supreme Court will ultimately recognize that zeroing out the mandate was never intended to wreak havoc across the entire American health care system.“As we continue to engage in the legal process, health insurance providers remain committed to serving all of their members, and to strengthening affordability, access, and choices for every American.” January 16, 2020: Planned Parenthood posted a press release titled: “Planned Parenthood Condemns Proposed Rules that Would Grant Recipients License to Discriminate”. From the press release: Today, as part of a series of similar rules released across several federal agencies, the Trump-Pence administration’s Department of Health and Human Services (HHS) and U.S. Agency for International Development (USAID) proposed religious refusal rules that would strip away critical protections from people rely on federally funded health and social services programs both domestically and abroad. The rules also make it substantially easier for faith-based organizations to receive tax-payer funding while simultaneously promoting their religion. They would eliminate protections that require faith-based organizations to notify people that they are serving about their rights, and refer them to other services providers if desired.This is the latest in a long line of dangerous policies that could impact peoples’ abilities to access HIV and STI prevention programs, reproductive health services and other vital health care; youth homelessness services; and foster care and adoption services. They represent a concerted effort by the Trump-Pence administration across the federal government to attack access to sexual and reproductive health care and other services by taking funds from qualified providers and give them to religious entities that may not provide comprehensive services……Discrimination in health care already prevents too many LGBTQ people from accessing care. According to the 2015 U.S. Transgender Survey, 33 percent of respondents who sought health care in the last year experienced mistreatment, including violence, because they were transgender – and nearly one-quarter avoided seeking health care service when they needed them out of fear of discrimination. Nearly one-third of transgender people surveyed said a doctor or health care provider refused to treat them due to their gender identity.When women are denied access to the full range of reproductive services, rates of unintended pregnancy, maternal mortality, mental health conditions, and sexually transmitted infections increase. Access to contraception also impacts women’s educational attainment, participation in the workforce, and economic growth. January 16, 2020: The American Civil Liberties Union (ACLU) posted a news article titled: “Arkansas Legislators’ Attack on Abortion is Unconstitutional.” It was written by Michele Goodwin and David S. Cohen. From the article: The U.S. Supreme Court has ruled time and time again that reproductive privacy is “central to personal dignity and autonomy, [which] are central to the liberty protected by” the Constitution. The Court has made eminently clear that under the Constitution, the right of a pregnant person to terminate a pregnancy prior to viability is a right so essential to our freedom that our government cannot ban or impose an undue burden on its exercise. But despite long-standing clarity of this principle, reproductive health and rights continue to come under blistering, unrelenting attack……Enough is enough. That’s why we, along with our colleagues and fellow scholars in constitutional law, filed a friend of the court brief in the 8th Circuit last week, speaking up against Arkansas’s recent attempts to interfere with the right to reproductive autonomy. Right now, Arkansas is asking the 8th Circuit to overturn a lower court order that blocked a set of abortion bans and restrictions the state passed last year from taking effect. These laws include: a ban on doctors performing abortions prior to viability if the abortion is sought after 18 weeks (18-weeks ban); a ban on doctors performing abortions prior to viability if the doctor has “knowledge” that the abortion is sought “solely” due to a belief that the fetus may have Down syndrome (reason ban); and a medically unnecessary restriction on the types of physicians who can perform abortion in the state, which would prohibit all qualified providers who are not board-certified or board-eligible in obstetrics and gynecology from continuing to provide the safe, compassionate abortion care they have been providing in Arkansas for years (OBGYN requirement).Arkansas insists that its two bans on pre-viability abortion are not actually bans but merely “regulations.” This is nothing but Orwellian subterfuge. We know a ban when we see one and so do people looking to terminate their pregnancies. Regulations are laws that control how a right can be exercised. Bans prohibit a right from being exercised at all. And that is exactly what the 18-week ban and reason ban would do if permitted to take effect……Thankfully, a district court saw through Arkansas’s sophistry and phony justifications and preliminary enjoined the state’s two bans on abortion prior to viability and OBGYN requirement, with a decision rooted in long-standing precedent and bedrock precedent of justice. Let’s hope the Eight Circuit Court of Appeals follows our brief and heeds the wisdom of the lower court, preserving not only that decision but also the civil rights and civil liberties of all people who want to terminate a pregnancy. January 16, 2020: New York Attorney General Letitia James posted a press release on her official website titled: “Multiple Groups Join Attorney General James in Urging Supreme Court To Take Up ACA Case”. From the press release: New York Attorney General Letitia James today announced that a diverse group of bipartisan patient groups, hospitals, health care providers, insurance companies, economists, and others filed multiple amicus briefs supporting a multistate effort to defend the Affordable Care Act (ACA). The amici urge the U.S. Supreme Court to grant expedited review of the coalition’s case and argue that such review is necessary to protect America’s health care system and the well-being of Americans across the nation.“Despite what the president may tweet, all he wants to do is strip health care away from 133 million Americans with pre-existing conditions, make it harder for children and young people to obtain coverage, and charge Americans more for health care,” said Attorney General James. “Obamacare has been the law of the land for a decade, but President Trump and his Administration continue to look for ways to chip away all the protections of the health care reform law. A wide-ranging and diverse group of organizations is joining our fight today to protect the ACA because health care should be a right every American has access to, not a privilege for a select few.”The amicus briefs filed today support the state coalition’s request for the Supreme Court to review a recent decision by the U.S. Court of Appeal for the Fifth Circuit that upheld a lower ruling finding the ACA’s individual mandate to be unconstitutional, and that simultaneously called into question whether the remaining provisions of the law could still stand. The state coalition has asked that the Supreme Court grant expedited review of this decision and decide the case before the court’s term ends in June – a resolution that is needed to alleviate the uncertainty created by this litigation.The ACA – also known as Obamacare – contains hundreds of protections that countless Americans rely on for health care, including: Prohibiting insurers from denying health insurance to the 133 million Americans with pre-existing conditions (like diabetes, cancer or pregnancy) or from charging individuals higher premiums because of their health status;Allowing young people, up to the age of 26, to stay on their parents’ insurance; Expanding Medicaid to provide health coverage to more than 12 million Americans, including young children and babies;Providing tax credits and financial assistance to nine million low- and middle-income individuals and families, so they can access affordable health coverage through the ACA marketplace; andPreventing insurance companies from imposing lifetime and yearly insurance limits, among other benefits. Amicus briefs in support of the state coalition’s request for expedited review by the Supreme Court were filed by America’s Health Insurance Plans (AHIP), National Hospital Associations; Small Business Majority Foundation, American Cancer Society, et al, State Hospital Associations, AARP, et all, and Bipartisan Scholars.Joining Attorney General James in defending the ACA are the attorneys general of California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Iowa, Massachusetts, Michigan, Minnesota (by and through its Department of Commerce), Nevada, New Jersey, North Carolina, Oregon, Rhode Island, Vermont, Virginia, Washington, and the District of Columbia, as well as the governor of Kentucky. January 16, 2020: California Attorney General Xavier Becerra posted a press release on his official website titled: “Diverse, Bipartisan Coalition Supports Attorney General Becerra’s Defense of the ACA, Urges Supreme Court to Act”. From the press release: California Attorney General Xavier Becerra today announced that a diverse group of bipartisan economists, patient groups, hospitals, healthcare providers, healthcare insurance companies, and others filed amicus briefs defending the Affordable Care Act. The diverse coalition of amici supports California’s state coalition in its fight to protect the Affordable Care Act. The amici urge the Supreme Court to grant review of California’s case and argue that it is necessary to protect America’s healthcare system and the well-being of Americans across the nation.“For nearly a decade, the Affordable Care Act has been the backbone of our nation’s healthcare, paving the way toward better care with protections that keep our loved once healthy and covered,” said Attorney General Becerra. “Our healthcare should never be used as a political football – people’s health isn’t a game, it’s a matter of life and death. Today, a bipartisan coalition of legal experts, patient and physician advocates, economists, and public health experts agree: This repeal lawsuit will cause immense harm and uncertainty, so our fight to save affordable healthcare must go all the way to the Supreme Court.”… January 16, 2020: The National Women’s Law Center posted a press release titled: “Federal Court Allows Challenge to Proceed Against Trump Administration and University of Notre Dame’s Back-Room Birth Control Agreement”. From the press release: Today, the U.S. District Court from the Northern District of Indiana ruled to allow a lawsuit brought by the National Women’s Law Center (NWLC) Americans United for Separation of Church and State (Americans United), the Center for Reproductive Rights (CRR), and law firms Fried Frank and Macey Swanson to proceed against the Trump-Pence Administration and University of Notre Dame.The lawsuit is brought on behalf of student group Irish 4 Reproductive Health and others on Notre Dame’s health plan and challenges the unlawful settlement agreement between the Administration and the University of Notre Dame that denies students and employees coverage of birth control guaranteed to them by the Affordable Care Act. It also challenges rules issued by the Trump-Pence Administration that allow virtually any employer or university to take birth control coverage away from employees and students. The court denied the Administration’s and University’s attempt to dismiss the lawsuit.The following is a statement by Fatima Goss Graves, president and CEO of the National Women’s Law Center (NWLC):“Today’s ruling sends a clear message to the Trump-Pence Administration that it cannot deny birth control coverage by entering into backroom deals or issuing unlawful rules. The Administration is once again trying to circumvent the law, and it must end. This is a win not only for Notre Dame students, but for everyone seeking access to birth control. We will keep fighting until every person across the country has the birth control coverage guaranteed to them by law, no matter where they work or go to school.” January 16, 2020: The American Civil Liberties Union (ACLU) of South Dakota posted a press release titled: “ACLU of South Dakota Opposes House Bill 1057”. From the press release: The ACLU of South Dakota opposes House Bill 1057, a bill that would criminalize doctors for providing medically necessary care for transgender youth.The bill, which was introduced Tuesday, would make it a felony for medical providers to treat youth consistent with evidence-based treatment protocols. HB 1057 continues the streak of bills that would codify discrimination against transgender youth that the South Dakota Legislature has attempted to pass over the last five years.Like all health care, health care for transgender youth is individualized and based on the needs of each particular person. This bill would take away private health care choices around the provision of medical care consistent with prevailing medical and scientific standards. Such choices should be made between a doctor and a patient, not politicians……By blocking medical care supported by every major medical association, including the American Academy of Pediatrics and the American Medical Association, the legislature is compromising the health of trans youth is dangerous and potentially life-threatening ways. Research shows that transgender youth whose families affirm their gender identity have a 52 percent decrease in suicidal thoughts, a 48 percent decrease in suicide attempts and significant increases in self-esteem and general health.No other state has passed a law like HB 1057. It is unconstitutional to single out one group of people and categorically ban all care, no matter how medically necessary… January 16, 2020: Governor Phil Murphy posted a press release on his official website titled: “Governor Murphy Signs Legislative Package Protecting the Affordable Care Act in New Jersey”. From the press release: Governor Phil Murphy today signed a package of bills to safeguard the provisions of the Affordable Care Act (ACA) in New Jersey. The bills, which will codify into state law the basic protections for health care consumers that are part of the Affordable Care Act, include protections for no-cost preventative care and contraception, prohibt exclusions for pre-existing conditions, allow children to stay on their parents’ plan until age 26 and incorporate mental health and maternity care as part of essential benefits, among others. The Governor highlighted the importance of these bills during an armchair discussion with Hackensack Meridian Health Chief Executive Office Bob Garrett… The Governor signed the following bills into laws: A5500 Expands rate review process in DOBI for certain individual and small employer health plans.AB5501 Requires continuation of health benefits dependent coverage until child turns 26 years of age.A5503 Establishes open enrollment period under Individual Health Coverage PlansA5504 Applies 85 percent loss ratio requirement to certain large group health benefits carriersA5506 Repeals statute authorizing offering of “Basic and Essential” health benefits plans under individual health benefit plans and other statutes concering basic health plans; makes confirming amendments.A5507 Requires health benefits coverage for preventative services.A5508 Revises law requiring health benefits coverage for contraceptivesA5248 Preserves certain requirements that health insurance plans cover essential health benefitsS626 Clarifies prohibition on preexisting condition exclusion in health insurance policies. As a clarification, A5508 is described as: “Federal changes to the Affordable Care Act aimed to jeopardize women’s access to safe, preventative care. This new law will remove those obstacles in New Jersey and preserve the benefits afforded to residents’ under the ACA. With this law, women will continue to have insurance that covers contraception without having to pay out of pocket.” January 16, 2020: The American Civil Liberties Union (ACLU) posted an article titled: “Lawmakers Playing Politics with Trans Kids’ Lives at the Start of the Decade”. It was written by Chase Strangio, Deputy Director for Transgender Justice. From the article: We’re just days into the first state legislative sessions of 2020 and across the country, lawmakers are once again targeting transgender young people with a slate of proposed laws that would bring devastating harms to the transgender community.In 2016, lawmakers fixated on where transgender people go to the bathroom. This year, lawmakers are zeroed in on transgender people playing sports and receiving life-saving medical care. It’s hard to imagine why state legislators have decided to prioritize barring transgender young people from sharing in the benefit of secondary school athletics or disrupting medical treatment consistent with prevailing standards of care. But here we are, the state of a session, a time to fight.As has been the case since 2015, South Dakota is leading the way with legislation targeting transgender youth. On the first day of this legislative session, South Dakota lawmakers introduced HB 1057, a bill that would make it a felony for medical providers to affirm a transgender minor’s gender. This bill would not only compromise positive health outcomes for transgender youth, but it would lead to the arrest and imprisonment for doctors simply for treating patients consistent with prevailing medical standards……Denying best practice medical care and support to transgender youth can be life-threatening. It has been shown to contribute to depression, social isolation, self-hatred, risk of self-harm and suicidal behavior, and more. The “problem” this bill and other similar bills in Florida, South Carolina, and Missouri is supposed to be addressing? That medical providers are treating children in accordance with long-established standards of medical care and the Hippocratic oath they took to do no harm.Lawmakers want to stop people from being transgender and they are willing to put doctors in jail and tell transgender youth that they shouldn’t receive health care in order to achieve their aims… January 17, 2020: Representative Hakeem Jeffries tweeted: “More than 100 million ppl have a preexisting condition. President Obama’s leadership provided healthcare protection for these Americans. Donald Trump is trying to strip it away. Those are the FACTS.” January 17, 2020: Reuters posted an article titled: “Supreme Court to hear Trump appeal in Obamacare contraception fight”. It was written by Lawrence Hurley. From the article: The U.S. Supreme Court on Friday took up an appeal by President Donald Trump’s administration seeking to enforce new federal rules allowing employers to obtain religious exemptions from an Obamacare requirement that health insurance that they provide to employees pays for women’s birth control.At issue is a challenge by the states of Pennsylvania and New Jersey to the administration’s 2018 rule that permits broad religious moral exemptions to the Affordable Care Act’s contraception mandate and expands accommodations already allowed under the 2010 law dubbed Obamacare. The administration has asked the Supreme Court to reverse a nationwide injunction issued by a lower court blocking the rule from taking effect.Arguments in the case before the high court, which has a 5-4 conservative majority including two justices appointed by Trump, are likely to be in April with a ruling due by the end of June……The legal question is whether Trump’s administration had legal authority to expand the exemption both under the Obamacare law itself and another federal law, the Religious Freedom restoration Act, which allows people to press religious claims against the federal government.The Philadelphia-based 3rd U.S. Circuit Court of Appeals last year upheld a nationwide injunction issued by a district court judge in the lawsuit by New Jersey and Pennsylvania, blocking implementation of the rule. Separately, the San Francisco-based 9th U.S. Circuit Court of Appeals last year upheld a lower court’s injunction on blocking the rule in a group of 14 states… January 17, 2020: Senator Bob Casey tweeted: “The ACA dramatically reduced racial disparities in health insurance coverage. In PA alone, the uninsured rate among Black and Hispanic adults each decreased by more then 11% from 2013 to 2018. This obscene Republican lawsuit threatens these gains. We must #ProtectOurCare” January 17, 2020: CBS News posted an article titled: “Supreme Court to hear Obamacare birth control case”. From the article: The Supreme Court will weigh in on contraceptive coverage under the nation’s health care law this term, agreeing to hear a case involving the Obamacare rule requiring large companies to help pay for their employees’ birth control. The high court will review whether the Trump adminisration was on solid ground when it gave religious employers and universities broader religious and moral exemptions to the Obamacare contraception mandate, which requires health care plans to offer free birth control.This is another case involving the Little Sisters of the Poor, an order of Roman Catholic nuns that objected to the birth control mandate and prevailed in its request from the Supreme Court for a religious exemption in 2016.Now the court will consider allowing the Trump adminisration to enforce rules that allow more employers to deny coverage for contraceptives to women.The case is likely to be heard in April. The Supreme Court will review an appeals court ruling that blocked the Trump administration rules because it did not follow proper procedures. The new policy on contraception, issued by the Department of Health and Human Services (HHS), would allow more categories of employers, including publicly traded companies, to opt out of providing no-cost birth control to women by claiming religious objections.The policy would also allow some employers, though not publically traded companies, to raise moral objections to covering contraceptives… January 17, 2020: National Women’s Law Center posted a press release titled: “SCOTUS to Hear Case That Threatens Access to Birth Control, Says NWLC”. From the press release: Today, the Supreme Court decided to hear a case – Trump v. Pennsylvania – that will determine whether employers and schools can deny insurance coverage of birth control to employees and students.In November 2018, the Trump-Pence administration finalized rules to undermine Affordable Care Act’s birth control benefit by allowing virtually any employer or university to deny birth control coverage otherwise required by law. These rules were challenged in courts across the country including by the National Women’s Law Center. In a case brought by Pennsylvania and New Jersey, the 3rd Circuit Court of Appeals issued a nationwide injunction blocking the rules.The following is a statement from Fatima Goss Graves, President and CEO of the National Women’s Law Center:“Birth control should never be determined by where someone lives or goes to school. The Supreme Court should affirm the lower court’s decision that these rules are illegal and harmful. We won’t stop fighting until all people have access to birth control despite these vicious attacks by the Trump-Pence administration.” January 17, 2020: Planned Parenthood posted a press release titled: “Supreme Court to Consider Trump Policy Allowing Employers and Universities to Deny Birth Control Coverage to Employees and Students”. From the press release: Today, the Supreme Court announced it would consider the validity of the Trump-Pence administration’s rules that allow employers and universities to refuse to provide insurance coverage for all contraception to their employees or students. These rules are currently blocked by the courts.This is the first time the Supreme Court will consider the issue of contraceptive coverage since Trump-appointed justices Neil Gorsuch and Brett Kavanaugh joined the Court……The Trump-Pence administration’s birth control rules allow employers, universities and any entity that provides health insurance to deny a person birth control coverage based on religious or moral objection. These harmful rules could have far-reaching implications for the Affordable Care Act’s requirement to guarantee birth control coverage which has benefited more than 62 million women, including 17 million Latina women and 15 million Black women.Data shows that an overwhelming majority of Americans believe women should have birth control coverage, regardless of their employer’s personal objections. This rule puts the Trump-Pence administration in direct opposition to the overwhelming majority of voters. January 18, 2020: SFGATE posted an article titled: “Louisiana Medicaid managed care contract awards thrown out”. It was written by Melinda Deslatte. From the article: Multibillion-dollar Medicaid contracts awarded by Gov. John Bel Edwards’ administration have been scrapped by Louisiana’s chief procurement officer, who determined the health department mishandled the bid process for deals to provide health services to 1.5 million people.Louisiana’s state procurement officer Paula Tregre said the health department failed to follow state law or its own evaluation and bid guidelines in determining which private companies should receive contracts to manage care for most of Louisiana’s Medicaid patients. In a decision issued late Friday, Tregre wrote the health department’s actions “resulted in a fatally flawed procurement process.”In response to protests filed by two losing bidders, Tregre rescinded the three-year contract awards estimated to be worth about $21 billion. She said the health department will have to redo the bid process to choose the insurance companies that will oversee care for about 90% of Louisiana’s Medicaid enrollees – mostly adults covered by Medicaid expansion, pregnant women and children.Tregre’s decision, which can be contested, won’t disrupt Medicaid health services to nearly one-third of Louisiana’s population. The Edwards administration signed emergency contracts to keep the state’s five current Medicaid managed care contractors in place this year because of the ongoing disputes about the contract awards and bid process… January 18, 2020: Morning Call posted an article titled: “Pennsylvania Democrats prod Republicans over Obamacare’s fate this election year”. It was written by Ford Turner. From the article: Pennsylvania House Democrats have dusted off a seldom-used legislative maneuver to push Republican action on health bills – including one on pre-existing conditions – that Democrats say will help if the Affordable Care Act gets nullified in the courts.“Discharge resolutions” filed in the state House last week push four stalled bills that work as a package, according to Democrat spokesman Bill Patton……The move comes as Democrats nationwide, cognizant of election-year ramifications, take steps to draw attention to the Trump administration’s vow to end Obamacare. A special focus is being placed on the law’s widely popular guarantees of preexisting condition coverage and parental plan coverage of offspring up to age 26……Pennsylvania’s House Democrats, including Allentown’s Peter Schweyer, said the state must act. Schweyer is prime sponsor of a bill that would preserve access to insurance and doctors by people with preexisting conditions even if Obamacare is thrown out. New Jersey’s Democratic governor on Thursday signed into law a bill on the same topic.Three other Pennsylvania bills mandate that insurance policies sold in Pennsylvania include coverages required by Obamacare, preserve coverage for adult children up to age 26, and ensure there are no “lifetime limits” on health care coverage……But the four have received no action in the House Insurance Committee despite being sent there more than 10 months ago. Republicans control the state House and Senate… January 19, 2020: NJ.com posted an article titled: “Murphy enacts laws to protect Obamacare benefits in N.J. from Trump cuts”. It was written by Susan K. Livio. From the article: Gov. Phil Murphy has signed a package of legislation that enshrines the tenets of the Affordable care Act into state law, giving New Jersey the authority to operate its own insurance marketplace and protect people with pre-existing conditions from losing coverage.The laws are a guard against pending legal threats to the landmark health care law, which in New Jersey insured 500,000 low-income people through the Medicaid program and 255,000 others who found coverage through the public marketplace last year.Murphy expects the state will operate its own Healthcare.gov marketplace later this year, enabling it to keep the $50 million it sends to the U.S. Centers for Medicare and Medicaid Services every year to handle that responsibility. The state would also be able to set a longer open enrollment period, which President Donald Trump’s administration cut in half to six weeks.The nine bills Murphy, a Democrat, signed into law Thursday protects benefits, such as coverage for pre-existing conditions and adult children up to age 26, that may be at risk should the courts or Congress repeal or furthe weaken the Affordable Care Act, also known as Obamacare… Here is a list of the bills Governor Phil Murphy signed: S626 – prevents carriers from denying a policyholder coverage because of a pre-existing medical conditionA5248 – requires insurance companies to cover benefits deemed essential under Obamacare and protects older people and people with disabilities from discriminationA5500 – creates a more rigorous review process for carriers seeking more than a 10 percent annual rate increaseA5501 – allows adult children to remain on their parents’ health coverage until they turn 26A5503 – establishes an open enrollment period for the state’s existing Individual Health Coverage ProgramA5504 – requires large insurance carriers to report their “medical loss ratio” to the state to prove they are spending at least 85 percent of premiums on medical-related expenses and keeping no more than 15 percent on administration, fees and profits. Policyholders would receive a credit if carriers keep too much money.A5506 – repeals the law allowing insurance carriers to offer “basic and essential” plans that do not contain the 10 benefits required under the ACA, such as maternity care, substance abuse treatment and mental health treatment and prescription drugsA5507 – provides free cancer and other preventative health screeningsA5508 – requires coverage for contraceptives January 19, 2020: Senator Patty Murray tweeted: “Let me be clear: the Republicans’ partisan health care lawsuit would put them one step closer to getting the health care plan they’ve always wanted – one that kicks millions of people off their care & takes away protection they rely on. We must keep fighting to #ProtectOurCare”. January 19, 2020: Herald-Tribune posted a Guest-Editorial titled: “Floridians are losing access to affordable health care.” It was written by Florida House of Representatives Margaret Good. From the Guest-Editorial: The health of Florida families is in jeopardy. More than 2.5 million Floridians are not covered by health insurance and prescription drug costs continue to rise.These are among the issues I hear about most from the people I serve. It is time for the Legislature to make real change to increase coverage and lower costs. This session, I filed House Bill 1293, which addresses access and costs.While Florida already has one of the highest uninsured rates in the country, the stage is set for the crisis to worsen. More than 3.5 million Floridians with preexisting conditions may lose access to affordable care, depending on the outcome of a court case challenging parts of the Affordable Care Act. If the special interests behind this lawsuit are successful, insurers will be free to charge Floridians with preexisting conditions whatever they want, effectively pricing people with preexisting conditions out of the market.This is especially concerning because of a bill that passed the Florida Legislature last session that allows insurers to sell short-term health insurance policies that avoid the pricing and term requirements of the ACA. Consumers who purchase these policies often believe they have comprehensive coverage, when, in fact, the short-term policy may exclude medically necessary treatment. This leaves Floridians, especially those with preexisting conditions, vulnerable……There are no federal or Florida regulations of the pharmaceutical industry’s pricing structure. House Bill 1293 holds pharmaceutical companies accountable by creating a Prescription Drug Affordability Commission, which would review increases in prescription drug prices, ensuring that companies cannot raise prices indiscriminately… January 19, 2020: Senator Ron Wyden tweeted: “Thanks to Republicans’ lawsuit against the Affordable Care Act, health care coverage for Americans with pre-existing conditions is once again on the chopping block. One thing remains certain: @morethanmySLE and I are committed in the fight to #ProtectOurCare” January 19, 2020: Axios posted an article titled: “Scoop: “Birth tourism” is Trump’s next immigration target”. It was written by Stef W. Knight and Jonathan Swan. From the article: The Trump administration has a new target on the immigration front – pregnant women visiting from other countries – with plans as early as this week to roll out a new rule cracking down on “birth tourism,” three administration officials told Axios.Why it matters: Trump has threatened to end birthright citizenship and railed against immigrant “anchor babies.” The new rule would be one of the first tangible steps to test how much legal authority the administration has to prevent foreigners from taking advantage of the 14th Amendment’s protection of citizenship for anyone born in the U.S……How the new regulations would work: It would alter the requirements for B visas (or visitor visas), giving State Department officials the authority to deny foreigners the short-term business and tourism visas if they believe the process is being used to facilitate automatic citizenship… January 20, 2020: The Columbus Dispatch posted an article titled: “‘Business negotiations’ result in Ohio’s Medicaid network losing 272 pharmacies”. It was written by Marty Schladen. From the article: Ohio Medicaid Director Maureen Corcoran says she was told that both CVS and Walgreens demanded last year that the other be excluded from the network of the state’s largest managed-care provider – a statement they both deny,Despite months of questions about the matter, it was the first time the state’s Medicaid chief acknowledged that she had been told that both pharmacy giants had demanded cuts to the provider network as the price of doing business with the federal-state health-care program. She also said it was hearsay.Meanwhile, CareSource, the Dayton-based company that, according to Corcoran, told her of the demands, continues its practice of not answering questions on the subject from The Dispatch.CareSource receives almost $8 billion a year from Ohio taxpayers. It is the largest contractor and its biggest Medicaid managed-care organization. But Corcoran expresses a disinterest in negotiations that have slashed 272 pharmacies from a network that serves almost 3 million poor Ohioans……CareSource would not comment on whether the big chains demanded each others’ ouster……As it has since this past fall, Walgreens said it did not ask that CVS be eliminated……CVS also said it did not demand that Walgreens be dropped… January 20, 2020: Senator Patty Murray tweeted: “Republicans are putting health care in our country on a completely avoidable, catastrophic crash course w/ their partisan lawsuit. I urge President Trump & Republicans to listen to patients & drop their partisan & deeply harmful attacks on families’ health care. #ProtectOurCare” January 20, 2020: The Hill posted an article titled: “Trump scrambles to defend pre-existing conditions record amid ObamaCare lawsuit”. It was written by Peter Sullivan. From the article: President Trump, who is backing a court challenge to the Affordable Care Act that would overturn the law and eliminate its protections for people with pre-existing conditions, is now tweeting about how he saved those protections.In an election year where Democrats are vowing to focus on health care, Trump’s tweets suggest he is recognizing the political danger posed by his support for the GOP-led lawsuit.Trump’s efforts have been undercut not only by the court challenge but also his repeated vows to repeal the 2010 law, including support for a House Republican bill in 2017 that would have allowed for weakening protection for pre-existing conditions… January 20, 2020: Reuters posted an article titled: “Women rarely regret decision to get abortion”. It was written by Lisa Rapaport. From the article: Five years after an abortion, most women still say it was the right decision even if they struggled with their choice at the time, a U.S. study suggests.Researchers surveyed 667 women who had abortions in 21 states a week after they had the procedures and then once every six months for five years. By the end of that period, 84% of women had either positive or neutral feelings about their choice.“We found no evidence of emergent negative emotions about the abortion over the five years,” said study leader Corinne Rocca of the University of California, San Francisco.“In fact, of all the emotions we looked at, relief remained the most commonly reported one at all times, even five years out,” Rocca said by email.Opponents of abortion have argued against legal access to these procedures in part because of concerns that abortion harms women by causing emotions and regret, researchers note in Science and Medicine. This idea has contributed to state laws and court decisions limiting abortion as well as state policies requiring women seeking abortions to be warned it might cause lasting emotional or mental harm, the study team notes… January 20, 2020: Houston Chronicle posted an article titled: “Critics: consumers should be wary of short-term health plans”. It was written by Kelli Kennedy. From the article: Consumers who bought short-term health insurance thinking they had found a better deal than “Obamacare” during the open enrollment season may be in for a shock when they show up at their doctor’s office this year.The low-cost plans aren’t required to cover basics such as prescription drugs or maternity care.The Trump administration rolled back restrictions on short-term plans in 2018. But critics quickly labeled them junk insurance, warning they come with gaps and don’t have to cover pre-existing medical conditions……With premiums about a third of the cost of comprehensive coverage, short term plans are significantly cheaper but don’t meet requirements under the Affordable Care Act. And while they cover major catastrophes such as a car accident, they don’t have to cover the law’s “essential benefits” – including mental health and substance abuse treatment and they won’t cover pre-existing conditions……Some short-term insurance companies are calling customers directly and repeatedly, said Islara Souto, a program director for Epilepsy Florida, which helps consumers secure health plans in Miami.“These plans are being targeted to those consumers in Spanish with misleading facts,” said Souto, adding some try to appear they’re from the federal marketplace by calling themselves the “Coverage Department”… January 21, 2020: CBS News posted an article titled: “Supreme Court declines to fast-track Obamacare case”. From the article: The Supreme Court refused Tuesday to consider a fast-track review of a lawsuit that threatens the Obama-era health care law, making it highly unlikely that the justices would decide the case before the 2020 election. The decision comes hours before Chief Justice John Roberts will preside over the president’s impeachment trial.The court denied a request by 20 mainly Democratic states and the Democratic-led House of Representatives to decide quickly on a lower-court ruling that declared part of the statute unconstitutional and cast a cloud over the rest……The justices did not comment on their order. They will consider the appeal on their normal timetable and could decide in the coming months whether to take up the case… January 21, 2020: New York Attorney General Letitia James posted a press release on her official website titled: “Attorney General James’ Statement On Supreme Court Decision to Not Expedite ACA Case”. From the press release: New York Attorney General Letitia James today released the following statement after the U.S. Supreme Court announced that it was denying a motion to expedite review of a decision in litigation threatening the Affordable Care Act (ACA):“While the Supreme Court has said it will not expedite its review, we are still urging the court to hear arguments next term. Day after day, President Trump makes false statements, sends misleading tweets, and spouts outright lies about Obamacare and the many protections the law has provided to millions across the country. Our coalition will never stop fighting against the president’s continued efforts to strip health coverage away from American families, including the 133 million Americans with pre-existing conditions.”Earlier this month, Attorney General James and a coalition of attorneys general from around the nation filed a motion asking the Supreme Court to expedite its review of a recent decision by the U.S. Court of Appeals for the Fifth Circuit in Texas v. U.S. The decision affirmed a lower court’s ruling that the individual mandate of the Affordable Care Act (ACA) is unconstitutional, yet refused to rule on the validity of the rst of the ACA – calling into question whether the remaining provisions of the statute could still stand, including those that protect and provide coverage to Americans with pre-existing conditions. Because this decision causes uncertainty that many harm the health of millions of Americans – in addition to doctors, clinics, patients, and the healthcare market – Attorney General James and the coalition petitioned the Supreme Court to take up the case and resolve it before the end of the court’s current term in June.While the Supreme Court did not expedite its review of the states’ petition, it is still reviewing the petition and has not yet determined whether it will grant review and hear arguments next term. Under the Fifth Circuit’s decision, the district court that originally ruled on the case will rehear and reconsider the validity of the rest of the health care reform law…. January 21, 2020: AARP posted information on its website titled: “Supreme Court Says No to Fast Review of ACA Ruling”. It was written by Dena Bunis. From the information: The U.S. Supreme Court will not take up a federal court ruling that said a key provision of the Affordable Care Act (ACA) is unconstitutional. The high court’s refusal on Tuesday to fast-track a review means all the protections of the ACA remain in force but the long-term status of the law remains uncertain.AARP and AARP Foundation joined two otehr nonprofit groups that fight for older Americans – Justice in Aging and the Center for Medicare Advocacy – in filing an amicus brief on Jan. 15 asking the high court to review a December 2019 rulng by the Court of Appeals for the 5th Circuit. That decision struck down the ACA’s individual mandate but left the fate of the rest of the law in the hands of a lower court judge who has already declared the entire law invalid. While the justices declined to fast-track an appeal, the Supreme Court could decide to hear the case at a later time… January 21, 2020: California Health & Human Services Agency posted a press release titled: “Health and Human Services Agency Announces Formation of Governor Newsom’s Behavioral Health Task Force to Address Urgent Mental Health and Substance Use Disorder”. From the press release: Following the unveiling of his budget proposal with its robust focus on improving behavioral health services, the California Health and Human Services Agency announced the formation today of Governor Gavin Newsom’s Behavioral Health Task Force to address the urgent mental health and substance use disorder needs across California. The panel will advise the Administration’s efforts to advance statewide behavioral health services, prevention, and early intervention to stabilize conditions before they become severe.“Behavioral health services and wellness are essential to living a healthy, happy, and fulfilling life,” said Governor Newsom. “All Californians should be able to get the mental health and substance use disorder assistance they need when they need it. We must also prevent these conditions when possible, and intervene early to reduce their severity, particularly among younger Californians.”The task force, chaired by Health and Human Services Agency Secretary Dr.Mark Ghaly, will consist of a broad range of stakeholders, including people living with behavioral health conditions – including mental health and substance use disorders, family members, adovocates, providers, health plans, counties, and state agency leaders……The mission of the task force is to develop recommendations for the Governor about ho California can best provide timely access to high-quality behavioral health care for all of its residents. The task force will include representatives from both the public and private sectors to align efforts to address behavioral health challenges from a public health perspective. What’s more, the task force will inform and bolster the state’s work to prevent mental health and substance use disorders and ensure that health and social service providers are able to intervene early to stabilize conditions before they become severe… January 21, 2020: The Hill posted an article titled: “Trump health chief: “Not a Need” for ObamaCare replacement plan right now.” It was written by Peter Sullivan. From the article: Secretary of Health and Human Services Alex Azar said Tuesday that “there’s really not a need” for the Trump administration to put forward an ObamaCare replacement plan at the moment. Azar was asked where the administration’s replacement for the health law is in an interview on the “Kevin Wall Radio Show.” He replied that there is not a need for one until the Supreme Court issues a final ruling on a GOP-backed lawsuit seeking to overturn the law……He also added that the administration could need a replacement if Republicans win back the House in this year’s election but noted that the current Democratic-led House has no interest in repealing and replacing ObamaCare……Azar’s comments stand in contrast to what President Trump said in an interview with ABC News in June. “We’ll be announcing that in about two months,” Trump said at the time when asked about an ObamaCare replacement plan… January 21, 2020: Speaker Pelosi posted a press release on her official website titled: “Pelosi Statement on Supreme Court’s Decision to Delay Review of ACA Lawsuit”. From the article: Speaker Nancy Pelosi issued this statement following the decision by the U.S. Supreme Court to not expedite review of Republicans’ Texas v. U.S. lawsuit, which, last month, the 5th Circuit Court of Appeals sided with the Republicans and instructed the District Court to redetermine how much of the Affordable Care Act to strike down:“Today’s disappointing decision by the Supreme Court only prolongs and worsens the uncertainty and fear that Republicans’ anti-health care agenda is inflicting on American families. The longer this GOP lawsuit continues, the longer it will needlessly drive up costs and endanger life-saving protections for people with pre-existing conditions.“The Trump Administration and its GOP allies have engaged in an outrageous sabotage campaign to systematicaly destroy protections for the millions of Americans with pre-existing conditions as well as every last benefit and protection provided by the Affordable Care Act. In the courts and in the Congress, the Democratic House Majority will continue to fight relentlessly to defend Americans’ health care as we work to preserve protections for people with pre-existing conditions and deliver lower health costs and prescription drug prices for all Americans.” January 21, 2020: New Jersey Governor Phil Murphy posted a press release on his official website titled: “Governor Murphy Signs Prescription Drug Bill to Limit Out-Of-Pocket Prescription Drug Expenses for New Jersey Families”. From the press release: Governor Phil Murphy today signed legislation (A2431) to help limit out-of-pocket prescription drug expenses for New Jersey families. The bill, which requires health insurers to provide plans that limit patient cost-sharing concerning prescription drug coverage, will improve affordability and access for thsoe who require necessary medication.“Few issues have a greater financial impact on New Jersey families than the unpredictable and ever-increasing cost of preventative drugs,” said Governor Murphy. “Cost-sharing too often presents a barrier to a patient’s ability to access medically-necessary treatments. This legislation will improve the affordability of medical care for many residents who unfortunately must make sacrifices in order to pay for their required medications.”… January 21, 2010: New Jersey Governor Phil Murphy posted a press release on his official website titled: “Governor Murphy Signs Legislation to Improve Hospital Transparency and Expand Reporting Requirements.” From the press release: Govenor Phil Murphy today signed legislation (A5916 and A5918) to improve hospital transparency and expand reporting requirements. The bills, which will provide more financial and operational insight into New Jersey’s hospitals, will ensure that these facilities will not abruptly discontinue services and leave communities without access to care. Today’s signings build upon Governor Murphy’s signing of A5917 last week, which increased the Department of Health’s oversight of hospital finances.“New Jersey is home to some of the nation’s leading hospitals, health care facilities, and treatment centers,” said Governor Murphy. “By requiring these institutions to disclose financial distress and expand their reporting obligations, we will enhance operational transparency and ensure that our communities have access to high-quality, affordable health care.: Governor Murphy signed the following bills: A5916 – Authorizes DOH to notify elected officials of financial distress of certain hospitalsA5918 – Expands hospital reporting requirements January 22, 2020: Texas Observer posted an article titled: “In Texas, Thousands of Kids Lose Medicaid Coverage Each Month”. It was written by Sophie Novak. From the article: …Texas has made it extremely difficult for kids to stay on Medicaid. While many states check children’s eligibility yearly, Texas moved in 2014 to a system of income checks multiple times per year, burdening families with heaps of paperwork. According to Adriana Kohler, policy director at Texans Care for Children, families have just 10 says – starting from when the when the state puts papers in the mail – to recieve the forms, gather necessary documentation, fill them out, and send them back. This caused thousands of eligible kids to lose Medicaid coverage each month. State lawmakers have repeatedly declined to pass bills to move to 12-month continuous coverage.There are other causes too: Attacks on the ACA from Trump and GOP lawmakers have reduced enrollment outreach and confused families. Anti-immigrant policies – particularly Trump’s “public charge” rule, which would make it harder to get a green card if applicants might need public assistance – have led families to pull kids out of benefit programs for fear that they could negatively affect the parents’ immigration status. The rule is currently blocked by the courts, but the “horrible” policy is already “having the desired effect,” according to Jason Terk, a Keller pediatrician and the former head of the Texas Pediatric Society. Missed vaccinations are one tangible effect of these coverage lapses, and they’re riskier than ever. Vaccine exemptions for kids have skyrocketed from about 2,300 in 2003 to 64,176 in 2018, and there were 21 confirmed measles cases in Texas this year… January 22, 2020: Planned Parenthood posted a press release titled: “On the 47th Anniversary of Roe v. Wade, Trump Administration Allows Texas To Bar Care at Planned Parenthood.” From the press release: Today, the Trump administration rewarded Texas’s long-standing effort to cut off people’s access to health care. The administration approved Texas’ request to implement a Medicaid family planning program that bars patients from accessing care at Planned Parenthood and other sexual and reproductive health providers that also provide abortion. This is the first time the federal government has allowed a state to explicitly waive Medicaid’s free choice of provider for family planning provision. This move upends longstanding federal law and sets a dangerous precedent for other states to pursue similar state-level measures, with grim consequences for health care access nationwide.By approving Texas’ request, the Trump administration puts federal funding behind a failed program that was designed to limit people’s access to health care and directly resulted in people losing health care. Because federal law safetuards the right of Medicaid patients to access reproductive health care at the qualified provider of their choice, six years ago, Texas rejected federal funding for its state family planning program and launched a fully state-funded program in order to bar access to care at Planned Parenthood. Prior ot this, and draconian family planning cuts in 2011, Planned Parenthood affiliates served more than 40 percent of patients in the program……Planned Parenthood provides important preventative health care including lifesaving cancer screenings, birth control, and STI testing and treatment. Nationally, 75 percent of Planned Parenthood patients have incomes at or below 150 percent of the federal poverty level (FPL), and at least 60 percent of Planned Parenthood patients access care through the Medicaid program. These approved waivers take away rights and freedoms from people who already face unequal and unfair treatment, including LGBTQ people, people of color, people with disabilities, and women. These groups are more likely to have lower income and rely on programs like Medicaid. Blocking access to Planned Parenthood and other providers can make it impossible to get the care they need. January 22, 2020: Speaker Pelosi posted a press release on her official website titled: “Pelosi Statement on the Anniversary of Roe v. Wade”. From the press release: Speaker Nancy Pelosi released the following statement marking the 47the anniversary of the Roe v. Wade decision today:“For 47 years, the Supreme Court’s decision in Roe v. Wade has stood as the law of the land, ensuring that a woman’s reproductive health decisions are her own – in consultation with her family, her physician and her faith. This fundamental principle is rooted in our founding values of liberty and equality for all, and it must be fiercely safeguarded from brazen attempts to roll back women’s constitutional rights.“Women’s freedom of choice is currently under unprecedented threat from this Administration, and from Republicans in Congress and in state capitols across the country who are determined to insert themselves into women’s private health care decisions. For millions of women and their families, this relentless GOP assault continues to jeopardize their future and threatens to undo decades of progress towards women’s equality.“Yet, American women are fearlessly standing up and speaking out to demand an end to Republican’s outrageous efforts to undermine the landmark Roe v. Wade decision. Together, with these tireless women, House Democrats are committed to ending the attack on Roe v. Wade. We will not rest until all women have access to the comprehensive health care they need and are treated equally under the law.” January 22, 2020: The American Civil Liberties Union (ACLU) posted an article titled: “47 Years Later, We’re Fighting to Make Roe a Reality Everywhere”. it was written by Jessica Arons, Senior Advocacy and Policy Counsel for Reproductive Freedom. From the article: …This Spring, the Supreme Court will hear arguments in June Medical Services v. Gee and could uphold state abortion restrictions identical to ones it struck down only four years ago, thereby allowing states to continue shutting down abortion clinics with no medical justification. Unsatisfied, 207 abortion opponents in Congress have asked the Court to overturn Roe entirely and pave the way for states to ban abortion outright.But while this high-stakes showdown plays out at the Supreme Court, we cannot take our eyes off the states. In 2019, seven states throughout the South and Midwest tried to ban abortion (all have been blocked so far) while seven other states passed eight affirmative measures to protect and expand access to abortion. This year will include new threats, as well as new opportunities to build on recent victories.…Already in 2020, bills that would ban abortion from the earliest days of pregnancy – like those passed in Georgia and Alabama last year – have been introduced in 13 states, with more likely to be filed in the coming days and weeks. Not all will advance, but there is a genuine risk that at least five more abortion bans could be enacted this year.Less aggressive but equally harmful and extreame measures are also being considered: a Florida bill that would force young people to obtain parental consent for an abortion, which would increase risks to vulnerable youth; bans on the standard of care for abortion after 14 weeks in Michigan and Nebraska; and an Ohio measure that promotes the dangerous and unproven theory that an abortion with pills can be “reversed”. Additionally, abortion opponents are taking steps to eliminate abortion protections or pass new restrictions via ballot measures in Colorado, Kansas, Kentucky, Louisiana, and elsewhere.But it’s not all bad news……Massachusetts is working to pass the ROE Act, which would, among other things, improve youth access to abortion and ensure coverage for abortion regardless of income or immigration status. In the wake of an historic election in Virginia, legislators are lining up to show their support with a bevy of proactive bills. And New Jersey Gov. Phil Murphy recently called for efforts to codify reproductive rights into state law.The reality is, however, that we will never break free from the relentless cycle of harmful state laws and court battles without federal action by Congress – which is why we are joining calls for Congress to pass the Women’s Health Protection Act. Already supported by more than 200 co-sponsors in the House and 42 in the Senate, WHPA would prohibit states from shutting down abortion clinics and banning abortion outright…. January 22, 2020: ABC News posted an article titled: “Trump suggests he may be open to entitlement cuts in future”. It was written by Ricardo Alonso-Zalidvar and Aamer Madhani. From the article: President Donald Trump appeared to suggest in a television interview Wednesday that he’s willing to consider entitlement cuts in the future, a move that would mark a tectonic shift from his stance during his 2016 run for the White House.Trump suggested he was open to a cut in social safety net benefits, such as Medicare and Social Security, in comments during a CNBC interview on the sidelines of the World Economic Forum in Davos, Switzerland……Asked if entitlement cuts would ever be on his agenda, Trump reponded, “At some point they will be.”……In the CNBC interview, Trump called tackling entitlement spending “the easiest of all things” and suggested higher economic growth would make it easier to reduce spending on the programs… January 23, 2020: Center for Reproductive Rights posted a press release titled: “Trump Administration ‘Defunds’ Reproductive Health Services Providers in Texas”. From the press release: Yesterday, on the 47th anniversary of Roe v. Wade, the U.S. Department of Health and Human Services (HHS) approved a previously-denied waiver request by the state of Texas for federal Medicaid funding to administer a family planning that discriminated against reproductive health care providers. The approval upends a longstanding Medicaid requirement that enrollees be able to recieve services from the qualified provider of their choice – including Planned Parenthood and other providers who also provide abortion services…. January 23, 2020: Politico posted an article titled: “Trump administration finalizing Medicaid block grant plan targeting Obamacare”. It was written by Dan Diamond. From the article: The Trump Administration is finalizing a plan to let states convert a chunk of Medicaid funding to block grants, even as officials remain divided over how to sell the controversial change to the safety net health program……Capping Medicaid spending, even among just Obamacare’s expansion population, would be a major transformation of how the federal government finances the safety net health care program that has grown to cover about 1 in 5 Americans. The plan is guaranteed to enrage critics and invite attacks from Democrats in an election year.Republicans have long argued that states should recieve defined funding for Medicaid, instead of the current open-ended structure in which the federal government matches state spending. Democrats, along with many hospital and physican groups, have fiercely opposed the idea, warning that strict funding constraints would result in cuts to enrollment and health care services.Democratic lawmakers have promised to fight the administration on block grants, contending CMS doesn’t have the authority to restructure the program’s financing without congressional approval……Congress has not been supportive of the idea. Lawmakers during the failed Obamacare replacement effort in 2017, rejected a similar plan to cap spending on Medicaid expansion and private health insurance subsidies, which would have resulted in millions losing coverage.The Trump administration is seeking to bypass congressional opposition by using existing Medicaid authority to test states’ health care ideas under what’s known as demonstration waivers.Several Republican-led states are pursuing plans to convert their Medicaid programs into block-grant funding. Tennessee, which has not expanded Medicaid, in November became the first state to submit a block grant plan to the Trump administration. That plan remains under review… January 24, 2020: California Attorney General Xavier Becerra posted a press release on his official website titled: “Attorney General Becerra Asks Court to Protect California’s Title X Family Planning Program”. From the press release: California Attorney General Xavier Becerra asked the Northern District of California court to rule on its complaint that alleges the federal government illegally promulgated a Final Rule (Gag Rule) to undermine the Title X program, the nation’s only federal family planning program. The Trump-Pence Administration’s Gag Rule attacks Title X by limiting access to preventative healthcare including access to birth control, restricting healthcare providers’ ability to provide comprehensive information to patients, and prohibiting referrals for abortion. California and other plaintiffs are still waiting for a ruling from the Ninth Circuit Court of Appeals regarding the federal government’s appeal of the district court’s earlier grant of a preliminary injunction halting the implementation of the Gag Rule.“The Title X program is a critical tool that helps low-income women and families access essential healthcare in California and across the nation,” said Attorney General Becerra. “This is yet another attack on women and their reproductive rights by the President and Vice President who circumvented the law and the public by jamming this Gag Rule through the process. That’s unacceptable. California won’t watch struggling families go without basic healthcare.”California’s renewed push against the Title X regulation is based on the physical separation requirement of the Title X Final Rule which will take effect on March 4, causing further devastating consequences for California’s Title X network. The physical separation requirement would require both physical and financial separation between any Title X program participant and any faculty that provides abortion services. This means a provide must have, at minimum, separate examination and waiting rooms, office entrances and exits, phone numbers, email addresses, educational services, websites, staff and personnel, electronic or paper-based health care records, and workstations. The financial and administrative burdens this requirement would impose on Title X providers would only increase the exodus of providers from the program. California has already experienced significant loss of Title X providers since the Gag Rule took effect. Without relief before the March 4 deadline, California may no longer have a Title X network, causing untold harm to thousands of women and families across the state. California seeks to resolve its Administrative Procedures Act (APA) claims before the physical separation deadline to mitigate this harm.In the brief, California argues that the Trump Administration’s final rule is in violation of the APA because it is arbitrary and capricious as well as contrary to federal statutes that require non-directive counseling and that forbid the federal government from creating unreasonable barriers to appropriate medical care. A copy of the the motion is available here. January 24, 2020: The U.S. Department of Health and Human Services (HHS) posted news on its official website titled: “HHS Issues Notice of Violation to California for its Abortion Coverage Mandate”. From the news: Today, the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR), announced an action to protect human life and the conscience rights of all Americans.OCR is issuing a Notice of Violation to the sate of California, formally notifying California that it cannot impose universal abortion coverage mandates on health insurance plans and issuers in violation of federal conscience laws……OCR’s investigation arose from two complaints alleging that California engaged in unlawful discrimination when California’s Department of Managed Health Care (DMHC) ordered, in August 2014, that all health plan issuers under its jurisdiction must offer coverage for elective abortion in every plan they offer. The two complainants are the Missionary Guadalupanas of the Holy Spirit, a Catholic order of religious sisters, and Skyline Weslyan Church, a non-profit Christian church – organizations whose religious beliefs preclude them, in good conscience, from helping to pay for insurance coverage for elective abortions.Pursuant to 45 CFR Part 88 (effective March 2011), OCR completed the investigation of the complaints and determined that California violated the Weldon Amendment by mandating that California health care plan issuers cover elective abortion in each plan product, and continues to violate federal law by continuing to require objecting health care entities protected by the Weldon Amendment to cover elective abortion. With this notice, OCR requests that California inform OCR, within thirty days, whether California will continue to enforce its requirement that all health plans cover elective abortions, or whether it will agree to take corrective action and remedy the effect of its discriminatory conduct.If after 30 days, OCR does not receive sufficient assurance that California will come into compliance with federal law, OCR will forward the Notice of Violation and the evidence supporting OCR’s findings in this matter to the HHS funding components from which California recieves funding for appropriate action under applicable grants and contracts regulations. This action may ultimately result in limitations on continued reciept of certain HHS funds.This is not the first time OCR has found California to be in violation of federal conscience statutes. In January 2019, OCR found that California violated the Weldon and Coats-Snowe Amendments when it subjected pregnancy resource centers in the state to potential fines and discrimination for refusing to post notices referring for free or low-cost abortions… I want to make this perfectly clear: the Trump-Pence administration has decided that states rights can be usurped by the complaints of Catholic and Christian organizations who wish to impose their will upon the people of a state. This means that the Trump-Pence administration has established a national religion. The Third Article of the U.S. Constitution clearly states: Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press, or the right of the people to peaceably assemble, and to petition the Government for a redress of grievances. NOTE: It does not say that the federal government is allowed to establish one religion – Christianity in this example – above all others and above the rights of people who do not follow any particular religion. Freedom to exercise one’s religion does not mean that religious groups are allowed to take away rights from … well, everyone else. January 24, 2020: California Attorney General Xavier Becerra posted a press release on his official website titled: “Attorney General Becerra Issues Response to Trump Administration’s Baseless Allegations of Weldon Violaton”. From the press release: Attorney General Becerra today issued a statement in response to a letter from the Trump Administration’s Office for Religious Consciousness that alleges California law violates the Weldon Amendment, a federal approprations rider that restricts abortion.“Women’s health should never be dangled as bait for the sake of political grandstanding. Today, Donald Trump is using the official levers of government to advance his political agenda. Sound familiar? In California, we will continue to protect our families’ access to healthcare, including women’s constitutional right to abortion. Nothing changes.”.. January 24, 2020: California Governor Gavin Newsom posted a tweet on his personal account: “Trump is threatening to take away ALL OF OUR HEALTHCARE FUNDING. TENS OF BILLION of dollars. 10 MILLION PEOPLE who are: poor, sick, kids, seniors, families, will LOSE their healthcare. And yet you call yourself “pro-life” @realDonaldTrump?? You sicken me.” The tweet included a link to the following Politico article. January 24, 2020: Politico posted an article titled: “Trump threatens to cut California funding over abortion coverage.” It was written by Alice Miranda Ollstein. From the article: The Trump administration on Friday threatened to cut off some federal funds to California unless it drops a state requirement that private health insurers cover abortion.The administration says the policy violates a federal ban on discriminating against health care entities that refuse to cover abortion services or refer patients for the procedure when taxpayer dollars are involved. HHS is giving the state 30 days to comply or face the loss of unspecified funds……Five other states – Illinois, Maine, New York, Oregon, and Washington – have similar laws on teh books. But HHS is, for now, only singling out California.California Gov. Gavin Newsom indicated the state won’t change the policy.“The Trump administration would rather rile up its base to score cheap political points and risk access to care for millions than to do what’s right,” he said. “California will continue to protect a woman’s right to choose, and we won’t back down from defending reproductive freedom for everybody – full stop.”California’s Attorney General Xavier Becerra tweeted: “California won’t be deterred. We will fight this by any means necessary.”The move is in line with other Trump administration actions targeting the progressive state over issues including environmental standards, immigration policies and homelessness. It was also timed to coiencide with the March for Life on the National Mall, where President Donald Trump will become the first president to address the anti-abortion demonstration in person as he works to shore up support from social conservatives……While public insurance programs like Medicaid have long been barred from covering abortion services, Friday’s announcement also marks the escalation of the administration’s efforts to extend the prohibition to private coverage. In December, HHS unveiled a rule requiring private insurers on Obamacare markets to send patients separate monthly bills to separate the portion of the premium that goes toward abortion coverage. The added administrative burden could prompt some insurers to drop abortion care altogether… January 24, 2020: The Hill posted an article titled: “Trump administration threatens to cut health funding for California over abortion insurance law”. It was written by Jessie Hellmann. From the article: The Trump administration is threatening to withhold federal funds from California over the state’s requirement that all insruance plans cover abortion.Officials with the Department of Health and Human Services (HHS) argued the insurance requirement forces people to pay for other people’s abortions and is a violation of federal law.The state will have 30 days to come into compliance with federal law or risk losing some of the health funding it gets from HHS……The decision by HHS also serves as a warning to the five other states that mandate abortion coverage in insurance plans, including Maine, Illinois and New York.California passed a state law in 2014 requiring all insurance plans, including those offered by employers, to cover abortion. Religious organizations argued the requirement is illegal because it violates their religious rights……The announcement from HHS came on the same day as the March for Life, the annual march against abortion in Washington, D.C.President Trump will become the first sitting president to speak at the march as he seeks to galvanize his conservative base ahead of the November election……The Supreme Court will hear a case this year challenging a Trump rule that allows employers with religious objections to contraception to opt-out of covering it in their insurance plans.Another rule issued by the Administration that was blocked in court would have penalized organizations that require employees to participate in abortions or other procedures that violate their consciences… January 24, 2020: National Women’s Law Center posted a press release titled: “Trump Administration Attempts to Take Away Comprehensive Health Coverage for Californians, says NWCL”. From the press release: Today, the Department of Health and Human Services’ (HHS) Office of Civil Rights has taken the extraordinary action of threatening to withhold critical funding to California – just because the state protects its residents by requiring all health insurance plans to cover the full range of reproductive services, including abortion. The Trump Administration is claiming that these plans violate the Weldon Amendment – one of several federal laws that allow various health care providers to refuse to provide care to a person seeking an abortion. This decision comes on the same day as the annual March for Life, an anti-abortion rally where Trump is proudly touting his record of limiting women’s rights.The following is a statement by Fatima Goss Graves, President and CEO of the National Women’s Law Center (NWLC):“It is no mistake that on the same day of the extremist anti-abortion March, the Trump Administration is trying to deny millions access to comprehensive health insurance that includes abortion. They claim they are ‘pro-women’ and ‘pro-life’, yet this action proves cruelty is the point for this administration. The very people they claim to be marching for are those who will be hurt by this decision. This is an illegal attempt to bully and punish the state of California for ensuring its residents have comprehensive health coverage that includes abortion. All health insurance plans should cover all basic health services and the full range of pregnancy-related care.” January 24, 2020: Planned Parenthood posted a press release titled: “Trump’s Travel Ban Targets and Discriminates Against Pregnant Women of Color”. From the press release: The Trump-Pence administration will allow the State Department to deny temporary visas to pregnant women. The new rule is expected to take effect today and will give discretion to consular officers to reject women they believe are traveling to the United States and its territories to give birth, making their children U.S. citizens. This policy will include visas issued for pleasure, medical treatment, or to see friends and family. The rule will primarily affect travelers from Africa, Asia, and Latin America, because it will not apply to countries in the Visa Waiver Program. Thirty one of the 39 countries in this protected program are from Europe.This rule is part of a long line of attacks on immigrants by the administration, including ending temporary protected status for several countries; the physical separation of children form their parents at the U.S.-Mexico border; the rollback of parental rights as part of immigration proceedings; and increased enforcement of detention and deportation……This isn’t the first time the administration has used visas as a tool for its extreme anti-immigrant ideology. Within months of taking office, Trump announced a travel ban against Muslims. The relentless attacks on immigrants by the administration have contributed to a culture of fear in immigrant communities, and often keep far too many from seeking the lifesaving care they need. January 24, 2020: Illinois Governor JB Pritzker posted a news release titled: “Gov.Pritzker Signs Law Capping Insulin Costs at $100/Month for 1.3 Million Illinoisans”. From the news release: Gov. JB Pritzker signed SB 667 into law today, capping out of pocket insulin costs at $100 for a 30-day supply. The new law is an important step forward in lowering healthcare costs for working families making Illinois a leader in ensuring healthcare is a right, not a privilege. The 1.3 million Illinoisans who rely on insulin will no longer face soaring prescription drug prices that force them to make tough decisions.“Health care is a right for all, not a privilege and that’s why I am so proud tha we created an insulin price cap that successfully puts patients above profits,” said Governor Pritzker. “As we work to address the high cost of prescription drug prices that are burdening millions of all our our state, this new law is an essential step in fulfilling our promise to put state government back on the side of working families.”Diabetes affects approximately 1,300,00 adults in Illinois. All people with Type 1 diabetes and some with Type 2 diabetes need insulin, but regular price hikes make insulin difficult to afford for the uninsured and those whose coverage requires significant cost sharing.Many patients either forgo insulin or they ration their prescribed insulin dose to stretch it until they can afford the next prescription. One if four Type 1 diabetics have reported insulin underuse due to the high cost of insulin… January 25, 2020: New York Attorney General Letitia James posted a press release on her official website titled: “Attorney General Secures Victory for Women Seeking Abortions in Rochester”. From the press release: New York Attorney General Letitia James today released the following statement after the Honorable David Larimer of the Western District of New York issued a decision authorizing the City of Rochester to continue to enforce a 2005 order establishing a sidewalk “buffer zone” outside a local Planned Parenthood facility:“In the nearly 50 years since Roe v. Wade, anti-choice activists have attempted to inflict theri will on women’s bodies, but this decision is another confirmation by the courts that no one has the right to interfere with women’s reproductive choices. Despite their denials, these anti-abortion activists attempted to harass, threaten, and block women from entering a local Planned Parenthood and strip them of the right to make a deeply personal choice to use every legal tool at its disposal to prioritize the reproductive rights of women. We thank the court for its decision and for ensuring Roe v. Wade is enforced in Rochester without interruption.”Deborah McDell-Hernandez, Senior Director of Public and Community Affairs of Planned Parenthood of Rochester added, “Planned Parenthood is very appreciative of the attention that the New York Attorney General’s Office offered to this case. This positive outcome will help ensure that we are able to continue to provide a welcoming and safe environment to patients and staff. Accessibility to quality, affordable health care is our priority.”In 1989, the Office of the New York Attorney General won a decision – in New York ex rel. Spitzer v. Operation Rescue Nat’l – establishing a buffer zone prohibiting protests, picketing and the blocking of the entry within 15 feet of “entrances and driveways of facilities that perform abortions in the Western District of New York,” including Planned Parenthood of Rochester.Despite this ruling, two years ago, anti-abortion activist Jim Havens and his group ROC Love Will End Abortion, began protesting women who were entering the Planned Parenthood of Rochester facility. When they were prohibited from continuing their protests within 15 feet of the facility, Havens and his group filed a lawshit against both the State of New York and the City of Rochester, asserting that they were being improperly prevented from conducting their protests.Under Attorney General James’ leadership, the Office of the New York Attorney General opposed the motion for a preliminary injunction and moved to dismiss the lawsuit, stating that Havens and his group were indisputably acting “in active concert or participation” with the original defendants to the state lawsuit.Yesterday afternoon, Judge Larimer denied the motion for a preliminary injunction and dismissed the lawsuit in its entirety, stating that Havens and his group were indisputably acting “in active concert or participation” with the original defendants of the state lawsuit. The court took particular note of Havens’ and the original defendants named ‘ shared common goal of deterring ‘abortion-minded’ women from seeking services at PPR,” and further held that Havens’ legal arguments wer based on “wishful thinking on [their] part,” concluding, “Any suggestion that plaintiffs acted ‘independent’ from thes Named Defendants… is not only disingenuous, but is also belied by plaintiffs’ own allegations.”… January 25, 2020: MSN posted an article titled: “Kansas lawmakers begin debate on Medicaid expansion”. From the article: While a bipartisan plan in Topeka seeks to end years of gridlock on the issue, Kansas Governor Laura Kelly says there is a long way to go before declaring victory.Supporters of Medicaid expansion in Kansas say the time is now for this to happen as the state senate’s public health and welfare committees start to debate the issue……Republican Senate Majority Leader Jim Denning and Democratic Governor Laura Kelly hammered out a compromise from previous proposals. That compromise calls for Medicaid expanding to Kansans who fall within 138 percent of the poverty line.It includes work requirements where applying for Medicaid will have to fill out a form showing they are looking for work or show why they are not able to work. Enrollees would pay monthly premiums of up to $25 per month, or $100 for a family of four, as proposed in the proposed bill. A hardship provision is also included.The plan also includes a re-insurance program to support Kansans who buy health insurance through the exchange. That program would go into effect no later than January 1, 2022… January 26, 2020: Cleveland.com posted an opinion piece titled: “DeWine administration deserves Ohioans’ thanks for uncovering – and vowing to fix – state Medicaid mess”. It was written by The Editorial Board of Cleveland.com and The Plain Dealer. From the opinion piece: Kudos to Republican Gov. Mike DeWine’s administration for its candor in exposing big flaws in a computer system, called Ohio Benefits, that’s supposed to help the state manage its part of the Medicaid, Temporary Assistance for Needy Families and food stamp (SNAP) programs.Instead, a system into which the state has already sunk more than a billion dollars — yes, nine zeros — is so flawed that it’s wrongly thrown an unknown number of Ohioans off Medicaid by erasing their eligibilty histories, failing to handle renewals correctly, or simply causing applicants to disappear from the system. It’s also violated recipients’ privacy by sending paperwork to the wrong address and, in one case, linked a baby to an 11-year-old who wasn’t the child’s parent……The state has already spent $1.2 billion on Ohio Benefits [State Medicaid Director Maureen] Corcoran said. And it likely will have to spend more to fix it…..In effect, the state is all but yoked to the vendor. And all told, Ohio Benefits has nearly 1,100 defects, cleveland.com’s Laura Hancock reports, citing Corcoran’s findings.The state adopted the benefits system six years ago when Kasich was governor, to help manage Ohio’s benefits systems, starting with Medicaid… January 27, 2020: Representative Debbie Dingell tweeted: “4,110,300 people in Michigan have a pre-existing condition. Because of the Affordable Care Act, insurance companies cannot deny their coverage. We must #ProtectOurCare.” January 27, 2020: The Supreme Court of the United States released a ruling on Department of Homeland Security, Et. Al. v. New York, Et. Al. on an application for a stay on the Trump administration’s Public Charge rule. It starts with: The application for stay presented to Justic Ginsburg and by her referred to the Court is granted, and the District Court’s October 11, 2019 orders granting a preliminary injunction are stayed pending disposition of the Government’s appeal in the United States Court of Appeals for the Second Circuit and disposition of the Government’s petition for a writ of certiorai, if such writ is timely sought. Should the ptetition for a writ of certiorari be denied, this stay shall terminate automatically. In the event the petition for a writ of certiorari is granted, the stay shall terminate upon the sending down of the judgement of this Court.Justice Ginsburg, Justice Breyer, Justice Sotomayor, and Justice Kagan would deny the application.Justic Gorsuch, with whom Justice Thomas joins, concurring in the grant of stay… It should be noted that the reason Chief Justice John Roberts is not mentioned in the ruling could be because he was presiding over President Trump’s impeachment trial in the U.S. Senate. January 27, 2020: CNBC posted an article titled: “Supreme Court allows Trump’s ‘public charge’ immigration rule to take effect.” It was written by Tucker Higgins. From the article: The Supreme Court said Monday that it will allow the Trump administration “public charge” rule to take effect after the immigration policy had been blocked by lower courts.The 5-4 vote was divided along partisan lines, with the court’s four Democratic appointees indicating that they would not have allowed the policy to be enforced.The rule, which was proposed in August, will make it more difficult for immigrants to obtain permanent residency, or green cards, if they are likely to use public benefits like food stamps and Medicaid.Under previous federal rules, a more narrow universe of public benefits, such as cash assistance and long-term hospitalization, were considered in determining whether an immigrant was likely to become a “public charge”.Civil rights groups criticized the rule, arguing that it would penalize poor immigrants and disproportionately affect non-white immigrants… January 27, 2020: Senator Patty Murray tweeted: “Just stepped out of the impeachment trial to news that the Trump Administration can begin implementing its cruel public charge rule that will threaten the lives & livelihoods of so many hardworking families in WA & across the country. This is just so wrong. January 27, 2020: The American Civil Liberties Union (ACLU) tweeted: “The “Public Charge” rule enshrines the false stereotype that people with disabilities do not contribute to our society. Congress has repeatedly declared that disability discrimination violates federal law. This rule must be stopped.” The tweet included a screenshot of a statement by the ACLU that said: In a 5-4 ruling, the Supreme Court, allowed the Trump administration’s “public charge” rule to temporarily take effect. The rule imposes new restrictions on green cards and visas, and particularly affects individuals with disabilities as well as low-income families. The American Civil Liberties Union opposes the rule. Claudia Center, senior staff attorney with the ACLU’s Disability Rights Program, had this reaction to the Supreme Court’s action:“This policy is yet another way for the Trump administration to hurt immigrants. It enshrines the false stereotype that that people with disabilities do not contribute to our society. Families will suffer. Congress has repeatedly declared that disability discrimination violates federal law. This rule must be stopped.” January 27, 2020: Representative Alexandria Ocasio-Cortez tweeted: “This is shameful. America shouldn’t have a wealth test for admission. It’s a place where millions of people are descendants of immigrants who came w noting & made a life. The American Dream isn’t a private club with a cover charge – it’s the possibility of remaking your future.” Representative Alexandria Ocasio-Cortez was responding to a tweet from Greg Stoher, a Supreme Court reporter for Bloomberg News, who tweeted: “BREAKING: On 5-4 vote, Supreme Court lets Trump administration start enforcing new immigrant wealth test, designed to screen out green card applicants seen as at risk of becoming “public charges.” January 27, 2020: Women’s Law Project posted statement titled: “WLP Statement on Trump’s Cruel “Public Charge” Rule”. From the statement: Today, in a 5-4 vote along ideological lines, the U.S. Supreme Court Justices said they would let the controversial immigration rules go forward even as lower courts wrestle with multiple legal challenges against them. “Today is another sad day for immigrants and a shameful one for our country. We have shut the golden door on the poor and huddled masses. Trump’s public charge rule effectively creates an immigration system that favors weatlh over hard-working individuals and families,” says Women’s Law Project staff attorney Christine Castro, who authored WLP’s comments on the rule. “These radical proposed changes will undermine they health and safety of immigrant families, especially immigrant mothers.”Under current policy, immigration officials can deny certain immigrants a visa or a green card if the official finds the immigrant would be a “public charge,” meaning someone deemed likely to become “primarily dependent” on current or past reciept of cash assistance programs like Supplemental Security Income (SSI) and Temporary Assistance for Needy Families (TANF) when predicting whether someone will become a “public charge”. (Only 3 percent of noncitizens use thes programs.)Trump’s new rule exapands the list of factors to be counted against a person to include safety-net programs like SNAP (“food stamps”), Section 8, Medicaid, earning a low income, English proficience, age (specifically, being over 60 or under 18 years old), having a low credit score, having a large family, and having a medical condition.“The rule’s preference for immigrants who speak English would codify the Trump Administration’s xenophobic rhetoric into actual policy and clearly targets people of color who are less likely to already speak English,” says Castro.Under the new rule, legal immigrants could be denied green cards or visas if they’ve ever used or are suspected of having used Medicaid, SNAP, or other safety-net programs. Currently, one in seven Americans rely on Medicaid, including two out of every five children, five in eight nursing home residents, and one in three people with disabilities… January 27, 2020: Southern Poverty Law Center posted a short thread that started with this tweet: “Today’s ruling allows yet another discriminatory and xenophobic Trump administration policy aimed at low-income Black and brown immigrants.” – SPLC’s Samuel Brooke”. The tweet included a link to the CBS News article (posted earlier in this blog post). Southern Poverty Law Center also tweeted: “The @DHSgov’s ‘public charge’ rule only hurts families struggling to make ends meet. It effectively cuts essential aid that helps ensure immigrants’ basic human right to housing, food and health care” – SLPC’s Samuel Brooke.” January 27, 2020: Senator Bernie Sanders tweeted: “In 2017, 10,000 people died waiting for Social Security Disability Insurance. Instead of addressing this crisis, Trump wants to make it harder for people with disabilities to get the help they need to get by. We will defeat him and undo this cruelty.” The tweet included a link to the following article from USA Today. January 27, 2020: USA Today posted an opinion piece titled: “Trump administration cuts to Social Security disability benefits among the cruelest.” It was written by Rebecca Vallas. From the article: Hardly a day goes by without the Trump administration finding a new way to slash the safety net.But its latest proposal – which would cut Social Security disability benefits by $2.6 billion over 10 years – is one of the cruelest. It would require millions of beneficiaries to re-prove their disability – and navigate a complex web of red tape and paperwork – every two years. Hundreds of thousands of people could lose benefits even though their condition has not changed……Proving eligibility for benefits is an ardurous process that can take months if not years, and hundreds, if not thousands of pages in medical evidence. America has among the strictest eligibility standards in the world. Over 60% of applicants are denied, and tens of thousands of people die each year waiting for benefits.While vital, benefits are so modest – averaging roughly $1,200 per month for Social Security Disability Insurance and $536 for Supplemental Security Income – that many beneficiaries live in poverty. Unspeakable hardship will result if this proposal takes effect.. January 28, 2020: Planned Parenthood posted a press release titled: “Planned Parenthood Denounces Supreme Court’s “Public Charge” Ruling”. From the press release: The Supreme Court furthered the Trump-Pence administration’s discriminatory and cruel attacks against immigrants yesterday by allowing its final “public charge” rule to go into effect. Under the rule, people may be denied entry into the U.S. or an adjustment in their immigration status (i.e. obtaining a green card), simply because they have received certain public benefits in the past – including health care, nutrition assistance, and public housing – or are judged likely to use benefits in the future. It is designed to keep families separated, and to scare immigrants already in the U.S. from accessing health care and other basic care and benefits, to which they are legally entitled, out of fear of retaliation from the administration……The Supreme Court’s 5-4 decision comes on the heels of other attacks on immigrants by this administration, such as banning pregnant women from entering the U.S.; ripping millions of families apart by rescinding DACA (Deferred Action for Childhood Arrivals) and ending TPS (temporary protected status) for several countries; the physical separation of children from their parents at the U.S.-Mexico border; the rollback of parental rights for parents involved in immigration proceedings; and increased enforcement of detention and deportation. January 28, 2020: A group of U.S. Senators sent a letter to Commissioner Andrew M. Saul of the Social Security Administration opposing the cuts to Social Security. From the letter: …We write to oppose the Social Security Administration’s (SSA) proposed regulations altering when and how often SSA conducts continuing disability reviews (CDR), published in the Federal Register on November 18, 2019. The proposed rule would dramatically increase the number of CDRs the agency conducts every year and burden millions of Americans with disabilities with more frequent, unjustified reviews of their eligibility for Social Security Disability Insurance (SSDI) benefits. At a time when leadership from SSA is sorely needed to further reduce unacceptably long disability application wait times and eliminate the disability hearing backlog, it is alarming that the agency appears more concerned with devoting limited resources toward making it harder for people with disabilities to receive essential benefits. This proposal appears to be yet another attempt by the Trump Administration to make it more difficult for Americans to access essential supports.Specifically, we oppose SSA’s proposal to create a new medical diary category with a two-year CDR review period, to change the criteria used to assign cases into each medical diary category and to change the frequency with which the agency performs CDRs for cases in one existing medical diary. In its Notice of Proposed Rulemaking (NPRM), SSA fails to justify the need for this rule. Specifically, SSA fails to clearly establish a need for these changes, fails to justify the specific procedural changes proposed, fails to fully evaluate the effects these changes will have on beneficiaries and fails to provide an adequate cost-benefit analysis. SSA does not even provide a cursory estimate of the number of people who will lose access to benefits earlier than they would have had otherwise as a result of this rule…Failure to Justify Proposed Procedural ChangesThroughout the NPRM, SSA repeatedly fails to justify the specific changes it is proposing to make. For example, in explaining what cases will be included in the new MIL diary category, SSA provides no ratinale for including step 5 allowances, which are cases in which beneficiaries were determined eligible for disability benefits at the last step of the five-step disability claims process. SSA never explains why this arbitrary administrative distinction, and not medical evidence, should dictate that these individuals have their cases reviewed every two years. Furher, SSA provides no medical or administrative rationale for assigning children approaching ages 6 and 12 to the new MIL diary category other than stating tha these are ages at which many children transition into formal education or transition into adolescence. SSA provides no explanation for how such transitions relate to a child’s underlying medical condition of likelihood of experiencing MI nor does SSA explain why such beneficiaries would require more frequent review of ongoing eligibility.The proposed changes to the Medical Improvement Not Expected (MINE) diary category similarly lack justification. For example, SSA states that step 5 allowances based only on 17 specific impairments or conditions will continue to be included in the MINE diary category, but provides no explanation of the criteria used to distinguish these impairments and conditions from all others. In proposing to change the CDR review period for cases in the MINE diary category from between 5 and 7 years to every 6 years, SSA does not provide any explanation of why a 6-year review period is more appropriate than a 7-year period and provides no data on current MINE case review periods to justify the proposed change. In addition, SSA does not explain why, despite the agency repeatedly citing the need for greater flexibility as among the primary reasons it has issued this proposed rule, the agency is proposing to significantly curtail its flexibility to schedule CDRs for the wide variety of cases included in the MINE category.Failure to Fully Evaluate Effects on BeneficiariesSSA also fails to fully evaluate the effects the proposed rule would have on beneficiaries. The only aspect of beneficiary welfare that SSA provides any analysis of is the proposed rule’s potential impact on beneficiary employment outcomes, and that analysis is entirely insufficient. On the issue of beneficiaries’ potential return to employment, SSA selectively references only intersection SSDI and SSI benefit receipt and employment outcomes. SSA also interprets the findings of these few studies – which seemingly show that the majority of people who lose their SSDI benefits are not able to consistently earn significant income in the years after losing access – as somehow being supportive of the agency’s position that the proposed rule will improve overall beneficiary outcomes. The only additional evidence SSA cites to support its assertions are numbers the agency produced itself looking at the relationship between time spent out of the labor force and future earnings. SSA, however, then admits that its numbers provide no evidence of a casual relationship between the factors examined, rendering the agency’s findings completely immaterial to its analysis of the proposed rules’ effects.SSA provides no analysis of how the proposed rule will impact beneficiaries’ financial security, health or any other measure of individual wellbeing. These exclusions are not explained in the NPRM. SSA’s contention that this rule could have positive effects on for beneficiaries cannot be considered complete if the agency arbitrarily selects which aspects of beneficiary welfare it analyzes. Employment is not the only outcome of importance to the welfare of beneficiaries.Perhaps the most egregious omission from SSA’s analysis of effects on beneficiaries is that the agency provides no estimate of the number of children, yought and adults who will lose acces to benefits more quickly than they would have otherwise as a result of the proposed rule. This includes losing access to SSDI and SSI cast benefits, but also Medicare and Medicaid coverage that are frequently tied to a person’s eligibility for SSDI and SSI. SSA should be capable of producing such estimates with available data, and the fact that SSA already presents estimates of the proposed rule’s effects on SSDI and SSI benefit expenditures in the NPRM suggests that SSA has already produced an estimate. Without an estimate of the number of children, youth and adults who would lose access to their cash and health care benefits sooner than under current rules, the public cannot evaluate the effects of the proposed rule… Here are the Senators who signed the letter (by state): California: Kamala Harris. Diane FeinsteinColorado: Michael F. BennetConnecticut: Richard BlumenthalDelaware: Christopher A. Coons, Thomas R. CarperIllinois: Tammy Duckworth, Richard J. DurbinHawaii: Mazie Hirono, Brian SchatzMaine: Angus S. King, Jr.Maryland: Benjaman L. Cardin, Chris Van HollenMassachusetts: Edward J. Markey, Elizabeth WarrenMichigan: Debbie Stabenow, Gary C. PetersMinnesota: Amy Klobuchar, Tina Smith,Nevada: Catherine Cortez Masto, Jackie RosenNew Hampshire: Margaret Wood Hassan, Jeanne ShaheenNew Mexico: Tom Udall, Martin HeinrichNew Jersey: Cory A. Booker, Robert MenendezNew York: Kristen Gillibrand, Charles E. SchumerOhio: Sherrod BrownOregon: Ron Wyden, Jeff MerkleyPennsylvania: Robert P. CaseyRhode Island: Jack Reed, Sheldon WhitehouseVirginia: Tim KaineVermont: Bernard Sanders, Patrick LeahyWashington: Maria Cantwell, Patty MurrayWisconsin: Tammy Baldwin January 28, 2020: Reuters posted an article titled: “Trump Administration urges Supreme Court not to expedite Obamacare hearing”. It was written by Antonita Madonna. From the article: The Trump administration has asked the U.S. Supreme Court to deny the Democrats’ request to expedite its review of a lower court’s decision on the validity of the Affordable Care Act.Attorneys general in Democrat-led states had appealed to the Supreme Court to review a ruling of the Fifth Circuit Court of Appeals on Dec. 18 that one component of the ACA – the soc called “individual mandate” – was unconstitutional but sidestepped a decision on the validity of the entire law by sending it back to a federal judge in a lower court for further analysis……Attorneys general in 20 states and the District of Columbia asked the Supreme Court to expedite its decision on the matter, citing the impact of the decision on the health care of millions of Americans and the health insurance market, at large.The Trump administration, however, argued in its filing last week that the appeals court’s decision has no “imminent consequences,” as the individual mandate it ruled unconstitutional was already repealed as part of the tax overhaul in 2017 in which the tax penalty associated with it was removed……Attorneys General in 11 Republican states, led by Texas also asked the Supreme Court to deny the Democrats petition… The Trump administration’s request is here. The request made by 11 Attoneys General of Republican states is here. January 28, 2020: Hawaii Attorney General Clare E. Connors posted a news release titled: “Hawaii Attorney General Joins a Multistate Brief Challenging Restrictive Abortion Laws”. From the news release: Hawaii Attorney General Clare E. Connors today joined a multistate coalition led by California and Illinois in filing an amicus brief in the Eighth Circuit Court of Appeals in Reproductive Health Services v. Planned Parenthood of St. Louis challenging the constitutionality of several recently enacted abortion bans in Missouri. Planned Parenthood of St. Louis, the only remaining abotion clinic in Missouri, and its Chief Medical Officer Dr. Colleen McNicholas, are seeking to overturn two state laws that would significantly curtail women’s rights and creates barriers to safe and legal abortion. The multistate coalition argues that these laws are unconstitutional restrictions on women’s right to choose.“The law is planly unconstitutional and would put the health and wellbeing of women at risk by denying access to healthcare,” said Attorney General Connors. “Because any attack on reproductive freedom is dangerous, we are committed to protecting women’s rights throughout the country”……Joining Attorney General Connors in today’s filing are the attorneys general of California, Illinois, Colorado, Connecticut, Delaware, Hawaii, Maine, Maryland, Massachusetts, Minnesota, Nevada, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, and the District of Columbia. January 28, 2020: New York Attorney General Letitia James posted a press release titled: “Attorney General James Fights Missouri’s Restrictive Abortion Laws”. From the press release: New York Attorney General Letitia James today continued her fight to protect a woman’s right to choose, pushing back against obstructive laws passed in the State of Missouri that impose unconstituional restrictions on a woman’s right to have an abortion. In a multistate amicus brief filed in support of the defendants in Reproductive Health Services v. Planned Parenthood of St. Louis, Attorney General James, part of a coalition of 20 attorneys general from around the nation challenged the constitutionality of several recently enacted abortion bans in Missouri. Planned Parenthood of St. Louis – the only remaining abortion clinic in Missouri – and its Chief Medical Officer, Dr. Colleen McNicholas, are seeking to overturn several state restrictions that would significantly curtail women’s rights and create barriers to have safe, legal abortions.“Nearly 50 years ago, the courts ruled that women across the country have the right to control their own bodies, but nearly every day since anti-choice legislators have tried to impost their personal beliefs on the wills of millions of women nationwide,” said Attorney General James. “These laws simply aim to control our bodies, control our choices, and control our freedom, which is why we will never stop fighting. We will not allow Missouri, nor any other state to undo all the progress we have made by restricting access to safe, legal, abortions.”Missouri recently enacted several anti-choice laws meant to deny women access to abortion care in the state. Included in those laws are several “Gestational Age Bans” that make it a felony for physicians to perform abortions before the stage of viability recognized by the Supreme Court and, in some cases, before women would even know they were pregnant. In particular, the bans prohibit abortion after 14, 18, and 20 weeks so that if the court strikes down the eight-week ban, for example, the 14-week ban woudl still be in effect. Also included in the Missouri laws is a “Reason Ban” that prohibits a doctor from performing a pre-viability abortion if the doctor “knows” that a patient is seeking an aborton “solely because” of a prenatal diagnosis of Down syndrome.In August 2019, Planned Parenthood of St. Louis secured a preliminary injunction in the U.S. District Court for the Western District of Missouri against the enforcement of the Gestational Age Bans. The district court subsequently issued an addition order prohibiting the state from enforcing the “Reason Ban.” Missouri appealed both decisions. Attorney General James and the coalition of attorneys general are today arguing that the challenged laws are unconstitutional, do not promote women’s healthcare, and deny women access to safe, legal abortions. As the coalition explains, states can advance their interests in support of women’s health while simultaneously protecting the rights of persons with Down syndrom without infringing on women’s reproductive rights.Today’s brief is just the latest victory in a long list of measures Attorney General James has taken to protect women’s reproductive freedom. Last week, Attorney Genral James secured a victory for women in Rochester seeking to have an abortion without being harassed, threatened, or blocked before entering a clinic when a district court judge dismissed a lawsuit by anti-abortion activists seeking to bypass a 15-foot “buffer zone” outside a local Planned Parenthood clinic……Joining Attorney General James in filing today’s brief are the attorneys general of California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Minnesota, Nevada, New Mexico, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, and the District of Columbia January 28, 2020: California Attorney General Xavier Becerra posted a press release titled: “Attorney General Becerra Leads Multistate Brief Challenging Restrictive Abortion Laws”. From the press release: California Attorney General Xavier Becerra and Illinois Attorney General Kwame Raoul today led a multistate coalition in filing an amicus brief in the Eight Circuit Court of Appeals challenging the constiutionality of several recently enacted abortion bans in Missouri in Reproductive Health Services v. Planned Parenthood of St. Louis. Planned Parenthood of St. Louis, which provides the only remaining abortion services in Missouri, and its chief Medical Officer Dr. Colleen McNicholas, are seeking to overturn two start laws that would significantly curtail women’s rights and create barriers to safe and legal abortion. The multistate coalition argues that these laws are unconstitutional restrictions on women’s right to choose.“No government, state or federal, has the right to make personal decisions for a woman about her body or her healthcare,” said Attorney General Becerra. “Missouri’s anti-choice laws are blatently unconstitutional and leave women in Missouri with no option within the state for safe, legal abortion care. We will continue to stand with women and the Constitution to protect theri access to comprehensive healthcare.”… A copy of the complaint is here, January 28, 2020: The American College of Physicians (ACP) posted a press release titled: “Internists Say Court’s Decision on Public Charge Rule Jeopardizes Health Care for Immigrants”. This statement is attributable to Robert McLean, MD, MACP, President of American Collge of Physicians. From the press release: The American College of Physicians (ACP) is deeply disappointed that the Supreme Court decided to allow the Administration’s “public charge” rule to take effect in most of the United States while legal challenges play out. ACP is greatly concerned that this decision will jeopardize the health of children, their families, and create barriers to care for legal immigrants.As a physician, I fear that with the changes to the public charge rule in place patients will forgo necessary care rather than face the threat of deportation or family separation, putting their own health and the health of their communities at risk. I worry that patients who are legal immigrants will opt out of health care services for themselves and their children – avoiding critical preventative services and leaving urgent medical conditions untreated.ACP has been on record opposing the changes to greatly expand the scope of the public charge rule. When the changes were first proposted, the ACP wrote to the Department of Homeland Security to say that the changes “would undermine the physician-patient relationship and disrupt care continuity, and it is anthetical to the College’s mission to ensure meaningful access to health care for our patients. The rule will have negative impacts that will reverberate across populations, including U.S. citizens and legal residents.” That is why just last week ACP and other major physician groups filed an amicus brief in the Supreme Court case, opposing the new rule and outlining the harms that it would cause if it went into effect.ACP asserts that immigration policy should not interfere with patient-physician relationship, and that health policy should not foster discrimination against any patient, regardless of immigration status. We will continue to urge the courts to issue a final ruling tha the public charge is unlawful and unconstitutional. At the same time, we also urge Congress to act to block its implementation. January 29, 2020: The Hill posted an article titled: “Appeals court reufses to reconsider ruling striking down ObamaCare mandate”. It was written by Harper Neidig. From the article: A federal appeals court voted against rehearing a legal challenge to ObamaCare after a three-judge panel struck down the health care law’s individual mandate.The 5th Circuit Court of Appeals voted 8-6, mostly along ideological lines, against rehearing the case, after one of the judges asked for a vote.Neither party in the lawsuit had asked the circuit court to rehear the case. A coalition of blue states has already appealed to the Supreme Court , which is currently deciding whether to take up the law…. January 29, 2020: The American Civil Liberties Union (ACLU) posted an article titled: “We’re Back in Court this Week Defending Access to Safe Abortion in Kentucky”. It was written by Amber Duke, Communications Director. From the article: The ACLU is back in court today once again to stop Kentucky’s attempt to block access to abortion. We’ve been here before. Over the past three years, the Kentucky General Assembly has passed bill after bill that limits – and even bans – a person’s ability to get an abortion. And time after time, we’ve gone to court to protect people’s rights to get the care they need.At issue this week is a law that makes it a crime for doctors at Kentucky’s last remaining abortion clinic to perform an abortion procedure that is the standard of care. In reality, the law is nothing more than a backdoor abortion ban: It would bar the only procedure available in the state after about 15 weeks of pregnancy.Following a trial last year, a federal district court blocked the law, finding that it imposed “a substantial obstacle to a woman’s right to an abortion” – as other courts around the country similarly found. But the Commonwealth of Kentucky appealed, and we are arguing the appeal in the U.S. Court of Appeals for the Sixth Circuit today.The commonwealth’s opposition to this type of procedure is blatently political, not medical. Leading medical expets such as the American Medical Association and the American College of Obstetricians and Gynecologists oppose these bans, saying they interfere with a doctor’s ability to provide the best possible care for their patient….…today Kentucky has only one clinic left in the entire state. And the state is trying to force that last clinic to close its doors, leaving Kentuckians with no abortion provider at all. It’s only because we went with the clinic, EMW Women’s Surgical Center, to get a court order that the doors are still open; this case is on appeal… January 29, 2020: Politico posted an article titled: “‘Block grants’ no more: Trump’s Medicaid overhaus has a new name, same goals”. It was written by Dan Diamond and Rachel Roubein. From the article: The Trump administration will rebrand its Medicaid block grant program and look to safeguard the policy against an expected wave of legal challenges from patient advocates, according to two officials with knowledge of the plan set for release Thursday.The forthcoming block grant program comes with a new name – “Healthy Adult Opportunity” – but retains the original mission long sought by conservatives: allowing states to cap a portion of their spending on Medicaid, a radical change in how the safety net health program is financed.The block grant plan, which invites states to request capped funding for poor adults covered by Obamacare’s Medicaid expansion, also would let states limit health benefits and drugs avaialble to some patients……Aware of criticism that any cap on Medicaid funding would target vulnerable patients, [Seema] Verma will stress during Thursday’s announcement that her plan, by focusing just on the Obamacare expansion, will not affect the poorest or disabled patients. Verma has long argued Medicaid expansion is siphoning away resources from the most vulnerable patient covered by the program CMS will frame the block grant as a way to reinvest any savings into care improvements for Medicaid beneficiaries.States will be required to report their performance in real time, such as whether Medicaid patients see declines in access to providers or health outcomes, which one official said would allow the administration to gague whether the block grant was truly working to make adults healthier. One official said this could help CMS guard the program against legal challenges as advocates who say the administration doesn’t have the authority to cap Medicaid……The Trump administration also will allow participating states to limit the drugs offered by their Medicaid programs, a sticking point for states frustrated by the requirements that the safety net program include an expansive list of medications. Patients with behavorial health needs of HIV would be protected under the Trump administration plan, said one official… January 29, 2020: Several U.S. Representatives signed a letter to U.S. Department of Health and Human Services Alex M. Azar, II and Administrator of Centers for Medicare and Medicaid Services regarding the Trump administration’s approval of Medicald block grant waivers. From the letter: …We write to express our strong concerns regarding your intent to approve Medicaid block grant waivers. Previous statements from those in the Administration make it clear that the goal of these block grants is to cut benefits and further limit access to publicly funded health care. Additionally, the approval of such waivers would directly oppose federal statutes, which describe how the agency must make matching funds available to state Medicaid programs.Medicaid was created in 1965 for the purpose of expanding access to healthcare to low-income children, families, people with disabilities, seniors and other adults. Section 1115 explicitly permits waivers of specific sections of the Social Security act, but does not allow waivers for Section 1903, the section that directs federal matching funds to states. Therefore, the Centers for Medicare and Medicaid Services (CMS) is required to match state’s spending as the statute prescribes and is powerless in determining alternative state payments, including capping the Medicaid funds it disburses. The power and responsibility to change these payments lies solely with Congress. The intent of the current structure and the federal match is to help states provide adequate medical support for their poorest residents.By contrast, the purpose of block grant waivers is to overhaul the state’s Medicaid program by capping federal funding. In turn, states would be given a lump sum of federal money, freed from federal oversight or accountability measures; measures which encourage baseline benefits and quality of care to be available to all enrollees. These waivers would give states the ablity to remove enrollees or cut certain health care benefits and rates, if they believe they are too costly or unnecessary.Permitting waivers to allow for less spending in return for limited oversight directly contradicts Congress’s intent when establishing Medicaid; a safety-net health program. Medicaid block grants necessitate cost-cutting measures like restricting enrollment, decreasing provider reimbursement, and limiting eligibility and benefits through managed care. These actions endanger the lives of the most vulnerable patients, the population Medicaid was created to protect.Not only do Medicaid block grants directly oppose Congress’s intent for the Medicaid program, but they are illegal under Section 1115.Earlier this month, House Energy and Committe Chairman Frank Pallone, Jr. and Senate Finance Ranking Member Ron Wyden sent a letter to the Office of Inspector General in the Department of Health and Human Services citing the illegality of Medicaid block grants. Chairman Pallone and Ranking Member Wyden are both members of the two Committees with jurisdiction over Medicaid; the agency should heed their concern over the lack of program integrity should these waivers be approved.Guidance providing states a roadmap to obtain Medicaid block grant waivers not only defies Congress and the federal Medicaid statute but if implemented, will threaten health care for millions of individuals, hurting them whne they are the most vulnerable. The Administration should not issue any guidance encouraging block grant waivers, should reject these waviers and the concept of block grants, and urge any state that is considering this misguided policy to commit its energy to implementing Medicaid as Congress intends. Here are the Representatives who signed this letter (by state): Alabama: Terri A. SewellArizona: Ann Kirkpatrick, Donald S. Beyer Jr.California: Ro Khanna, Grace NapolitanoColorado: Jason CrowConnecticut: Rosa L. DeLauroFlorida: Darren Soto, Cathy Castor, Debbie Mucarsel-Powell, Val B. DemmingsIowa: Abby FinkenauerKansas: Sharice L. DavisMaine: Chellie PingreeMassachusetts: Joseph P. Kennedy, III, Ayanna PressleyMichigan: Debbie Dingell, Daniel Kildee Minnesota: Angie Craig, Ilhan OmarNew Hampshire: Chris PappasNew York: Thomas R. Suozzi, José E. Serrano, Eliot Engel, Adriano Espaillat, Nydia M. VelázquezNorth Carolina: G.K. ButterfieldOhio: Marcia L. FudgePennsylvania: Susan Wild, Mike DoyleTennessee: Jim Cooper, Steve CohenTexas: Eddie Bernice JohnsonVermont: Peter WelchVirginia: Jennifer WextonWisconsin: Gwen Moore January 29, 2020: WiscNews posted an article titled: “Wisconsin further delays Medicaid work requirments for childless adults.” It was written by David Wahlberg. From the article: Wisconsin’s work requirement for childless adults on Medicaid, initially schedulled to begin Nov. 1 and delayed until Thursday, has been postponed again – with a new requested start date of April 29.Premiums and some other stipulations adopted by former Republican Gov. Scott Walker and approved by President Donald Trump’s administrtion are set to begin Saturday……Wisconsin plans to limit Medicaid coverage to four years for poor adults without dependent children unless they work, train for a job, or particiapte in certain other activities.Gov. Tony Evers, a Democrat who took office last year, tried to block the work requirment, but the Republican-controlled Legislature kept it. Evers’ administartion has said it would implement it. January 29, 2020: The American Civil Liberties Union (ACLU) posted a press release titled: “ACLU of South Dakota Urges Lawmakers to Stop Hurting Transgender Youth”. From the press release: Ahead of today’s full chamber vote on House Bill 1057, legislation that would criminalize doctors for providing medically necessary care for transgender youth, some South Dakota legislators continue their attempts to codify discrimination against trans kids.The ACLU of South Dakota opposes Senate Bill 88 and Senate Bill 93.Senate Bill 88 would mandate that school counselors, school psychologists or social workers disclose to a parent any young person’s identification as transgender, exploration of gender identity or reference to potential symptoms of gender dysphoria. This bill could result in forced disclosure of someone’s trans or questioning status to a non-affirming parent which could result in the young person becoming homeless or physically harmed.“When transgender youth face discrimination and victimization at school, it can often lead to serious negative health and mental health consequences,” said Libby Skarin, policy director for the ACLU of South Dakota. “Senate Bill 88 infringes on the rights of privacy of youth and deters young people from seeking support from trusted adults in positions to consel them.”Senate Bill 93 would give a parent the right to refuse to consent to a range of health care treatment options, including mental health treatment, for transgender young people. Parents, however, already have broad constitutional and common law powers to make decisions about medical treatment for minor children in their care and custody that cannot be limited by legislation.“Transgender yough are among society’s most at-risk populations,” Skarin said. “Senate Bill 93 just amounts to a proclamation of government disapproval of transgender young people and contributes to the already dangerous rates of family rejection for transgender youth.”Like House Bill 1057, Senate Bill 88 and Senate Bill 93 would hurt transgender yough, violate federal law and expose South Dakota to legal liability. The ACLU of South Dakota is committed to ensuring that transgender South Dakotans can live openly without discrimination remains strong and urges South Dakota lawmakers to stop hurting transgender youth… January 29, 2020: The Buffalo News posted an article titled: “Lawmakers push back against Cuomo Medicaid deficit reduction ideas”. It wa written by Tom Precious. From the article: …Before Health Commissioner Dr. Howard Zucker and Medicaid Director Donna Frescatore departed a legislative hearing room Wednesday, they were told by lawmakers in no uncertain terms that: fiscal books are somehow being cooked; facts are being withheld; painful service cuts are aimed at elderly, poor and disabled New Yorkers; and county taxpayers are going to be harmed by cost shifts proposed by Cuomo……[State Senator Gustavo] Rivera, and others were frustrated by a lack of specifics, the blocking of information to legislative staff experts and a plan by Cuomo to create a private, outside panel to come up with $2.5 billion in Medicaid savings that won’t report its findings until sometime shortly before a state budget is due March 31……Officials in New York City, which accounts for about half of Medicaid costs in the state, said Cuomo’s cost shift plan could, based on recent insurance cost levels, hit the city with a $1.1 billion tab in the coming year. [Cuomo officials later said the city’s $1.1 billion claim was vastly overstated by at least $880 million.]……Last week, Erie County Executive Mark Poloncarz said Medicaid costs would have been about $8 million higher in each of 2017 and 2018 had Cuomo’s new cost-sharing plan been in effect. How muchcould it be in 2020 is anyone’s guess at this point.The state is facing a $6.1 billion deficit in the coming fiscal year, with two-thirds of that generated by Medicaid red ink. High costs for providers meeting the state’s new minimum wage requirements and rising long-term care costs for seniors and disabled people are among the big expense drivers. The Cuomo administration has solved part of the problem by rolling over – or delaying – payments to providers from one fiscal year to the next.Cuomo has two other ideas now: incentivize counties to help find Medicaid savings by raising state costs onto them if those savings aren’t realized, and, create a panel – called the Medicaid Redsign Team (MRT) – to find $2.5 billion in savings. With budget talks already underway, Cuomo has yet to appoint the panel, except its two co-chairs: a longtime health care union leader and the New York head of a hospital system that is the state’s largest. One lawmaker Wednesday pondered out loud about potential conflicts of interest inherent in having a hospital boss decide winners and losers in Medicaid cuts… January 30, 2020: The Guardian posted an article titled: “South Dakota lawmakers vote to jail doctors for treating trans teens”. It was written by Guardian staff and agency. From the article: South Dakota lawmakers voted in favor of a law that would see doctors jailed for giving puberty-blocking drugs to transgender children, the latest in a slew of such bills sweeping the United States.The bill, which cleared the South Dakota house of representatives on Wednesday but still has to clear the state’s senate, would bar doctors in the state from providing anyone under 16 with the drugs, which can temporarily stop the body from producing the hormones that lead to puberty, a reversable process.Critics of the proposed ban say the drugs play a crucial role in allowing trans children struggling with the onset of puberty to hit pause.“One of the biggest problems for these kids is… their sense of who they are isn’t matching their body,” Anne Dilenschneider, a South Dakota psychologist, told the Thomson Reuters Foundation.“They’ve got a body developing in a way that is causing a huge crisis. And they want it to stop,” said Dilenschneider, warning that this could make young people suicidal.Studies have found that young trans people have a much higher suicide rate than their peers……The bill follows the introduction in South Carolina of measures that could see the licenses of doctors who treat trans children revoked, one of a series of such measures in conservative US states……Experts and parents of trans children warn such restrictions could harm young people already struggling with the challenges of adolescence and gender dysphoria……The ban passed with 46 votes to 23 in the state’s Republican-controlled house of representatives. It will still have to clear the senate, where it may face greater opposition. The state’s govenor will have the final say. January 30, 2020: The American Academy of Pediatrics (AAP) posted news titled: “AAP opposes new Medicaid guidance on block grants, per capita caps”. It was written by Trish Korioth. From the news: Sweeping new federal guidance on Medicaid issued by the Centers for Medicare & Medicaid Services (CMS) would be detrimental to children and families, according to the AAP, five other major medical organizations and several health groups. The guidance announced by CMS Thursday allows caps on federal funding and offers states the option to use block grants and per capita caps for low-income adult populations, including parents with young children.“The American Academy of Pediatrics urges CMS to immediately rescind this guidance and instead pursue policis that strengthen Medicaid. CMS must instead work to revers the troubling trend of rising child uninsurance rates due to children losing Medicaid and CHIP (Children’s Health Insurance Program) coverage,” AAP President Sara “Sally” H. Goza, M.D., FAAP, said in a statement.Medicaid enrolls 37 million children nationwide. When parents lose coverage, their children are more likely to lose coverage as well. However, the full impact of the guidance on children remains unknown. The AAP and health groups isued a joint statement “united in opposition to any threat to Medicaid that would dismantle a pillar program millions of families rely on.”The block grant or per capita financing mechanism for Medicaid also violates joint principles on Medicaid waivers supported by the six major medical organizations that represent more than a half-million U.S. physicians. Children, including those with special health care needs and those from low-income families, make up the single largest group of people who rely on Medicaid.Following the release last September of the U.S. Census Bureau data showing 425,000 fewer childrne had health insurance coverage in 2018, the groups called for immediate action by Congress and the Trump administration to protect and improve health coverage for all children……The Medicaid program guarantees specific benefits designed for children, known as Early and Periodic Screening, Diagnostic and Treatment (EPSDT). As a result, children on Medicaid are more likely to get checkups, miss less school, graduate and enter the workforce than their uninsured peers. But under the new guidance, states also will be allowed to opt out of providing EPSDT to some populations.“We urge CMS to immediately rescind the guidance and keep Medicaid strong,” Dr. Goza said. “Simply put: Medicaid works.” The letter from six major medical organizations is here. It includes the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American College of Obstetricians and Gynecologists, American Osteopathic Association, and American Psychiatric Association. January 30, 2020: New York Attorney General Letitia James posted a press release titled: “Attorney General james Sues Trump Administration For Attempting To Raise Costs Of Abortion Services Under ACA”. From the press release: New York Attorney General Letitia James today co-led a coalition of seven attorneys general in suing the Trump Administration for making it more difficult for women in New York and across the nation to access abortion services under the Affordable Care Act (ACA). In late December 2019, the U.S. Department of Health and Human Services (HHS) issued a final rule that unlawfully reinterpreted Section 1303 of the ACA by requiring qualified health plans that particupate in the state exchanges – like the New York State of Health – to send separate bills and collect separate payments of at least one dollar for abortion services. In their lawsuit, Attorney Geeneral James and the colaition argue that HHS’s new onerous and confusing requirement threatens women’s access to abortion. The lawsuit also highlights that the new rule is incompatible with the ACA’s requirement of equitable access to health care and disproportionately affects states – like New York, California, Maine, Oregon, and Vermont – that are committed to ensuring access to comprehensive reproductive health care by requiring health plans to provide abortion coverage.“Every day, the Trump Administration and anti-choice activists look for new ways to undermine Roe v. Wade and impose burdensome restrictions on women’s reproductive freedoms,” said Attorney General James. “This new rule is just another attempt to control women’s bodies and make it harder for those struggling financially to exert their constitutional right to an abortion. New York will not sit idly by as this Administration continues its assault on women. We will never stop fighting to ensure every woman is able to make her own reproductive choices.”Under New York law, all private health plans regulated by the state are required to offer abortion coverage as part of their basic health care services, but the new federal rule requires insurers to separately bill for the portion of health insurance premiums attributable to abortion coverage. The rule also requires consumers to make a separate payment of at least one dollar for these services or risk losing all of their health care coverage. HHS itself has conceeded that requiring separate bills and separate payments will inevitably lead to confusion for the more than 260,000 New Yorkers that have already enrolled in a qualified health plan this year. The rule will also burden states with unnecessary administrative costs and harm consumers who will face higher insurance premiums as a result to increased cost to carriers. For example, initial compliance is expected to cost all impacted insurance companies nearly $400 million, with another $100 million in estimated annual costs to maintain the separate systems. These excessive costs put pressure on insurers to remove abortion coverage from their plans and punish those companies that do business in states, like New York, where abortion coverage is required.In the lawsuit filed today – led by Attorney General James and California Attorney General Xavier Becerra – the coalition aruges that the new rule is unlawful because it:Imposes onerous and unnecessary regulatory barriers aimed at restricting women’s constitutionally-protected right to access abortion care;Seeks to frustrate state sovereignty by coercing states to change their policies relating to the protection of abortion care;Violates section 1554 of the ACA, which prohibits the prmulgation of any regulation that creates unreasonable barriers to the ability of individuals to obtain appropriate medical care; andExceeds HHS’s statutory authority under Section 1303 of the ACA..…Joining Attorney General James and Attorney Genearl Becerra in filing today’s lawsuit were the attorneys general of Maine, Maryland, Oregon, Vermont, and the District of Columbia. A copy of the brief is here. January 30, 2020: California Attorney General Xavier Becerra posted a press release titled: “Attorneys General Becerra and James File Lawsuit Challenging Trump Administrtion Attack on Healthcare Access and Reprodcuctive Rights”. From the press release: California Attorney General Xavier Becerra and New York Attorney General Letitia James, leading a coalition of six states and the District of Columbia, today sued the U.S. Department of Health and Human Services (HHS) for its unlawful reinterpretation of Section 1303 of the Affordable Care Act (ACA). On December 27, 2019, HHS issued a final rule requiring qualified health plans participating in the state exchanges like Covered California to send separate bills and collect separate payments of at least one dollar for abortion coverage. This onerous and confusing requirement threatens women’s access to abortion and puts millions at risk of accidentally losing critical health insurance coverage. The lawsuit highlights that the new rule is incompatible with the ACA’s requirement of equitable access to healthcare and disproportionatelly affects states that are committed to ensuring reproductive healthcare.“This new rule is just another Trump Administration attack on women and reproductive rights,” said Attorney General Becerra. “We have a long history of protecting women’s access to comprehensive reproductive healthcare, including abortion. We won’t let an unlawful administrative rule change that. And we will defend California’s ability to enact and enforce laws that promote the health of its residents.”Under California law, all health plans regulated by the state are required to offer abortion coverage as part of their basic healthcare services. The new federal law requires insurers to separately bill for the portion of health insurance premiums attributable to abortion coverage. The rule also requires consumers to make a separate payment of at least one dollar for these services or risk losing all of their healthcre coverage. HHS itself has conceded that requiring separate bills and separate payments will inevitably lead to confusion, putting more than 1.4 million enrolles in California alone at risk of losing coverage if they inadvernently fail to make full premium payments on time. The rule will also burden carriers. For example, initial compliance is expected to cost all impacted insurance companies nearly $400 million, with another $100 million in estimated annual costs to maintain the separate systems. These excessive costs put pressure on insurers to remove abortion coverage from their plans and punish those companies that do business in states like California where abortion coverage is required……Attorney General Becerra was joined in filing today’s lawsuit by the attorneys general of New York, Maryland, Maine, Oregon, Vermont and the District of Columbia. January 30, 2020: The Department of Health and Human Services Centers for Medicare and Medicaid Services sent a letter to state Medicaid directors about “Healthy Adult Opportunity”. From the letter: Dear State Medicaid Director:The Centers for Medicare & Medicaid Services (CMS) is pleased to announce a new opportunity for states to potentially achieve new levels of flexibility in the administration and design of their Medicaid programs while providing federal taxpayers with greater budget certainty. The Healthy Adult Opportunity (HAO) initiative will allow states to carry out demonstrations under section 1115 (a)(2) of the Social Security Act (the Act) to provide cost-effective coverage using flexible benefit designs under either an agressive or per-capita financing model for certain populations without being required to comply with a list of Medicaid provisions identified by CMS.CMS recognizes that states, as administrators of the program, are in the best position to assess the needs of their respective Medicaid-eligible populations to drive reforms that result in better health outcomes. States that agree to implement demonstrations under either of these financing models and to increased transparancy and accountaiblity for effective administration of their programs, quality and access to care, which in the judgement of CMS, are likley to assist in promoting the objectives of the Medicaid program, will be granted extensive flexibility to test alternative approaches to implementing their Medicaid programs, including the ability to make many ongoing program adjustments without the need for demonstration or state plan amendments that require prior approval. The list of Medicaid provisions with respect to which we will consider providing flexibility for states participating in demonstrations approved under the HAO initiative is provided in Appendex A. This includes flexibility on provisions such as retroactive coverage, cost-sharing limits, presumptive eligibility, and other requirements that CMS historically has waived under section 1115 of the Act.Through the HAO initiative, CMS is inviting states to design demonstrations for consideration by CMS that will promote the objectives of the Medicaid program, including the furnishing of medical assistance in a manner that promotes the sustainability of government health care spending through the use of an annual budget neutrality limit, calculated in the aggregate or on a per capita basis. While federal funding will be capped, federal financial participation (FFP) will continue to flow to states as it does today; nothing in this letter changes the need for states to submit claims reflecting actual expenditures to obtain federal matching funds for the Medicaid program. Demonstrations approved utilizing this approach will ofeer states far greater flexibility and discretion than is available under ordinarily-applicable Medicaid rules without the need for complex amendments or advance federal approval of certain changes……The HAO initiative encourages states to apply for all flexibilities that been previously approved in other demonstrations where such flexibilities would be likely to promote the objectives of the Medicaid program, such as… The ability to cover adults who qualify for Medicaid on a basis other than disability or need for long-term care services and supports and who are not covered under the state plan, including covering all individuals… that would apply if they were covered under the state plan;Providing populations covered under an HAO demonstration with coverage more consistant with insurance benefits provided the the Exchanges, rather than the traditional Medicaid benefit package;The ability to pay for services that cannot be funded by Medicaid, including those deisgned to address certain health determinants, such as enhnaced case management services that link individuals to housing or other supports;Design of flexible premium and cost sharing structures that are not required to comply with the terms of section 1916(f) of the Act;The ability to impose additional conditions of eligibility, such as community engagement requirements for non-elderly, non-pregnant Medicaid beneficiaries who are eligibile for Medicaid on a basis other than disability;The ability to make certain changes in benefits, premiums, and co-payments during the course of the demonstration without the need for state plan or demonstration amendments and further approval by CMS;The ability to change eligibility and enrollment processes, such as eliminating retroactive eligibility. Additionally, the HAO initiative potentially offers states new opportunities, including: The ability to make certain administrative changes during the course of the demonstration, such as certain changes in provider payment rates and application of claims review prior to making payment, without amendments or further approval by CMS;The ability to adopt a closed forumulary in line with Essential Health Benefit (EHB) requirements (with special protections for individuals with HIB and behaviorial health conditions);The ability to include coverage of services provided by a federally qualified health center as part of the state’s value-based payment reform option;The opportunity to propose alternate approaches to compliance with statutory managed care provisions that differ from those set forth in regulations;The opportunity for states implementing an aggregate cap demonstration to be elibible for shared savings when actual FFP is less than FFP allotment under the aggregate cap, provided a state meets certain performance criteria. …States will have the opportunity to impose conditions of eligibility on coverage under an HAO demonstration that do not generally apply to Medicaid coverage under state plans, such as community engagement requirements, … and consistent with other applicable laws, including title VI of the Civil Rights Act of 1964, section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, the Age of Discrimination Act of 1975, and section 1557 of the Patient Protection and Affordable Care Act (PPACA). CMS, in consultation and coordination with the Department of Health and Human Services (HHS) Office for Civil Rights, is available to assist states in designing projects that comply with the civil rights laws……States choosing to participate in the HAO initiative also will ahve the opportunity to set the income standard for eligibility for coverage under an HAO demonstration, as well as to change the standard over the course of the demonstration, and/or to limit coverage to a defined subset of individuals, such as individuals with severe mental illness, individuals needing treatment for substance use disorder, or individuals with HIV/AIDS. States may also propose to require an asset test for individuals seeking coverage under an HAO demonstration. Under the HAO initiative, and in other demonstration projects covering the adult group under section 1115(a)(2) authority, increased FMAP will be availble in accordance iwth sections 1905(y) and 1905(z) of the Act, provided that demonstration includes a standard for eligibility based on a household income standard of at least 133 percent of the federal poverty level (FPL), no asset test for those with income at or below 133 percent FPL, and eligibility for all individuals described in the adult group, even when benefits are not provided in accordance with section 137 of the Act… …For populations covered under an HAO demonstration, CMS will not require compliance with the effective date of eligibility prescribed under 42 CFR 435.914. Instead, states may propose to not to provide retroactive eligibility, as well as to establish a prosptective effective date of coverage – for example, to coincide with enrollment in a managed care plan or a Qualified Health Plan (QHP). States could also propose to conduct an individual’s first regularly-scheduled renewal of eligibility prior to the end of the 12-month renewal called for in 42 CFR… in order to align with the open enrollment period for Exchange coverage. In addition, many states may propose to not comply with the requirment to operate Hospital Presumptive Eligibility (HPE), … although states implementing an HAO demonstration can elect to offer such coverage to individuals covered under an HAO demonstration……States may propose under an HAO demonstration may propose to noe be required to comply with restrictions on premiums and cost-sharing imposed under sections 1916 and 1916A of the Act… Instead, states will have broad flexibility to propose alternative premiums and cost sharing structures. We would expect states to adhere to two overarching limitations:(1) Aggregate out-of-pocket costs incurred by beneficiaries covered under the demonstration would not exceed 5 percent of the beneficiary’s household income, meaured on a monthly or quartly basis.(2) Premiums and cost-sharing charges for tribal beneficiaries as well as individuals needing treatment for substance use disorder and individuals living with HIV, as well as cost-sharing charges for prescription drugs needed to treat mental health conditions, would not exceed amounts permitted under the statute and implementing regulations. States similarly would not be permitted to suspend enrollment for such individuals for failure to pay premiums or cost-sharing, even if authorized for other individuals under the demonstration……While nothing in this letter represents final approval of any program or is binding on any state or any Medicaid recipient, CMS hppes this information is helpful and looks forward to continuing to work with states to consider and implement innovative solutions to improve their Medicaid programs. CMS is available to provide technical assistance to states, as well as to preview states’ draft section 1115 proposals to help ensure states have the best chance possible of meeting federal requirements… January 30, 2020: The American College of Physicians (ACP) posted a press release titled: “Internists Say Changes to Medicaid Program Will Put Health Care at Risk for Vulnerable Patients”. This statement is attributable to Robert McLean, MD, MACP, President of American College of Physicians. From the press release: The American College of Physicians (ACP) is greatly concerned that the new Healthy Adult Opportinity Plan announced by the administration today will put access to health care at risk for Medicaid beneficiaries. ACP strongly opposes transforming Medicaid’s existing financial structure into a block grant approach because it will increase the nimer of people without health insurance coverage for essential health care services. Likewise, the per-capita cap option will restrict crucial health care funding.The Medicaid program is meant to provide a safety net for those most in need. For states that apply for the new demonstration project there would be a cap on the federal funding provided to cover adults under age 65 who are primarily eligible for Medicaid through Medicaid expansion, giving those states only a fixed amount of money no matter the need in the state. Just as troubling, they would also no longer need to ensure that their program is providing those beneficiaries with the same benefits and coverage. Fewer patients will be covered, and those who remain covered will have less access to health care services.We are concerned that enacting a cap on Medicaid funding leaves states unprepared to respond quickly to potential public health crises. In the event of an economic downturn, states would be unable to quickly accomodate people who might be unexpectedly and suddenly dealing with a loss of insurance and employment. States will have more ability to impose premiums and cost-sharing on adult Medicaid beneficiaries under these changes. We know that imposing cost-sharing dissuades low-income beneficiaries from seeking needed care.We are also concerned that this may encourage states, in a cost-saving effort, to cut prescription drug benefits. They also will be permitted to cut non-emergency transporation benefits tha could be vital to those seeking necessary care in rural or remote locations.Further, by restricting federal funding available to states, they may reduce payments to physicians under Medicaid. Currently, many state Medicaid programs reimburse at much lower rates than Medicare and commercial payers. Encouraging states to further reduce payments to physicians will have a particularly adverse impact on primary care physicians, making i more difficult for them to continue seeing Medicaid beneficiaries.As a physician, I worry abotu what will happen to my patients who depend on Medicaid for their health care. Medicaid programs across the country are vital in the effort to ensure that our nation’s most vulnerable population has access to health coverage. ACP calls on the Centers for Medicare and Medicaid Services to reverse this guidance that would drastically weaken coverage under the Medicaid program for low-income adults and instead focus on policies that would strenghten it.Our current healthcare system with problems of accessiblity and affordability already leaves too many patients behind. ACP is greatly concerned this Medicaid change will exacerbate these problems. Our patients deserve better. January 30, 2020: Planned Parenthood posted a press release titled: “Trump Administration Greenlights Massive Cuts to Medicaid”. From the press release: Today, the Trump administration announced what could lead to a major overhaul to Medicaid, paving the way for states to slash Medicaid funding and jeopardize health care coverage for people with low incomes, including reproductive and sexual health care……The Trump administration’s move to allow states to overhaul Medicaid into a block grant system would result in drastic cuts to funding, and could cause women with low incomes across the country to lose access to their health care. About one in five women of reproductive age rely on Medicaid for their health care, and women account for over half of all adult Medicaid enrollees. Medicaid covers more women’s health services than any other payer. Medicaid is also the largest payer of reproductive health care coverage, paying for nearly half of all births in the United States and 75 percent of family planning services.The attack on Medicaid comes barely a week after the Trump administration granted Texas federal funding for their state program that blocks patients in the program from accessing care at Planned Parenthood health centers, setting a dangerous precedent for other states that may follow suit. After Texas barred Planned Parenthood from providing care through the program in 2013, there was a sharp decline in access to women’s health services, resulting in nearly 45,000 fewer women accessing health care services through the Texas program… February 2020 February 1, 2020: The Gainesville Sun posted an article titled: “State House Speaker seeks health care reform”. It was written by John Kennedy. From the article: Backed by a scorched earth attack on Big Pharma and the “health care industrial complex”, House Speaker Jose Oliva is promoting wide ranging changes to the state’s medical landscape that may cause a possible side effect.Republicans hope they help at the ballot box in the nation’s biggest presidential swing state.With polls showing health care access and cost among the top issues for voters, Oliva is among a chorus of Florida Republicans getting behind President Donald Trump’s promise last spring to make the GOP “the party of health care.”But in a state when Republican leaders’ opposition to the Affordable Care Act also has left it among the few not to expand Medicaid coverage for lower-income residents, some think the Miami Republican is more interested in the optics and political messaging of reform……Indeed, the issue has fallen out of discussions among lawmakers even as 36 states have embraced Medicaid expansion, which is 90 percent financed by the federal government.About 2.8 million Floridians are uninsured, or 14 percent of the state’s population, a survey by the Centers for Disease Control shows… February 4, 2020: NARAL Pro-Choice America posted a press release titled: “NARAL Pro-Choice Iowa Speaks Out Against Proposed Constitutional Amendment Seeking to Ban Abortion in the State”. From the press release: Iowa Republicans in the House are today debating a proposed constitutional amendment (HSB577), which would roll back the right to access abortion in the state. Republicans are trying to sneak through discussion of the amendment by scheduling the hearing the morning after the biggest day in Iowa politics, the presidential caucus. This extreme measure is dramatically out of step with Iowans’ values and beliefs that decisions about pregnancy should be made by a woman, not politicians.NARAL Pro-Choice America National Communications Director Kristin Ford released the following statement:“Anti-choice Republicans in Iowa are trying to steamroll Iowans with their extreme agenda, attempting to roll back access to abortion by changing the state constitution. Every Iowan must be able to decide if, how, and wen to grow a family. Iowans overwhelmingly support protecting the right to access abortion and believe that politicians have no place interfering in personal decisions best left up to a woman with the support of those she loves and trusts. Iowa is ground zero in the fight for reproductive freedom, and NARAL Iowa members will continue to take politicians to taks for attacking our fundamental freedoms.”SJR2001, the corresponding Senate version of the bill which passed out of the Senate State Government committee earlier this year, proposes an amendment to the Constitution of Iowa tha would declare that there is “no right to an abortion” in the state……It’s clear that abortion is a critical issue to caucus-goers and voters in Iowa. Abortion and reproductive freedom remain a top issue for Iowa caucus-goers. When researching presidential candidates, “abortion” was among the top two most-searched issues in Iowa over the past week, according to Google Trends. Similarly, 8 out of 10 likely Democratic caucus-goers call support for abortion rights a “must have” for any candidate they would support, according to a recent CNN poll. Americans are aligned in their support for reproductive freedom and Roe v. Wade is more popular than ever. The vast majority of Americans (including Republicans!) support the landmark Supreme Court ruling, and there is no state in the country where banning abortion is popular. February 5, 2020: Kaiser Family Foundation posted an issue brief titled: “Implications of CMS’s New “Health Adult Opportunity” Demonstrations for Medicaid”. It was written by Robin Rudowitz, MaryBeth Musumeci, Rachael Garfield, and Elizabeth Hinton. From the issue brief: On January 30, 2020, the Centers for Medicare and Medicaid Services (CMS) released guidance inviting states to apply for new Section 1115 demonstrations known as the “Healthy Adult Opportunity” (HAO). These demonstrations would permit states “extensive flexibility” to use Medicaid funds to cover Affordable Care Act (ACA) expansion adults and other nonelderly adults covered at state option who do not qualify on the basis of disability, without being bound by many federal standards related to Medicaid eligibility, benefits, delivery systems, and program oversight. In exchange, states would agree to a limit on federal funding financing in the form of per capita or aggregate cap. States that opt for the aggregate cap and meet performance standards could access a portion of federal savings if actual spending is under the cap.HAO demonstrations differ from other Medicaid demonstrations already granted by this Administration in several ways, including the scope and flexibility offered to states and the capped federal funding……Background……Today, states operate their Medicaid programs within federal minimum standards and a wide range of state options in exchange for federal matching funds that are available with no limit. The matching structure provides states with resources that automatically adjust for demographic and economic shifts, health care costs, public emergencies, natural disasters and the changing program’s role in covering a low-income population with limited resouces and often complex health needs. Over time, states have transformed tand updated their Medicaid programs to adopt new service deliver models, payment strategies, and quality initiatives.Capped financing can present challenges for health programs. Unlike Medicaid in the states, the U.S. territories operate Medicaid under a federal cap, which has been set too low to meet enrollees’ needs and inflexible when responses to emerging health issues and natural disasters are required. Anotehr capped entitlement, the Children’s Health Insurance Program (CHIP), has been successful mainly becaise most states administer CHIP in conjunction with Medicaid (which is not capped), and the federal funding caps for CHIP have been set at levels that have not required states to make substantial program cuts. However, requirements to reauthorize federal CHIP funding and failure of Congress to act timely resulted in state budget issues and confusion for some enrollees……The Trump administration has used Section 1115 authority to implement substantial policy changes to the Medicaid program. Previous administrations have also used 1115 authority to advance policy priorities, but the Trump administration marked a new direction for Medicaid demonstrations beginning with the release of revised demonstration approval criteria in November 2017 that no longer included expanding coverage among stated objectives. Section 1115 demonstrations issued under the Trump administration to date hve included state programs to condition Medicaid eligibility on fullfillment of work and reporting requirements; use of premiums, copayments, and benefit restrictions not otherwise allowed under federal law; and behavioral health programs to use Medicaid funds for inpatient psychiatric hospital payments, among others… The HAO demonstrations also will use Section 1115 (a) (2) expenditure authority, which CMS maintains enables the Secretary to permit states to “not apply” federal Medicaid requirements to expenditures for individuals covered under the HAO demonsrations…. In using Section 1115 (a) (2), this Administration is inviting states to choose from a “menu” of provisions included in other approved demonstrations to date, and it is offering states the opportunity to modify or eliminate some program rules not previously granted.Key Provisions of HAO DemonstrationsFinancing The HAO demonstrations will be subject to an annual spending cap.The HAO spending caps differ from current methods used to determine budget neutrality for demonstrationsIn exchange for greater risk, states choosing an aggregate cap can obtain 25 to 50% of federal savings if spending is below the cap and performance benchmarks are met.States would be able to propose adjustments to an approved cap to account for changes in projected expenditures or enrollment due to unforseen circumstances outside the state’s control such as a public health crisis or major economic event. EligibilityStates could include in HAO demonstrations ACA expansion adults and other adults under age 65 that do not qualify on the basis of disability. These adult groups include low-income parents and pregnant women covered at the state option and other populations currently covered under Section 1115 demonstration authority. All children, mandatory pregnane women (those with incomes up to 138% FPL), manditory low-income parents (those up to the state’s 1996 cash assistance levels), and adults eligible based on a disability or long-term care need are excluded from the new demonstrations. Still, some people included in HAO demonstrations may have functional or other disabilities, as a large share of Medicaid adults have such disabilities even though they do not qualify on the basis of a disability. The guidance also notes that CMS may consider state requests to include other adult populations who are not covered under the state plan, which may open these demonsrations up to additional adult populations. States could use HAO demonstrations to extend coverage to groups not already covered. States could also terminate current state plan authority for optional groups and move that coverage to an HAO demonstration with additional restrictions.States could limit eligibility for certain adults under HAO demonstrations. States could set an income limit for expansion adults below 138% FPL and apply an asset test to limit eligibility for any demonstration enrollees. However, states can only recieve enhanced matching funds for ACA expansion adults if they cover the full population (alll adults with incomes under 138% FPL) without an asset test. Under the ACA, asset tests are not allowed for low-income parents, pregnant women, and expansion adults. States also can use HAO demonstrations to cover a subset of ACA expansion adults (at the regular matching rate), using other (non-financial) criteria, such as establishing geographic limits or restricting coverage to people with specific illnesss, such as behavoral health diagnoses.Under the HAO demonstrations, states could limit Medicaid eligibility in other ways not allowed by current law……Benefits and Cost Sharing The HAO demonstrations would allow staets to limit covered benefits compared to current law. States would not have to provide the full Medicaid alternative (formerly known as benchmark) benefit packate to demonstration enrollees.. …States could recieve enhanced ACA matching funds for expansion adults without provideing the full benchmark benefits package as required by current law…States could establish closed prescription drug formularies, a change from current Medicaid rules that generally require states to include all FDA-approved drugs from manuracturers with Medicaid rembate agreements.States would have broader authority to impose cost-sharing on enrollees… February 6, 2020: Planned Parenthood posted a press release titled: “House of Representatives Oppose Trump-Pence Attacks on Medicaid”. From the press release: Today, the House of Representatives voted to oppose the Trump-Pence administration’s invitation to states to cut Medicad funding, and jeopardize health care coverage for people with low incomes, including reproductive and sexual health care……The Trump-Pence administration’s move to allow states to shrink Medicaid into a block grant system would result in drastic cuts to funding, and could cause people with low incomes across the country to lose access to their health care or provider. Half of the people seeking care at Planned Parenthood health centers across the country use Medicaid. About one in five women of reproductive age rely on Medicaid for their health care, and women account for over half or all adult Medicaid enrollees. Medicaid covers more women’s health services than any other payer. Medicaid is also the largest payer of reproductive health care coverage, paying for nearly half of all births in the United States and 75 percent of family planning services. February 6, 2020: The U.S. House of Representatives voted on H.Res 826. It is titled: “Expressing disapproval of the Trump administration’s harmful actions towards Medicaid.” It is a resolution, which means it does not have the force of law. Here is the text of the resolution: Whereas Medicaid and the Children’s Health Insurance Program (CHIP) provide comprehensive, quality health care to 71 million Americans and children;Whereas Medicaid expansion has provided coverage to millions of adults and reduced the uninsured rate for both adults and children;Whereas Medicaid is a lifeline for some of our most vulnerable populations, including children with complex medical needs, people living with disabilities, low-income seniors, and individuals with mental illness and substance use disorders;Whereas Medicaid expansion has improved access to diagnoses and treatment for people with life-threatening conditions, including heart disease, and substance use disorder;Whereas Medicaid expansion improves and saves lives;Whereas research shows that Medicaid expansion saved at least 19,000 lives since 2014;Whereas Medicaid is the larges payer of behavioral health services in the country;Whereas Medicaid is the largest payer of long-term services and supports, including those provided in community-based settings;Whereas the opioid epidemic has claimed hundreds of thousands of lives, and Medicaid provides access to evidence-based treatment for individuals with opioid use disorder;Whereas researchers found that Medicaid expansion is linked to a 6-percent reduction in the opioid death rate, an 11-percent lower death rate for heroin, and a 10-percent lower death rate for fentanyl;Whereas Medicaid and CHIP play a key role in maternity services, pay for nearly half of all births in the United States, and provide access to prenatal and postpartum care;Whereas nearly all States and the District of Columbia provide Medicaid coverage to pregnant women with incomes higher than the minimum Federal standards;Whereas maternal mortality rates have risen nationally and disproportionately affect women of color;Whereas access to health care can prevent, detect, and treat conditions that put women at increased risk of pregnancy-related complications;Whereas research shows that Medicaid expansion improves postpartum care for women, reduces maternal and infant death, and reduces the likelihood a woman will experience a gap in coverage;Whereas research shows that Medicaid expansion improves postpartum care for women, reduces maternal and infant death, and reduces the likelihood a woman will experience a gap in coverage;Whereas rural hospitals are closing at an alarming rate, jeopardizing access to care for the 20 percent of Americans who live in rural areas, including 13,000,000 children, and research has found that States that expanded Medicaid had fewer rural hospital closures, and that rural hospitals in those States experienced improved financial peformance;Whereas Medicaid expansion reduces medical debt for individuals receiving coverage, which improves their individual and family financial security;Whereas once in office, President Trumo has gone further than any President in the history of the proram to make life harder for working families who rely on Medicaid for their health and well-being;Whereas the President has waged an unrelenting war on Medicaid, making it easier for States to take coverage away and create barriers for reenrollment;Whereas on President Trump’s watch, the number of uninsured children has increased, reversing years of declines, largely as a result of substantial losses in Medicaid coverage for children – many of whom remain eligible;Whereas under President Trump, over 1,000,000 children have lost Medicaid and CHIP coverage and over 750,000 adults have lost Medicaid coverage; andWhereas, despite President Trump’s campaign promise that he would “save Medicaid”, his administration has – (1) issued guidance to allow States to cap their Medicaid funding through a block grant, putting the financial viability if the States’ programs at risk and taking coverage and access to health care away from our citizens;(2) proposed regulations to roll back access standards put in place to ensure beneficiares recieve the care they need;(3) issued guidance to allow State Medicaid programs to restrict access to prescription drugs by adopting closed formularies;(4) proposed massive, annually componding cuts in Federal funding to the program in direct contradiction to an explicit campaign promise; and(5) allowed States to institute policies that have resulted in people improperly losing Medicaid coverage; Now, therefore be itThat it is the sense of the House of Representatives that –(1) the illegal actions taken by the Trump administration to undermine the Medicaid program, including the beneficiary protections, are a cruel attack on a program that provides for the health and well-being for some of our most vulnerable citizens;(2) the Trump administration should immediately withdraw its illegal block grant guidance and cease its campaign to undermine and weaken Medicaid; and(3) the Trump administration should uphold its responsibility to faithfully execute the law, including the Medicaid Act, and cease any and all efforts that threaten the care of the millions of Americans who rely on Medicaid. Here are the Representatives who voted YES on H.Res 826 (by state): Alabama: Terri Sewell (Democrat – district 7)Arizona: Tom O’Halleran (Democrat – district-1), Raúl Grijalva (Democrat – district 3), Ruben Gallego (Democrat – district 7), Greg Stanton (Democrat – district 9)California: Jared Huffman (Democrat – district 2), John Garamendi (Democrat – district 3), Mike Thompson (Democrat, district 5), Doris Matsui (Democrat, district 6), Ami Bera (Democrat, district 7), Jerry McNerrey (Democrat, district 9), Josh Harder (Democrat, district 10), Mark DeSaulnier (Democrat, district 11), Barbara Lee (Democrat, district 13), Jackie Speier (Democrat, district 14), Eric Swalwell (Democrat, district 15), Jim Costa (Democrat, district 16), Ro Khanna (Democrat, district 17), Anna Eshoo (Democrat, district 18), Zoe Lofgren (Democrat, district 19), Jimmy Panetta (Democrat, district 20), TJ Cox (Democrat, district 21), Salud Carbajal (Democrat, district 24), Julia Brownley (Democrat, district 26), Judy Chu (Democrat, district 27), Adam Schiff (Democrat, district 28), Tony Cárdenas (Democrat, district 29), Brad Sherman (Democrat, district 30), Pete Aguilar (Democrat, district 31), Grace Napolitano (Democrat, district 32), Ted Lieu (Democrat, district 33), Jimmy Gomez (Democrat, district 34), Norma Torres (Democrat, district 35), Raul Ruiz (Democrat, district 36), Karen Bass (Democrat, district 37), Linda Sánchez, (Democrat, district 38), Gilbert Cisneros (Democrat, district 39), Lucille Roubal-Allard (Democrat, district 40), Mark Takano, (Democrat, district 41), Maxine Waters (Democrat, district 43), Nanette Barragán (Democrat, district 43), Katie Porter (Democrat, district 45), Alan Lowenthal (Democrat, district 47), Harley Rouda (Democrat, district 48), Mike Levin (Democrat, district 49), Juan Vargas (Democrat, district 51), Scott Peters (Democrat, district 52), Susan Davis (Democrat, district 53)Colorado: Diana DeGette (Democrat, district 1), Joe Neguse (Democrat, district 2), Jason Crow (Democrat, district 6), Ed Perlmutter (Democrat, district 7)Connecticut: John Larson (Democrat, district 1), Joe Courtney (Democrat, district 2), Rosa DeLauro, (Democrat, district 3), James Himes (Democrat, district 4), Jahana Hayes (Democrat, district 5)Delaware: Lisa Blunt Rochester (Democrat – at large)Florida: Al Lawson (Democrat – district 5), Stephanie Murphy (Democrat, district 7), Darren Soto (Democrat, district 9), Val Demmings (Democrat, district 10), Charlie Crist (Democrat, district 13), Kathy Castor (Democrat, district 14), Alcee Hastings (Democrat, district 20), Lois Frankel (Democrat, district, 21), Theodore Deutch (Democrat, district 22), Debbie Wasserman Schultz (Democrat, district 23), Frederica Wilson (Democrat, district 24), Debbie Mucarsel-Powell (Democrat, district 25), Donna Shalala (Democrat, district 27)Georgia: Sanford Bishop (Democrat, district 2), Hank Johnson (Democrat, district 4), Lucy McBath (Democrat, district 6), David Scott, (Democrat, district 14)Hawaii: Ed Case (Democrat, district 1)Illinois: Bobby Rush (Democrat, district 1), Robin Kelly (Democrat, district 2), Daniel Lipinski (Democrat, district 3) Jesús Garcia (Democrat, district 4) Mike Quigley (Democrat, district 5), Sean Casten (Democrat, district 6), Danny Davis (Democrat, district 7), Raja Krishnamoorthi (Democrat, district 8), Jan Schakowsky (Democrat, district 9), Bradley Schneider (Democrat, district 10), Bill Foster (Democrat, district 11), Lauren Underwood (Democrat, district 11), Cheri Bustos (Democrat, district 17)Indiana: Peter Visclosky (Democrat, district 1), André Carson (Democrat, district 7)Iowa: Abby Finkenauer (Democrat, district 1), David Lobesack (Democrat, district 2), Cynthia Axne (Democrat, district 3)Kansas: Sharice Davids (Democrat, district 3)Kentucky: John Yarmuth (Democrat, district 3)Louisiana: Cedric Richmond (Democrat, district 2)Maine: Chellie Pingree (Democrat, district 1), Jared Golden (Democrat, district 2)Maryland: Dutch A. Ruppersburger (Democrat, district 2), John Sarbanes (Democrat, district 3), Anthony Brown (Democrat, district 4), Steny Hoyer (Democrat, district 5), David Trone (Democrat, district 6), Jamie Raskin (Democrat, district 8)Massachusettes: Richard Neal (Democrat, district 1), Jim McGovern (Democrat, district 2), Lori Trahan (Democrat, district 3), Joseph Kennedy (Democrat, district 4), Katherine Clark (Democrat, district 5), Seth Moulton (Democrat, district 6), Ayanna Pressley (Democrat, district 7), Stephen Lynch (Democrat, district 8), William Keating (Democrat, district 9)Michigan: Daniel Kildee (Democrat – district 5), Elissa Slotkin (Democrat – district 8), Andy Levin (Democrat – district 9), Haley Stevens (Democrat – district 11), Debbie Dingell (Democrat, district 12), Rashida Tlaib (Democrat – district 13), Brenda Lawrence (Democrat, district 14)Minnesota: Angie Craig (Democrat, district 2), Dean Phillips (Democrat, district 3), Betty McCollum (Democrat, district 4), Ilhan Omar (Democrat, district 5), Collin Peterson (Democrat, district 7)Mississippi: Bennie Thompson (Democrat, district 2)Missouri: Clay Lacy (Democrat, district 1)Nevada: Dina Titus (Democrat, district 1), Susie Lee (Democrat, district 3), Steven Horsford (Democrat, district 4)New Hampshire: Chris Pappas (Democrat, district 1), Ann Kuster (Democrat, district 2)New Jersey: Andy Kim (Democrat, district 3), Josh Gottheimer (Democrat, district 5), Frank Pallone (Democrat, district 6), Tom Malinowski (Democrat, district 7), Albio Sires (Democrat, district 8), Bill Pascrell (Democrat, district 9), Donald Payne (Democrat, district 10), Mikie Sherrill (Democrat, district 11), Bonnie Watson Coleman (Democrat, district 12)New Mexico: Debra Haaland (Democrat, district 1), Xochitl Torres Small (Democrat, district 2), Ben Luján (Democrat, district 3)New York: Thomas Suozzi (Democrat, district 3), Kathleen Rice (Democrat, district 4), Gregory Meeks (Democrat, district 5), Grace Meng (Democrat, district 6), Nydia Velázquez (Democrat, district 7), Yvette Clarke (Democrat, district 8), Jerrold Nadler (Democrat, district 9), Max Rose (Democrat, district 11), Carolyn Maloney (Democrat, district 12), Adriano Espaillat (Democrat, district 13), Alexandria Ocasio-Cortez (Democrat, district 14), José Seranno (Democrat, district 15), Eliot Engel (Democrat, district 16), Nita Lowey (Democrat, district 17), Sean Mahoney (Democrat, district 18), Antonio Delgado (Democrat, district 19), Paul Tonko (Democrat, district 20), Anthony Brindisi (Democrat, district 22), Brian Higgins (Democrat, district 26)North Carolina: G.K. Butterfield (Democrat, district 1), David Price (Democrat, district 4), Alma Adams (Democrat, district 12)Ohio: Joyce Beatty (Democrat, district 3), Marcy Kaptur (Democrat, district 9), Marcia Fudge (Democrat, district 11), Tim Ryan (Democrat, district 13)Oklahoma: Kendra Horn (Democrat, district 5)Oregon: Suzanne Bonamici (Democrat, district 1), Earl Blumenauer (Democrat, district 3), Peter DeFazio (Democrat, district 4)Pennsylvania: Brendan Boyle (Democrat, district 2), Dwight Evans (Democrat, district 3), Madeleine Dean (Democrat, district 4), Mary Scanlon (Democrat, district 5), Chrissy Houlahan (Democrat, district 6), Susan Wild (Democrat, district 7), Matthew Cartwright (Democrat district 7), Connor Lamb (Democrat, district 17), Mike Doyle (Democrat, district 18)Rhode Island: David Cicilline (Democrat, district 1), Jim Langevin (Democrat, district 2)South Carolina: Joe Cunningham (Democrat, district 1), Jim Clyburn (Democratic, district 6)Tennessee: Jim Cooper (Democrat, district 5), Steve Cohen (Democrat, district 9)Texas: Lizzie Fletcher (Democratic, district 7), Al Green (Democrat, district 9), Vicente Gonzalez (Democrat, district 15), Veronica Escobar (Democrat, district 16), Shelia Jackson Lee (Democrat, district 18), Joaquin Castro (Democrat, district 20), Henry Cuellar (Democrat, district 28), Sylvia Garcia (Democrat, district 29), Eddie Johnson (Democrat, dsstrict 30), Colin Allred (Democrat, district 32), Marc Veasey (Democrat, district 33), Filemon Vela (Democrat, district 34), Lloyd Doggett (Democrat, district 35)Utah: Ben McAdams (District 4)Vermont: Peter Welch (Democrat at large)Virginia: Elaine Luria (Democrat, district 2), Bobby Scott (Democrat, district 3), Donald McEachin (Democrat, district 4), Abigail Spanberger (Democrat, district 7), Donald Beyer (Democrat, district 8), Jennifer Wexton (Democrat, district 10), Gerald Connolly (Democrat, district 11)Washington: Suzan DelBene (Democrat, district 1), Rick Larsen (Democratic, district 2), Derek Kilmer (Democrat, district 6), Pramila Jayapal, (Democrat, district 7), Kim Schrier (Democrat, district 8), Adam Smith (Democrat, district 9), Denny Heck (Democrat, district 10)Wisconsin: Mark Pocan (Democrat, district 2), Ron Kind (Democrat, district 3), Gwen Moore (Democrat, district 4) The vote was 223 YES (54%) to 190 NO (46%). February 6, 2020: The American Civil Liberties Union (ACLU) of Oklahoma posted a press release titled: “ACLU of Oklahoma Statement on HB 1182”. From the press release: In response to today’s scheduled floor hearing of HB 1182, a bill equal to an abortion ban, the ACLU of Oklahoma released the following statement:The following is attributable to Nicole McAfee, Director of Policy and Advocacy:“Less than five days after members of the Oklahoma Legislature cheered the Governor’s commitment to reducing wasted taxpayer dollars, the first major piece of legislation to be considered this session on the House floor is HB 1182, an unconstitutional measure which undermines reproductive autonomy and inserts the government in private healthcare decisions by punishing abortion care providers. Yet another legal fight over yeat another unconstitutional bill is an unfortunate misuse of power that our state cannot afford.Across the country, politicians have created a web of medically unnecessary, politically-motivated restrictions that push aboriton care out of reach for many, but particularly for low-income people, young people, and people of color. And while this pandering attack is business as usual for the Oklahoma legislature, it is disappointing to see the body so quickly into session use their power to try and push this thinly veiled attempt at an abortion ban.As we turn our eyes to the House floor for this scheduled vote, we call on leadership and legislatuors from across the aisle and across the state to stop this dangerous and stigmatizing attempt to score partisan political points. This session provides real opportunity for change, and instead of continuing to violate fundamental rights and liberties protected by the Constitution, the legislature should prioritize being good stewards of Oklahoma taxpayer dollars by focusing on issues like healthcare access, education funding, and criminal justice reform that reqire their urgent attention.” February 6, 2020: The American Civil Liberties Union (ACLU) of South Dakota posted a press release titled: “South Dakota Lawmakers Need to Focus on Real Issues, Not Discriminatory Bills”. From the press release: Issues that matter most to South Dakotans are being ignored as some South Dakota legislators continue their attack the LGBTQ and Two Spirit community and erode their rights with bills that stoke fear and hatred amid discriminatory rheortic.Bills like House Bill 1057, which will be heard in the Senate Health and Human Services Committee on Monday, House Bill 1215 and Senate Bill 109 detract from the state’s real problems. House Bill 1057 would criminalize life-saving medical treatment for transgender youth. No other state has passed a law like HB 1057. It is unconstitutional to single out one group of people and categorically ban all care, no matter how medically necessary.House Bill 1215 would prohibit the state from endorsing or enforcing certain policies regarding same-sex marriage. Marriage equality is the law of the land in South Dakota and the entire nation. South Dakota lawmakers cannot defy the U.S. Supreme Court based on their extreme personal views.Senate Bill 109: would allow health care providers, medical institutions, and health insurance providers to refuse to care for a patient on religious, moral, ethical, or philosphical grounds. This means a public school counselor could refuse to care for a young LGBTQ person in distress or an EMT could refuse care to a gay man in an emergency situation. “With serious and complex issues like the lack of adequate education funding for teacher salary increases to access drug addiction treatment in the rural areas of our state, it’s disturbing that legislators have spent so much time attacking vulnerable transgender youth and the LGBTQ and Two Spirit community as a whole,” said Libby Skarin, ACLU of South Dakota policy director. “Bill after bill seems fixated on the incorrect notion that some of our friends and neighbors are not entitled to the same dignity and respect as others. Our committment to ensuring that LGBTQ and Two Spirit South Dakotans can live openly without discrimination remains strong. We urge South Dakota lawmakers to focus in the issues that really matter.”South Dakotans agree.On behalf of the Human Rights Campaign, Change Research polled 720 likely voters in South Dakota between Jan. 28-30 and found 69% say that “legislators are too focused on divisive issues and should be focusing on pressing issues that will actually have an impact on South Dakotans, like growing the economy.” Additionally, nearly two-shirts of voters say “we need to stop stigmatizing transgender people as a society.” February 7, 2020: Representative Jan Shakowsky (D-Illinois) posted a press release on her official website titled: “Schakowsky Votes to Protect Medicaid from Caps and Cuts”. From the press release: This week, Congresswoman Jan Schakowsky, Senior Chief Deputy Whio and Chair of the Energy and Commerce Consumer Protection and Commerce Subcommittee, voted YES on H.Res. 826, a resolution expressing disapproval of the Trump Administration’s harmful actions towards Medicaid. Last week, the Trump Administration unveiled its illegal Medicaid block grant plan, inviting states to cap and slash Medicaid. The plan would essentially allow states to recieve a waiver to block grant their Medicaid programs for certain low-income Medicaid recipients.The Administration’s Medicaid block grant plan undermines crucial protections of the Medicaid program and gives states broad authority to scale back important beneficiary protections, restrict eligibility standards and limit access to prescription drugs. The effect would be to push Medicaid recipients off lifesaving medicines, impose unaffordable premiums to maintain coverage and leave more vulnerable families exposed to catastrophic medical bills – with ruinous and even fatal consequences for the most vulnerable in our communities.The Resolution of Disapproval affirms the sense of the House of Representatives that:The illegal actions taken by the Trump Administration to undermine the Medicaid program, including beneficiary protections, are a cruel attack on a program that provides for the health and well-being for some of our most vulnerable citizens;The Trump Administration should immediately withdraw its illegal block grant guidance and cease its campaign to undermine and weaken Medicaid; andThe Trump Administration should uphold its responsibility to faithfully execute the law, including the Medicaid Act, and cease any and all efforts that threaten the care of the millions of Americans who rely on Medicaid… February 10, 2020: The American Civil Liberties Union (ACLU) of South Dakota posted a press release titled: “ACLU of South Dakota Commends Decision to Kill House Bill 1057”. From the press release: Today, in a 5-2 vote, the Senate Health and Human Services Committee voted to kill amended legislation that would prohibit doctors for providing medically unnecessary care to transgender youth and take away parents’ rights to make decisions about their children’s care.The ACLU of South Dakota opposed House Bill 1057. It is unconstitutional to single out one group of people and categorically ban all care, no matter how medically necessary.“Though supporters claimed House Bill 1057 was aimed at protecting vulnerable youth, it was clearly fueled by a fear and misunderstanding of transgender South Dakotans,” said Libby Skarin, policy director for the ACLU of South Dakota. “It’s time we stop these attacks and the very real harm they cause to transgender youth across our state. Let this be a signal to the South Dakota Legislature that discrimination against a marginalized group is a distraction from the needs of the state and hurts us all.In addition to the ACLU of South Dakota, companies and organizations like the Sanford Health, the South Dakota Chapter of the American College of Obstetricians and Gynecologists, the South Dakota Pharmacists Association, the South Dakota Chamber of Commerce and Industry, the South Dakota State Medical Association, the South Dakota Retailers Association, the Sioux Falls Area Chamber of Commerce, LEAD South Dakota and the Human Rights Campaign also opposed House Bill 1057. February 10, 2020: The White House released the President’s Budget for fiscal year 2021. For the purpose of this blog post, I will focus on the things that are related to health care that the Trump administration wants to eliminate. Agency for Healthcare Research and Quality (AHRQ): The 2020 budget funded AHRQ 338 million dollars. The Trump budget reduces that funding for 2021 to zero. The Agency for Healthcare Research and Quality (AHRQ) is the lead Federal agency charged with improving the safety and quality of America’s health care system. AHRQ develops the knowledge, tools, and data needed to improve the health care system and help Americans, health care professionals, and policymakers make informed health decisions. Some of AHRQ’S areas of focus include: Project ECHO (Extention for Community Healthcare Outcomes) for training and supporting primary care clinicians in rural communities to provide specialized care for patients. Re-Engineered Discharge (RED) is a structured protocol and suite of implementation tools that helps hospitals rework their discharge processes to reduce readmissions by determining patients’ needs and carefully designing and communicating discharge plans. Comprehensive Unit-based Safety Program (CUSP) is a highly effective method of preventing healthcare-associated infections. Consumer Assesment of Healthcare Providers and Systems survey, which provide valid assessments of patients’ experience of care in hospitalss, nursing homes, and doctor’s offices. Medical Expenditure Panel Survey data helped the Medicaid and CHIP Payment and Access Commission develop estimates of eligibility for Medicaid and the Children’s Health Insurance Program. CDC Chronic Disease Activities: The 2020 budget funded it with $1,240 million. The Trump budget is going to reduce that amount by $427 million in 2021. Part of the CDC includes the National Center for Chronic Disease Prevention and Health Promotion. Its website points out that six in ten adults in the US have a chronic disease and four in ten adults have two or more. Chronic disease includes, but is not limited to, the following: heart disease or stroke; cancer; diabetes. Here is what the National Center for Chronic Disease Prevention and Health Promotion does: Works to reduce the risk factors for chronic diseases, especially for goups affected by health disparities which are differences in health across different geographic, racial, ethnic and socioeconomic groups. Finds out how chronic diseases affect populations in the United States. Studies interventions to find out what works best to prevent and control chronic diseases. Funds and guides states, territories, cities, and tribes to use interventions that work. Shares information to help Americans understand risk factors for chronic diseases and how to reduce them. Health Workforce Programs: In 2020, it was funded $734 million. The Trump budget reduces that by $484 million for 2021. The Health Workforce website says that it is part of the Health Resources & Services Administration (HRSA). It improves the health of underserved and vulnerable populations by strengthening the health workforce and connecting skilled professionals to communities in need. HSRA programs provide health care to people who are geographically isolated, economically or medically vulnerable. This includes people living with HIV/AIDS, pregnant women, mothers and their families, and those otherwise unable to access high quality health care. HRSA also supports access to health care in rural areas, the training of health professionals, the distribution of providers to areas where they are needed most, and improvements in health care delivery. Low Income Home Energy Assistance Program: In 2020, this program was funded $3,740. The Trump Budget will reduce that funding to zero. The Low Income Home Energy Assistance Program (LIHEAP) helps keep families safe and healthy through initiatives that assist families with energy costs. It is part of the Office of Commiunity Services. The Purpose of LIHEAP is: to assist households with low incomes, particularly those with the lowest incomes that pay a high proportion of household income for home energy, primarily in meeting their immediate home energy needs. National Institute for Occupational Safety and Health: In 2020, it was funded $343 million. The Trump Budget reduces that by 153 million in 2021. The National Institute for Occupational Safety and Health (NIOSH) is part of the Centers for Disease Control and Prevention. Its vision is: safer, healthier workers. Its mission is: To develop new knowledge in the field of occupational safety and health and to transfer that knowledge into practice. NIOSH mission goals include: Goal 1: Conduct research to reduce worker illness and injury, and to advance worker well-being. Goal 2: Promote safe and healthy workers through interventions, recommendations and capacity building. Goal 3: Enhance worker safety and health through global collaborations. Federal Emergency Management Agency State and Local Grants/Training was funded $2,052 million in 2020. The Trump budget reduces it by 535 million in 2021. Federal Emergency Management Agency (FEMA) supports citizens and emergency personnel to build, sustain, and improve the nation’s capacity to prepare for, protect against, respond to, recover from, and mitigate all hazards. It is responsible for disaster assistance, the national flood insurance program, and U.S. fire adminisration. The national flood insurance program is government-run, and is the only one allowed to sell flood insurance. This type of insurance covers your home and the things inside it, and helps people to cope with the costs of flood damage. The Trump Budget also reduces Flood Hazard Mapping and Risk Analysis Program from the $263 million it was funded in 2020 by 163 million for 2021. The National Flood Insurance Program Flood Hazard Mapping program is also part of FEMA. This program identifies flood hazards, assesses flood risks, and partners with states and communities to provide accurate flood hazard and risk datat to guide them to mitigation actions. Flood hazard mapping is an important part of the National flood Insurance Program (NFIP), as it is the basis of the NFIP regulations and flood insurance requirements. FEMA mantains and updates data throigh Flood Insruance Rate Maps (FIRMs) and risk assessments. FIRMs incude statistical information such as data for river flow, storm tides, hydrolic/hydraulic analyses and rainfall and topographical surveys. In addition, the Trump Budget has a list of things that it wants to “reform”. Here are the things that directly relate to health: Federal Disability Programs …The Budget would introduce new reforms that remove barriers to work for people with disabilities and improves access to services to help them return to work… The changes will impose the following upon people who have disabilities: Test New Approaches to Increase Labor Force Participation: Allows the administration to test new program rules and requires manditory participation by program applicants and beneficiaries. This proposal calls on Congress to establish an expert panel that will identify specific changes to program rules that increase LFP and reduce participation on disability programs based on the results of successful demonstrations of other evidence. The panel would be responsible for making recommendationg to reduce participation levels that would be directly tied to reaching a five percent reduction in Disability Insurance (DI) and Supplemental Security Income (SSI) projected outlays by 2032. SSI Youth Transition to Work: Institutes initial disability reviews at age 6 and age 12. Disregards all earned income and elminiated income reporting requirements through age 20. Improves access to vocational rehabilitition services for SSI transition-aged youth by allowing the Social Security Administration to make referrals to these services. Replaces that Ticket To Work (TWW) program: It will replace this program with block grants to the states. Create a Sliding Scale for Multi-Recipient SSI Families: “Currently, multi-recipient SSI families are eligible to recieve an equal full benefit amount for each SSI child recipient. However, economies of scale in some types of consumption such as housing reduce per capita living expenses so that two children generally do not need twice the income of one child….” Eliminate Workers’ Compensation (WC) and Temporary Disability Reverse Offset Allow State Hearing Officers to Hold Disability Hearings: This proposal would allow State disabilitiy hearing officers to conduct hearings resulting from disabiity cessation determinations issued by a Federal component. This would allow additional flexibility for SSA to manage workloads at a national level, while preserving the individual’s right to an evidentiary hearing. Modernize the Commissioner’s Collection of Medical Evidence: This proposal would allow SSA to more quickly recieve the medical evidence it needs to determine initial and continuing entitlement to disability benefits by allowing custodians to release medical records to SSA without the signed authorization of the person applying for or recieving disability benefits. What follows is the Trump Budget’s proposed changes to Medicare: This section of the Trump Budget is titled: “Medicare: Address Wasteful Spending, Fraud, and Abuse”. …The budget includes two proposals aimed at reforming how the Federal Government reimburses hospitals for certain “add-on” payments that are not directly tied to Medicare beneficiary care. These reforms improve the sustainability of the Medicare Trust Fund and ensure that Medicare funds are spent on meeting the health needs of the Nation’s seniors. In addition, thes proposals better align the Medicare program with private sector health insurance business practices. Medicare currently makes payments to hospitals related to uncompensated care for non-Medicare beneficiaries. The Budget proposes to reform uncompensated care payments by removing the payment from the Medicare payment system, moderating the rate of growth of spending, and establishin a new process to distribute uncompensated care amounts to hospitals based on their share of chairty care and non-Medicare bad debt… … The Budget includes several additional proposals aimed at eliminating wasteful spending in Medicaire. Establish a unified payment system for post-acute care providers: …The budget would transition payment for post-acute care to site-neutral payments over five years. It would reduce the growth rate of post-acute care payment during the transition period. The proposed value-based payment system is based on the anticipated clinical needs and risk factors of the patient, rather than the site of services. All types of facilities would remain available, and patients with their doctors would determine the right site of care. Pay all hospital-owned physician offices located off-camous at the physician office rate:…The Budget would equalize Medicare payment for all physician practices and off-campus facilities, regardless of whether they are hospital-owned or when established, lowering out-of-pocket costs for seniors receiving services at those facilities. Pay on-campus hospital outpatient departments at the physician office rate for certain services: …The Budget proposes to make site-netural payments between on-campus hospital outpatients departments and physician offices for certain servics to include imaging tests, clinic visits, and drug administration. Authorize long-term care hospital (LTCH) site neutral exceptions criteria: The Budget proposes to better align payments to LTCHs based on patient need by modifying the criteria for payment… Researchers, including the nonpartisan Medicare Payment Advisory Commission (MedPAC), have suggested that the current criterion of at least three days in the intensive care unit (ICU) may be too low, and that a higher number of days may more accurately identify patients who require the intensity of care provided at an LTCH. The Budget proposes to extend the criterion to at least an eight-day stay in an ICU, as recommended by MedPAC, to better identify chronically ill patients who would more likely benefit from an LTCH. Reduce Medicare coverage of bad debts: The budget would reduce the amount Medicare pays to certain institutional providers to cover copayments or deductibles that beneficiaries fail to pay. Medicare currently reimburses certain providers at 65 percent of bad debt. Private insurance companies do not typically cover any portion of uncollected cost-sharing, which is the responsibility of the beneficiary. The Budget would bring Medicare more in line with the private sector by gradually reducing reimbursement to 25 percent of bad debt over three years. Reform and expand durable medical equipment competitive bidding: The Budget proposes to implement a more rational approach for setting payment rates in competitively bid areas by eliminating the single payment amount, and paying winning durable medical suppliers at their bid amounts… Expand basis for benefiary assignment fir Accountable Care Orgnizations (ACOs): …ACOs are designed to help reduce wasteful Medicare spending and improve quality by coordinating patient care and preventing unnecessary duplication of services. The Budget proposes to provide additional flexibilities to increase providers, including nurse practitioners, physician assistants, and clinical nurse specialists, moving more beneficiaries from fee-for-service Medicare to value-based care, without affecting beneficiaries access to providers or the care they recieve. Modify payment for hospital care provided to beneficiaries in skilled nursing facilities: Currently, Medicare pays hospices the same rate for care provided in skilled nursing and nursing facilities as it does for care provided in other settings, such as the home. This results in overpayment to hospice providers since nursing facilities are staffed with professional caregivers and are often paid separately under Medicare and Medicaid. Therefore, the Budget proposes to reduce hospice reimbursement by $10 per day to account for separate Medicare and Medicaid payments already provided for personal care services delivered to beneficiaries who elect hospice in skilled nursing and nursing facilities. Remove the cap on Medicare Advantage benchmarks and remove the doubling of quality bonus payments in qualifying counties: The Budget proposes to remove two Medicare Advantage payment mechanisms put in place by the Affordable Care Act. Removing the benchmark caps will allow Medicare Advantage organizations to fully realize their quality bonus payments by removing caps set by spending patterns that are over 10 years old. Removing double bonus payments will eliminate inequitable payments made to plans based on their geographic location that are not tied to quality. Taken together these two proposals result in a streamlined Medicare Advantage payment methodology that also produces net savings to Medicare…. February 11, 2020: The American College of Physicians (ACP) poste a press release titled: “Internists Say President’s Budget Would Harm the Health of Americans”. The statement is attributed to Robert McLean, MD, MACP, President of American College of Physicians. From the press release: The American College of Physicians (ACP) is extremely disappointed in the proposed fiscal year 2021 budget proposal released by President Trump. The drastic cuts to key government health programs would harm the health and healthcare of Americans.The budget proposes deep cuts in funding for both Medicare and Medicaid, hurting the programs that our elderly and vulnerable depend on to access necessary health care services. Medicare would be cut by $756 billion over ten year. These cuts would include drawing down payments for uncompensated care, expanding costlier Medicare Advantage plans at the expense of traditional Medicare, and promoting high deductable health plans for seniors. Medicaid would be cut by $920 billion over ten years by limiting eligibility, imposing work requirements, and offering states waivers to curtail Medicaid spending. All of thes changes would hurt access to coverage and care for Medicaid beneficiaries.The proposal would cut funding for the Department of Health and Human Services by 9 percent or almost $10 billion in FY2021. This would include $2.6 billion in cuts to the National Institutes of Health (NIH) threatening the U.S. standing as a world leader in medical and biomedical research. Nearly $700 million is cut from the Centers for Disease Control and Prevention, harming public health at a critical time. The proposal moves or consolodates the Agency for Healthcare Research and Quality (AHRQ) into NIH without specific details about ow that change would be structured, while providing nearly $100 million less for the agency to meet its mission.The budget proposal also includes cutes to many of the programs that support our health care workforce. For instance, over $50 billion would be cut for vital payments to the Graduate Medical Education program, by which graduated medical students become competent physicians in a particular field of medicine and add to the nation’s physician supply. The proposal would also eliminate a large portion of Title VII health professions funding including $49 million of Section 747 training in Primary Care Medicine, the only federal program dedicated to funding and improving training of primary-care physicians. Budget cuts that harm support for training physicians and other health care professionals would reverberate for years to come. Congress should set aside this flawed plan. Instead, Congress should enact a budget that woudl support the health and well-being of all Americans. February 11, 2020: California State Senator Lena A. Gonzalez (Democrat – district 33) posted a press release on her official website titled: “Equal Insurance HIV Act announced to end discrimination against HIV-positive Californians for life and disability income insurance”. From the press release: Today, Senator Lena Gonzalez (D- Long Beach), Insurance Commissioner Ricardo Lara, and Equality California announced the Equal Insurance HIV Act to stop insurance companies from denying life and disability income insurance coverage based solely on HIV status. This bill proposal would enact anti-discrimination to ensure they have equal access to the coverage they deserve.“Everyone deserves access to life and disability income insurance, regardless of preexisting conditions,” said Senator Lena Gonzalez. “I am so proud that my first bill introduced in the legislature will ensure access to these critical resources for residents who are HIV-positive. It is time that we end the practice of insurance companies refusing to provide services to those who need it most.”This proposed bill overturns a law passed in 1989 when treatment for someone who tested HIV-positive was extremely limited. Therapies were ineffective, and came with severe side effects causing many individuals who were HIV-positive to bypass treatment. Today, with access to health care, advancement in HIV testing, and more effective treatment, a person who is HIV positive and undergoes and remains on treatment can live a long healthy life. HIV status is treated by medical professionals like any other treatable chronic condition……With HIV-positive people living longer healthier lives, their need for life and disability income insurance is imperative to protect themselves and their families. Current California law allows insurers to deny coverage for life or disability income insurance to HIV-positive individuals based on positive results of an ELISA test followed by a positive Western Blog Assay performed by or at the direction of the insurer – tests that are no longer commonly used today……A person’s HIV positive status should be treated in the same way as any other chronic condition in the writing of life and disability income insruance. This bill will ensure that life and disability insurance companies can no longer use outdated and discriminatory insurance underwriting law that allows insurers to refuse life and disability income insurance applications for HIV-positive individuals based solely on a positive HIV test… February 11, 2020: The American Civil Liberties Union (ACLU) posted a press release titled: “ACLU, Planned Parenthood, And Consumers Challenge Trump Administration Rule That Threatens Insurance Coverage For Abortion”. From the press release: The Rule Imposes More Than $1 Billion In Unnecessary Costs In An Effort To Coerce Insurance Companies to Stop Offering Coverage For Abortion, Affecting More Than 3 Million Consumers.Planned Parenthood of Maryland, Inc. and several consumers around the country filed a lawsuit today challenging the Trump administration’s new rule designed to make insurance companies stop offering coverage for abortion. They are represented by attorneys with the American Civil Liberties Union (ACLU), Planned Parenthood Federation of America, Inc., and Brown Goldstein & Levy, LLP.In December 2019, the Department of Health and Human Service (HHS) and the U.S. Centers for Medicare and Medicaid Services (CMS) released a new rule that, if implemented, would force insurance companies that sell plans in the Affordable Care Act individual marketplaces to send two separate bills to customers – onefor the coverage of abortion care, and another for coverage of other health care. Insurers will also have to instruct their customers to pay the bills using two checks, two money orders, or two electronic transactions every month.As the adminsitration acknowledged in finalizing the rule, the extensive administrative burdens will lead to higher premiums for consumers and will cause some insurers to drop insurance coverage for abortion altogether. As the administration also acknoweledged, confusion about these new requirements will lead some people to miss payments and risk losing their health insurance coverage entirely.“If this rule takes effect, I face the terrifying risk of losing not only my insurance coverage for abortion, but my insurance coverage entirely, which would be devistating for me given my pre-existing condition,” said Rebecca, a resident of Washington, D.C., and plaintiff in the case. “That’s why I’m joining the ACLU and Planned Parenthood to fight back. It is curel and unacceptable that the Trump administration is interfering in my health care and trying to interfere with how health insurance companies do business, just because they want to make it more difficult for me to access my right to abortion.”..…More than 3 million consumer would be affected by the rule’s onerous restrictions, including the individual plaintiffs in the lawsuit from Maryland, the District of Columbia, New Jersey, and Maine. The rule would also affect one-third of the individual market exchange plans nationwide, including every individual plan offered on the marketplaces in Maryland. A fact sheet on the impact can be found here……The lawsuit was filed in the U.S. District Court for the District of Maryland. February 12, 2020: California Attorney General Xavier Becerra posted a press release on his official website titled: “Attorney General Becerra Files Reply Brief in Supreme Court, Asks to Resove the ACA Repeal Lawsuit”. From the press release: Attorney General Becerra today led a coalition of 20 states and D.C. in filing a reply brief in the U.S. Supreme Court in California v. Texas. In the brief, the attorneys general reiterate the harms this ACA Repeal Case is causing our healthcare system and Americans’ healthcare. The brief also opposes arguments by the Trump Administration and the Texas coalition that the case should be sent back to the district court, and urges the Supreme Court to take up teh case to resolve uncertainty in the healthcare market.“Today, our coalition made clear that we must end the uncertainty and harm in our healthcare system caused by the Trump Administration and Texas coalition’s Repeal Lawsuit,” said Attorney General Becerra. “We are hopeful that the Supreme Court agrees with hospitals, bipartisan economists, public health experts, patients groups, businesses and others, and swiftly resolves this lawsuit.” A copy of the brief is here. February 12, 2020: Center for Reproductive Rights posted a press release titled: “In Congressional Testimony, Center for Reproductive Rights Urges Congress to Pass Historic Abortion Rights Legislation that Answers Calls to ‘Codify Roe;”. From the press release: Today, Nancy Northup, President and CEO of the Center for Reproductive Rights, testified in the U.S. House of Representatives on the Women’s Health Protection Act (H.R. 2975/S. 1645), federal legislation that answers the recent calls to ‘codify Roe’ by safeguarding the right to access abortion care for all people in the United States.In her testimony, Nancy Northup described the growing crisis in abortion care across the United States and urged Congress to take action on the landmark legislaton:“Our Constitution protects the right of each of us to chart our own life path and to make the deeply personal decisions that impact our lives, our families, and our health, including whether and when to become a parent. One in four women in the United States will make the decision to have an abortion in the course of her life. Yet in large parts of the United States, obtaining abortion care is difficult – and in some cases, impossible – due to a coordinated, nationwide strategy to eliminate access to abortion care.The Women’s Health Protection Act would ensure the right to abortion recognized nearly fifty years ago in Roe v. Wade is a day-to-day reality for people in the United States, no matter what state they live in … We need this law now – because the crisis is now.”Read Nancy Northup’s testimony here.The Women’s Health Protection Act establishes a statutory right for health care providers to provide, and their patients to recieve, abortion care free from medically unnecessary restrictions and bans.The hearing took palce in the House Energy and Commerce Subcommittee on Health, chaired by Representative Anna Eshoo (D-CA.). The Women’s Health Protection Act was introduced in the House of Representatives by Judy Chu (D-CA.), Lois Frankel (D-FL.), and Marcia Fudge (D-OH), on May 23, 2019. The bill has earned the support of over 210 cosponsors in the House, nore than in any previous Congress. Senators Richard Blumenthal (D-CT) and Tammy Baldwin (D-WI) introduced an identical bill in the Senate with 42 cosponsors… February 12, 2020: Planned Parenthood posted a press release titled: “Planned Parenthood Applauds Historic Women’s Health Protection Act”. From the press release: Today, the U.S. House Committee on Energy and Commerce, Subcommittee on Health will hold a historic hearing on the Women’s Health Protection Act (WHPA).WHPA is a critical piece of legislation that would protect against medically unnecessary abortion restrictions being pushed foward by politicians. Reproductive health champions Rep. Judy Chu (D-CA-27) and 215 co-sponsors in the House of Representatives, and Sen. Richard Blumenthal (D-CT) and 42 co-sponsors in the Senate, are pushing the legislation forward……During the 2019 state legislative sessions alone, 58 new restrictions on abortion were enacted into law. All in all, in 2019, a record 25 abortion bans were enacted in 12 states. At the bottom of the above press release, Planned Parenthood linked to a Fact Sheet about the Women’s Health Protection Act. From the Fact Sheet: Roe v Wade recognized the constitutional right to abortion. But for many people in the United States, accessing abortion is difficult and, in some places, nearly impossible. We need a federal law to assure that the right to access abortion first recognized in Roe v. Wade is a reality in every state. The Women’s Health Protection Act is that law.There is a coordinated, nationwide strategy to eliminate abortion accessIn 2016, the U.S. Supreme Court reaffirmed the right to access abortion care without undue burden. Yet anti-abortion lawmakers have escalated their attacks, pushing through over 170 harmful laws since them, and nearly 450 since 2011.These laws: Delay and obstruct accessLower the quality of care that is deliveredAre designed to shame those seeking abortionRequire providers to preform medically unnecessary procedures and tell patients factually incorrect informationIncrease costs and risks of reproductive health care servicesCreate gross inequities in access to health care These restrictions do nothing to protect health or safety of patients and can have long-lasting socioeconomic consequences for people and their families. The harms these barriers create are deeply unequal, falling most heavily on underserved people and commmunities, including people living in poverty, people of color, young people, LGBTQ people, and people living in rural or medically underserved areas.How does the Women’s Health Protection Act work?The Women’s Health Protection Act (WHPA) creates a nationwide safeguard against bans and medically unnecessary restrictions that single out abortion care, and protects the long-held constitutional right to access abortion. WHPA works by establishing a statutory right for health care providers to provide, and for their patients to receive, abortion care free from medically unnecessary limitations and bans. February 12, 2020: The House Committee on Energy & Commerce held a hearing titled: “Protecting Women’s Access to Reproductive Health Care”. The statements of some Committee members and the testimony of some of the participants will be included in this blog post. Opening Statement Chairman Frank Pallone, Jr. Today’s hearing is on legislation to protect women’s access to abortion care.This legislation is necessary today because states have passed an onslaught of ideological bans and restrictions intended to interfere with women’s personal medical decision-making and to severely limit women’s access to abortion care.Since 2011 alone, anti-abortion state lawmakers have passed nearly 450 restrictive laws with the sole purpose of making it more difficult for women to access this care. They’ve passed mandatory that waiting periods, requirements for multiple in-person visits, and requirements that doctors provide their patients with medically inaccurate information about the potential risks of the procedure. They have also passed rediculous and unnecessary building requirements for abortion providers tha are intended solely to shut down clinics that provide abortion services.The result of these increasingly restrictive laws is that women all across the country are having a harder time accessing abortion care, which they have a constitutional right to obtain. Comprehensive health care means having access to affordable abortion care, which is a safe medical procedure with far fewer risks than many routine medical procedures. Repeated studies have confirmed the safety of abortion, including comprehensive findings by the National Academics of Science, Engineering, and Medicine. It is a safe and legal procedure, but ideological state legislators continue to put up roadblocks for women and providers.Today, nearly 90 percent of American counties are without a single abortion provider, and six states only have one abortion clinic in the entire state. The unfortunate reality in America is that your constitutionally guaranteed health care rights are now dependent upon where you live, and that is wrong.Sadly, we know that anti-abortion restrictions fall hardest on those who already face significant barriers to health care: low-income women, women of color, LGBTQ people, young people, and people living in rural communities. At a time when we should all be working together to reduce health care disparities, we are watching states across the country actively pass legislation that increases those disparities, we are watching states across the country actively pass legislation that increases those disparities. Their actionsare putting access to care further out of reach. One particularly alarming study from the Center for Reproductive Rights and Ibis Reproductive Health found that states with more anti-abortion lawas have poorer health outcomes generally for both women and children than states that have fewer restrictions. This should be alarming to all of use especially as we are faced with an increasingly dire national maternal health crisis that we also know disproportionately impacts women of color.It is for all these reasons that we are holding this important and timely hearing on the Women’s Health Protection Act. This legislation simply ensures that patients can access, and health care providers can provide, abortion services. It prevents medically unnecessary and burdensome restrictions that single out abortion providers and deny women access to care. It is long past time that we affirm women’s health care rights by ensuring that they can actually utilize those rights. The Women’s Health Protection Act would do just that by ensuring the constitutional right to have an abortion is a reality for all people, no matter where they live… The full text of H.R. 2975 The Women’s Health Protection Act is here. Opening Statement Chairwoman Anna G. Eshoo Nearly 50 years ago, the Supreme Court affirmed the right of every woman to make decisions about her own life, body, and future.Now that right is under threat by state laws restricting and banning reproductive healthcare and abortion care.Since 2011 states have passed more than 450 medically unnecessary restrictions on reproductive care.For example, Alaska, Kansas, Oklahoma, and Texas force doctors to lie to their patients by having them inaccurately link abortion and breast cancer in theri patient counseling.Louisiana, Texas, and Wisconsin require providers to perform medically unnecesssary ultrasounds and show and describe the images to women who have already decided to have an abortion.Eighteen states have specific requirements for procedure rooms and corridors, as well as requiring facilities to be near and have relationships with local hospitals. These requirement do not improve patient care but set expensive standards that make it difficult for clinics to stay open.Today, 90 percent of counties in our country are without a single abortion provider, and six states have only one abortion clinic.So, why is this a problem that the Subcommittee should address?First, these restrictions deny women access to safe health care. Restricting abortion doesn’t stop abortion. It makes it less safe.A nonpartisan study by the National Academies of Sciences found that the biggest threats to the quality and safety of abortion care are state regulation that create barriers to trained abortion providers.When abortion is accessible and legal, it is extremely safe. The rate of serious complications in first-trimester abortions is less than 0.05 percent, making abortion 40 times safer than a colonoscopy.But when abortion care is restricted, women face devistating consequences.The landmark Turnaway Study, a five-year longitudional study by reserachers at UCSF, followed 1,000 women who sought, but did not always obtain, abortion care. The researches found that the women who were denied health care consistently fared worse outcomes than those who recieved it.The women forced to carry a pregnancy were more likely to experience eclampsia and were more likely to stay with abusive partners. They were four times more likely to be living below the poverty level. Two women who were denied abortion care died of pregnancy-related causes. The Women’s Health Protection Act makes sure that every Americanhas equal access to comprehensive reproductive health care, no matter where they live.This legislation follows in the tradition of the Voting Rights Act of 1965 where Congress safeguarded a constitutionally-protected right. That’s because states don’t get to pick and choose what part of the Constitution to follow… Holly Alvarado – advocate – provided testimony in support of H.R. 2975: The Women’s Health Protection Act. From her testimony: In her testimony, Holly Alvarado stated that she served in the United States Air Force from 2006 to 2011 as a law enforcement officer. In 2009, she was given orders for deployment with a 10 person team. Two weeks before her deployment, she wsa gathering supplies, packing, and moving her apartment into a storage unit, she realized she could be pregnant. ….I knew immediately that I did not want to continue this pregnancy. I knew me. 22 year old me knew that what now 33 year old me wanted out of life and this pregnancy was not part of my plan. Even though this was an immediate feeling, I took time to think about how I was not financially or emotionally in a state of my life where I was ready to continue a pregnancy and raise a child. While serving in the military, I saw the many challenges facing servicewomen with children… I made a deeply ethical and moral decision by myself and was resolute on what I needed to do……I called Planned Parenthood of North Dakota and learned that the closest facility that could perform abortions was in Fargo, ND, approximately 2 hours away. North Dakota only has one abortion clinic. which means longer wait times for an appointment. They did not have any appointments in the next two week and were unable to help me. I was encouraged to call St. Paul, MN’s Planned Parenthood office, 4 hours away. I called and scheduled my first and second appointment……My first appointment was needed to verify my pregnancy with an ultrasound and urinalysis, they would give me information, and an ultrasound picture. I needed to book a second appointment for the procdure itself. This was not due to any medical reason and it was certainly not my preference. Minnesota law mandates a 24 hour waiting period between the first appointment and the day of the procedure. And because of the wait times for an appointment at the clinic I would have to wait 3 days between appointments. I would spend a total of 4 days in Minnesota without resources. The day before my appointment I would have to wait for a mandatory phone call. I was told to wait by my cell phone and be somewhere with good service because I would need to answer and couldn’t miss the call. If I had missed the call they would have to cancel my appointment for the next day and I would have to start the process all over again. If that had happened I would have missed my deployment deadline, I would have been financially unable to repeat this process, and close to the gestitational limit of having an abortion. In that phone call I would be told I have options like adoption or continuing the pregnancy, that I am eligbile to receive child support and WIC, that my procedure could be dangerous and prevent me from having children in the future, and then I would need to confirm my appointment for the next day if I did not want to continue the pregnancy……I confirmed my appointment the next morning. The state laws, the biased counseling, the waiting period, the protesters in front of Planned Parenthood, all felt like a slap in the face……I chose the surgical abortion because it was a one day procedure with no follow up. If I took the medication abortion, I would need to have a follow up appointment after a week of taking the medication to make sure the pregnancy had ended. I would not be able to do that because I would be in training for deployment on an isolated base, so the only option was a surgical abortion…. The appointment was long as I would need another pregnancy test, an RH test, another ultrasound, and counseling with an RN. …When the procedure was complete I felt relief…..Because of a federal ban on abortion coverage I was unable to use TRICARE as my healthcare insurance and was unsure what I would do if there had been any complications… ….Regardless, the abortion was a saf procedure and I had zero complications, I returned to duty within 12 hours of having my procedure.The procedure for an abortion was approximately 500 dollars, coupled with preperation in purchasing gear for deployment, needs for gas, and food and the 4 hour, 600 mile roundtrip journey to get the healthcare I needed. I had 16 dollars to my name the day I drove back to North Dakota and pay day was 1 week and a half away… Nancy Northup, President and CEO of the Center for Reproductive Rights, provided testimony in support of the Women’s Health Protection Act. From her testimony: …Our Constitution protects the right of each of us to chart our own life path and to make the deeply personal decisions that impact our lives, our families, and our health, including whether and when to become a parent. One in four women in the United States will make the decision to have an abortion in the course of her life. Yet in large parts of the United States, obtaining abortion care is difficult – and in some cases, impossible – due to a coordinated, nationwide strategy to eliminate access to abortion care.Anti-abortion rights lawmakers in state legislatures are doing whatever they can to ensure that patients face insurmountable barriers to care and that clinics are forced to close – effectively banning abortion without ever havin to touch Roe v.Wade. Since 2011, nearly 450 laws restricting and banning abortion care have been pushed through state legislatures. These laws close clinics, increase health care costs, exacerbate ineqhalities, and harm women and their families. In 1992, the year that Planned Parenthood v. Casey was decided, there were 2,380 clinics in the United States. In 2017, there were 1,587 – a decrease of one third. Already six states are down to one abortion clinic, and nearly 90 percent of American counties are without a single abortion provider. The harms caused by the decimation of abortion access are deeply unequal, falling most heavily on marginalized and underserved people and communities who already experience stignificant structural and systemic barriers to accessing quality health care including abortion. These communities include low-income people, people of color, immigrants, young people, and people living in rural and other medically underserved areas. The Women’s Health Protection Act would ensure that the right to abortion first recognized nearly 50 years ago in Roe v. Wade is a day-to-day reality for people in the United States, no matter what state they happen to live in. This bill would create a federal statutory right for providers to provide abortion services, and a corresponding right for their patients to receive abortion services, free from medically unnecessary restrictions and bans that single out abortion and impede access to care.Congress has the authority under the Commerce Clause to regulate health care as interstate commece, and the authority under Section 5 of the Fourteenth Amendment to protect against the abridgement of constitutionally protected rights. It must exercise this authority now and protect the right to access abortion care first recognized in Roe by passing the Women’s Health Protection Act… Yashica Robinson, MD, who is a board certified obstetrician-gynecologist, provided testimony. She serves on the board of directors of Physicians for Reproductive Health and is the medical director of Alabama Women’s Center. From her testimony. …I came to this work because of my passion for young people, one that is deeply connected to my personal experience with teen pregnancy. Prior to finishing high school, I learned I was pregnant. As a result of fear and lack of resources, by the time I confided in my mother and grandmother, I had no choice – I was going to be a mother. Becoming a mother as a teenage came with many harsh realities. I love ny children with all my heart, but I know that everyone should be able to make the decision to parent for themselves. I have been in the shoes of many of the young people I see in my clinic, and it’s important for them to know that regardless of their decision, that I am here to support them.I support the Women’s Health Protection Act becasue it would help ensure tha access to care does not look differently depending on your zip code. In states like California or Maryland, today a patient can access abortion care without the state forcing medically inaccurate information on them, or making them endure a medically unnecessary waiting period. This is what care should look like. Unfortunately, today that is not the case for my patients in Alabama.Providing abortion care in Alabama is challenging. Just last year, the legislature passed a near total ban on abortion. Under that ban a physician could be sent to prison for 99 years for performing an abortion. This law, should it ever go into effect, it would threaten doctors like myselfwith prison for providing ethical, medically appropriate care. There is no other area of medicinewhere politicians threaten physicians with prosecution for doing their jobs. Represented by the ACLU, I and other abortion providers in the state filed suit to prevent this bill from going into effect. Thankfully, the ban was blocked, and abortion remains legal in Alabama, as it is in every other state.…It is not unusual for patents to travel up to eight hours, or from as far away as Louisiana and Florida – because so many other providers have been forced to shut their doors. Then they are required to wait an additional 48 hours before I can provide the care they need due to a state-imposed waiting period. I know people who have slept in their cars as a result of this manditory delay period because they had no other options.The state also requires that my patients recieve outdated materials as part of so-called “counseling” that are filed with misinformation that I then need to correct. We are required to do ultrasound examinations, even when they are unnecessary and provide no medical value. These restrictions only add costs and delays. Their effects on my patients are painful for me to see.Alabama also bans abortion after 20 weeks post-fertilization. Patients needing care after that point have to travel out of state, making care even more expensive. And young people in Alabama have to navigate an onerous, time-intensive process to have an abortion if they cannot involve a parent. I have cared for a 12-year-old victim of incest who faced many delays before finally getting judicial approval for the abortion she needed. Even though I met her in her first trimester of pregnancy, she was nearing Alabama’s legal limit by the time she navigated all of these hurdles……in 2018, the National Academies of Sciences, Engineering, and Medicine (NASEM) published a comprehensive study affirming that abortion is extremely safe and the biggest threat to patient safety is the litany of medically unnecessary regulations that raise costs and delay procedures, ultimately putting women’s health at risk. They confirmed what we already know: that access to safe abortion care all too often depends on where you live and how much money you have……The bottom line is this: Abortion is healthcare! The Women’s Health Protection Act would bring needed federal protections for my patients and safeguard their right to abortion care. Protecting abortion care will also protect access to pregnancy care because they are interconnected. Health care in any speciality should be patient-centered, and medical decisions should remain between the patient and her physician, without political interference. There were also two anti-choice people who provided testimony. Their words do not belong in my blog post. February 13, 2020: New York Attorney General Letitia James posted a press release titled: “AG James Voices Support for Legalization of Surrogacy In New York”. From the press release: Attorney General Letitia James released the following statement in support of legalizing gestational surrogacy in New York. “Our antiquated surrogacy ban makes it prohibitively expensive and burdensome for many New Yorkers to become parents. Countless families, particularly members of the LGBTQ community and those with fertility issues, have been unable to have a child through surrogacy because of this outdates law. The current proposal has been well-researched, well-written, and will not only support families, but provide critical legal and medical protections to surrogates, parents, and children. I respect the legislative process and look forward to meeting with members of the legislature to address their concerns so we can move forward to adopt this proposal.”“New York is one of the most progressive states in the nation and a leader in LGBTQ and women’s rights, and yet we are only one of three states that does not allow LGBTQ individuals and people struggling with fertility to conceive a child and start a family through gestational surrogacy,” said Governor Andrew M. Cuomo. “We need to right that wrong, and with the support of the Attorney General and our broad coalition of advocates, this year we will get it done and complete marriage and family equality”… February 18, 2020: The American Civil Liberties Union (ACLU) posted an article titled: “There is a Coordinated Attack Agains Trans Youth in State Legislatures”. It was written by Rose Saxe. From the article: Less than a month and a half into 2020, this state legisative session has seen unprecedented attacks on LGBTQ people, and an alarming focus on bills that would harm trans youth……Right now, bills are pending in 10 states that would criminalize life-saving, best practice medical care for trans youth, putting govenrment in the way of decisions that should be left up to the young person, their parents, and their medical providers. Proponents of these bills repeat similar lies about medical care, but these bills are opposed by all major medical associations that just want to be sure all kids can get the health care they need.At the same time, 16 states currently are considerin bills that would ban young trans athletes from participating in athletic activities consistent with their gender (bills in Missouri and Idaho have hearings this week.) Some of the bills only exclude girls who are trans, echoing language tha was once used to keep cisgender women out of sports. Others also require boys who are trans to participate solely on girls’ teams. Statewide scholastic sports organizations typically regulate the terms of participation in sports to ensure all youth can participate fairly. These bills would instead authorize invasive medical examination of young athletes, and would substitute a categorical exlcusion from school sports that doesn’t match up even with the most strignent regulations governing elite competition like the Olympics.And still, other bills would allow all health care providers to refuse care based on religious objections to trans people, or make it harder for schools to support trans youth.These bills – and dozens of other anti-LGBTQ measures – are pending in states across the country from Alaska to Florida. That’s not a coincidence. These efforts are part of an orchestrated national campaign led by groups like Heritage Foundation, Alliance Defending Freedom, – who last week filed a lawsuit attacking trans student athlethes – and the Family Policy Alliance, to demonize trans youth and drive a wedge among supporters of LGBTQ equality. We can’t let them succeed… February 18, 2020: New York Attorney General Letitia James posted a press release titled: “Attorney General James Condems Federal Proposal To Roll Back Critical Anti-Discrimination Protections For Patients and Students”. From the press release: New York Attorney General Letitia James today sent two multistate comment letters to the Trump Administration, opposing federal proposals that roll back critical anti-discrimination protections for patients and students. Both proposals stem from President Trump’s Executive Order that allows faith-based organizations to deny services to various groups. In the first proposal, the U.S. Department of Health and Human Services (HHS) would eliminate transparency requirements for faith-based providers that help patients to understand their rights and access referrals to care from alternative providers. In the second, the U.S. Department of Education is vastly expanding the definition used to claim a religious exemption under Title IX of the Education Amendments Act of 1972. This would allow schools to discriminate on the basis of sex against students or faculty based on the moral beliefs and practices of administrators, even if those practices have no connection with a religion. Together, these federal proposals are part of the Trump Administration’s ongoing assault on the rights of women, survivors of sexual harassment and violence, and LGBTQ+ individuals.“The president’s Executive Order is nothing more than a veiled attempt to discriminate against our nation’s patients, students, and those who are most vulnerable,” said Attorney General James. “Religion should never be used as weapon, yet the Trump Administration has repeatedly worked to pit Americans against each other by using faith as a wedge between us. Our coalition is fighting the president’s attempts to divide Americans along religious lines, and will continue to do everything in our power to protect women, LGBTQ+ individuals, and those who need these vulnerable protections.”In the first comment letter, the coalition of 23 attorneys general contends that HHS’ proposal fails to safeguard the rights of women and LGBTQ+ individuals – both groups which already disproportionately face barriers to care. particularlu when it comes to obtaining accurate information about theri health care and referrals. The reciept of accurate and impartial information from providers is vital to a patient’s health and could mean the difference between the life and death. Under the proposal, faith-based providers will no longer be required to notify patients of their rights, including the right to a referral. For instance, removing notice and referral requirements will adversely impact a woman’s ability to access critical reproductive care, including an abortion. In fact, religiously-affiliated crisis pregnancy centers – which have seen an uptick in federal funding under the Trump Administration – have been known to offer patients misleading information in an attempt to discourage them from obtaining an abortion or accessing contraception. In the comment letter, the coalition maintains that HHS’ proposal is arbitrary and capricious because it failes to consider evidence or adequately justify the proposed changes.In the second comment letter, the coalition of 20 attorneys general highlights how the Department of Education’s proposal to expand religious expemptions under Title IX could give schools free rein to discriminate against students or faculty on the basis of sex – significantly harming people who have suffered discrimination, including sexual harassment and violence. Currently, Title IX contains a narrow religious exemption for educational institutions controlled by a religious organization. The proposal would allow more schools to discriminate on the basis of sex by broadening the criteria for institutions to claim a religious exemption, such that even schools with a tenuous relationsip with religion could claim exemption from Title IX requirements. As a result, under the proposal, a student could unlawfully face discrimination – for using birth control, being pregnant or parenting a child out of marriage, or for being LGBTQ+ – simply because of the moral beliefs or practices of school administators. Sexual harassment and violence survivors could also be denied the protections of Title IX by schools claiming to be exempt under the proposed rule. This kind of discrimination can needlessly and seriously disrupt a student’s academic trajectory and career and could have a detrimental long-term effect on their mental health. The coalition also notes that the proposal is arbitrary and capricious because the federal government failed to provide any substantive reasoning that would justify this dramatic departure in policy, which is contrary to the goals of Title IX.Joining Attorney General James in sending the first letter to HHS are the attorneys general of California, Connecticut, Delaware, Hawai’i, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, North Carolina, Oregon, Pennsylvania, Vermont, Virginia, Washington, Wisconsin, and the District of Columbia.Joining Attorney General James in sending the second letter to HHS are the attorneys general of California, Colorado, Connecticut, Delaware, Hawai’i, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, North Carolina, Oregon, Pennsylvania, Vermont, and the District of Columbia. February 20, 2020: The American Civil Liberties Union (ACLU) posted a press release titled: “ACLU, Center for Reproductive Rights, Planned Parenthood File Motion For Summary Judgement In Georgia Abortion Ban Lawsuit”. From the press release: Today, the American Civil Liberties Union, the ACLU of Georgia, the Center for Reproductive Rights, and Planned Parenthood filed a motion for summary judgement in their lawsuit challenging Georgia’s abortion ban, SisterSong v. Kemp. The motion asks the court to block the ban permanently from taking effect.The lawsuit, which was filed in June 2019, challenges Georgia’s abortion ban which was set to take effect on January 1, 2020. The law would ban abortion care from the earliest weeks of pregnancy, before many women even know they are pregnant.According to the lawsuit, Georgia’s abortion ban is in clear violation of Roe v. Wade and nearly a half century of Supreme Court precedent reaffirming Roe’s central holding. Writing for the court in 1992, U.S. Supreme Cout Justice Sandra Day O’Connor wrote, “The ability for women to participate equally in the economic and social life of the Nation has been facilitated by their ability to control their reproductive lives.”On October 1, 2019, the federal district court granted the plaintiffs motion for preliminary injunctive relief and temporarily blocked the ban from taking effect while the lawsuit is pending. The preliminary injunction will remain in place until the court explicitly says otherwise.If plaintiffs’ motion for summary judgement is granted, the abortion ban will be permanently blocked unless an appeals court says otherwise.“As a reproductive justice organization based in Georgia for over 20 years, SisterSong is committed to centering and amplyfying the needs of those communities historically pushed to the margins. Georgia’s maternal mortality rate is the second highest in the nation and Black women in our state are dying at six times the national average. SisterSong is bringing this lawsuit to protect maternal health and reproductive rights so that every person – especially persons of color – can thrive in their families and communities as well as maintain their reproductive lives,” said Monica Simpson, executive director of SisterSong……According to a 2019 Atlanta Journal-Constitution poll, 70 percent of Georgians support Roe v. Wade, the landmark U.S. Supreme Court case that guaranteed the right to an abortion……The organizations bringing forward the lawsuit are SisterSong Women of Color Reproductive Justice Collective, Feminist Women’s Health Center, Planned Parenthood Southeast, Inc., Atlanta Comprehensive Wellness Clinic, Atlanta Women’s Medical Center, FemHealth USA d/b/a carafem, Columbus Women’s Health Organization, P.C., Summit Medical Associates, P.C., Carrie Cwiak, M.D., MPH., Lisa Haddad, M.D., M.S., M.P.H., and Eva Lathrop M.D., M.P.H.The defendants in the case are Georgia Governor Brian Kemp, Attorney General Christopher M. Carr, Commissioner for the Department of Public Helath Kathleen Toomey, the Executive Director and Members of the Georgia Composite Medical Board, and the District Attorneys for the counties where the plaintiffs provide medical care – all sued in their official capacities… A copy of the lawsuit can be found here. February 20, 2020: Center for Reproductive Rights posted a press release titled: “Appeals Court Blocks Mississippi’s Six-Week Abortion Ban”. From the press release: Today, the Fifth Circuit Court of Appeals temporarily blocked Mississippi’s six-week abortion ban, upholding a lower court’s decision from May 2019. The case was brought by the Center for Reproductive Rights, civil right attorney Robert B. McDuff, of Jackson, Miss., Paul, Weiss Rifkind, Wharton & Garrison, and the Mississippi Center for Justice on behalf of Jackson Women’s Health Organization (JWHO) – the last remaining abortion clinic in Mississippi. On December 13th of last year, the Fifth Circuit struck down a 15-week ban passed by Mississippi.In today’s decision, a three-judge panel of the Fifth Circuit wrote, “[A]ll agree that cardiac activity can be detected well before the fetus is viable. That dooms the law. If a ban on abortion after 15 weeks is unconstitutional, then it follows that a ban on abortion at an earlier stage of pregnancy is also unconstitutional.” “This is now the second time in two months the Fifth Circuit has told Mississippi that it cannot ban abortion,” said Hillary Schneller, senior staff attorney at the Center for Reproductive Rights. “Despite the relentless attempts of Mississippi and other states, the right to legal abortion remains the law of the land.”The six week abortion ban was signed into law in March 2019 and blocked in May by District Judge Carlton W. Reeves. In his decision, he wrote, “Here we go again: Mississippi has passed another law banning abortions prior to viability.” He went on to say that, [This law] prevents a woman’s free choice, which is central to personal dignity and autonomy.”“A ban at six weeks of pregnancy means many of our patients would lose their right to have an abortion before they even know they’re pregnant,” said Shannor Brewer, director of Jackson Women’s Health Organization. “Most of our patients are past that point. Some have spent weeks saving money for the procedure and have driven hundreds of miles to reach us. Keeping thsi law blocked means abortion remains legal in Mississippi and gives those women a chance to access it.”The ban violates Supreme Court precedent dating back to Roe v Wade affirming that a state may not ban abortion prior to viability, meaning the point at which a fetus can survive for a sustained period outside the womb… February 24, 2020: The American Civil Liberties Union (ACLU) of Wyoming posted an article titled: “ACLU of Wyoming Supports Funding Mental Health, Substance Use Diversion Programs”. From the article: Mental health and substance use diversion programs are an effective way to redirect people out of the criminal legal system and into supportive community treatment. Current diversion efforts in Wyoming, however, have proven ineffective because of a lack of adequate upfront funding. That’s why ACLU of Wyoming supports House Bill 31, legislation that would require the Department of Health and the Department of Corrections to collaborate to reduce criminal offender recidivism by improving mental health and substance use programming and funding. House lawmakers passed House Bill 31 last week. The ACLU of Wyoming urges the Senate to take up consideration of the bill as soon as possible……Although House Bill 31 comes with a price tag – the Legislative Service Office estimates it would cost $648,760 to fund – diversion programs like this are cheaper and more effective than incarceration……Expanding the use of mental health and substance use diversion programs is among the proposed reforms in the ACLU of Wyoming’s Blueprint for Smart Jusice report. The report includes an overview of Wyoming’s incarcerated populations, including analysis on who is being sent to jail and prison and the racial disparities that are present, what drives people into the system, how long people spend behind bars and why people are imprisioned for so long. It also offers a calculation on the impact of certain reforms by 2025 on racial disparities in the prision population, fiscal costs and progress toward a 50 percent decarceration goal. February 24, 2020: Planned Parenthood posted a press release titled: “Court Denies Relief for Title X Patients”. From the press release: Today, an en banc panel of the U.S. Court of Appeals for the 9th Circuit voted 7-4 to uphold the Trump administration’s unethical and dangerous gag rule on Title X, the nation’s program for affordable birth control and reproductive health care. Planned Parenthood sued the Trump administration in March to block to tell patients how or where to access abortion, and imposes cost-prohibitive and unnecessary “physical separation” restrictions on health centers that provide abortion. These moves were obvious and ultimately successful tactics to push Planned Parenthood health centers and other reproductive health care providers out of Title X.In “strongly” dissenting, Judge Paez, joined by three other judges, wrote, “In vacating the preliminary injunctions, the majority blesses an executive agency’s disregard of the clear limits placed on it by Congress. The consequences will be borne by the millions of women who turn to Title-X funded clinics for lifesaving care and the very contraceptive services that have caused unintended pregnancy – and abortion – to plummet.”… February 24, 2020: The American Civil Liberties Union (ACLU) posted an article titled: “ACLU Response to Ninth Circuit Ruling on Title X Family Planning Program”. From the article: The U.S. Ninth Circuit of Appeals upheld a Trump administration policy that is destroying the Title X family planning program.The rule prohibits family planning clinics – which previously served as the source of health care for more than four million low-income people every year – from providing Title X patients with referrals for abortion care and imposes other onerous requirements that have resulted in the widespread loss of critical Title X providers.The Eastern District of Washington blocked the Trump administration’s rules, but the Ninth Circuit overturned that decision and issued a ruling on the merits.“We are deeply disappointed that today’s decsion allows the Trump administration to once again make it harder and harder for people to get the health care they need, including family planning care,” said Ruth Harlow, senior staff attorney at the ACLU Reproductive Freedom Project, who argued the case before the Ninth Circuit. “We are looking at any further options to rescue the Title X program and to restore the critical care it has provided to marginalized patients for almost five decades.”The ACLU’s lawsuit was brought on behalf of the National Family Planning & Reproductive Health Association and Cedar River Clinics. February 24, 2020: The American Medical Association posted an article titled: “U.S. appeals court upholds Title X gag rule on physicians”. It was written by Senior News Writer, American Medical Association, Andis Robeznieks. From the article: …The Trump administration gag rule that violates the AMA Code of Medical Ethics by mandating that physicians serve as government mouthpieces in discussions with patients in the Title X program will be allowed to take effect. The 9th U.S. Circuit Court of Appeals, in a 7-4 decision, vacated orders previously entered by federal district courts in California, Oregon, and Washington.“The AMA is disappointed by – and strongly disagrees with – the reasoning behind a federal appeals court’s decision to allow the Trump administration to enforce a gag rule on physicians,” said AMA President Patrice A. Harris, MD, MA.The ruling upholds the decision made last June by a three-judge panel from the same court that lifted a nationwide injunction issued by the district court. The AMA appealed that decision in the case, AMA v. Azar, and asked for it to be heard by a larger, “en banc” panel from the 9th Circuit.A brief filed by the AMA and its co-plaintiffs included arguments against the gag rule and noted that the Health and Human Services Department (HHA) “cannot point to one instance where Title X funds have been misapplied.”The court dismissed the arguments….…Dissenting Judge Richard A. Paez cited the decision from last April by U.S. District Judge Michael McShane. That judge blocked the rule’s implementation arguing that the gag rule contradicted the Code of Medical Ethics’ prohibition on withholding information from patients and that it instructed doctors “to intentionally mislead patients.”“The majority would return us to an older world, one in which a government bureaucrat could restrict a medical profession from informing patients of the full range of health care options available to her,” Paez wrote……Unless it is appealed to the Supreme Court, the ruling ends proceedings regarding injunctions on the gag rule and other new HHS regulations. The decision also hands the case back to the district court “for further proceedings consistent with this opinion.”In the immediate future, however, Paez predicted it will be patients who will feel the biggest impact.“In vacating the preliminary injunctions, the majority blesses an executive agency’s disregard of the clear limits placed on it by Congress,” he wrote. “The consequences will be borne by the millions of women who turn to the Title X-funded clinics for lifesaving care and the very contraceptive services that have caused rates of unintended pregnancy – and abortion – to plummet.”Dr. Harris said the AMA will continue to oppose gag rules on physicians… February 26, 2020: The American College of Physicians (ACP) posted a press release titled: “Internists Say Court Decision to Uphold Title X Changes Will Harm Patient-Physician Relationship”. The statement is attributable to Robert McLean, MD, MACP, President, American College of Physicians. From the press release: The American College of Physicians (ACP) is disappointed in the federal appeals court decision to allow the Trump administration’s restrictions on the Title X program to go into effect. The changes will interfer in the patient-physician relationship, restricting the counsel that physicians can provide to their patients.Restricting the program will jeopardize access to health care for vulnerable, often working, low-income patients who may have limited to no access to health insurance. They rely on the clinics who depend on Title X funding to provide preventative car and contraception services.ACP opposes any restrictions that interfere with the patient-physician relationship. We will continue to fight against this or any other regulations that would prevent the physician from using sound medical judgement to counsel patients. February 26, 2020: American Civil Liberties Union (ACLU) posted an article titled: “Stopping the Anti-Abortion Ordinances of East Texas”. It was written by Anjali Salvador. From the article: Waskon. Naples. Joaquin. Tenaha. Rusk. Gary. Wells. These names might sound unfamiliar now, but you’ll be hearing more about the soon enough.They are seven cities in East Texas that, within the last several months, each passed so-called “sanctuary city for the unborn” ordinances – moves that are blatently unconstitutional. Waskom, Texas, was the first municipality to pass such an ordinance in July 2019. Soon after, other east Texas cities followed suit. The ordinances attempt to ban abortion within the cities if Roe v. Wade is overturned and some of them even try to ban emergency contraception.The ordinances also declare organizations working to protect the right to abortion, including our clients Lilith Fund and Texas Equal Access Fund (TEA Fund), as “criminal organizations,” even though they have done absolutely nothing wrong. The ordinances function to silence abortion advocates, preventing them from operating and even speaking about abortion within the city limits.These ordinances constitute an outright attack on abortion and free speech, which is why today we filed a lawsuit against these seven cities……Under these local laws, our clients cannot speak up about abortion rights, recruit volunteers to help them do their important work, or congegate to share informational materials in these cities without worrying about getting sued. The laws intentionally and unconstitutionally obstruct our plaintiffs’ ability to do their jobs, impeding the advocacy work that is intregral to their mission.In contrast, anti-abortion organizations face no such restrictions, remaining free to undermine access to reproductive health care without legal ramifications. It’s this targeted and discriminatory suppression of speech and assembly that violates our clients’ First Amendment rights – and exactly what we are challenging in our lawsuit… February 27, 2020: Openstates posted information about Georgia House Bill HB 1060, which is called “Vulnerable Child Protection Act; enact”. The purpose of the bill is to prevent doctors from providing gender-affirmative health care to minors – even if the minor’s parent believes it is the healthiest choice for their child. The Abstract says: A BILL to be entitled an Act to amend Title 31 of the Official Code of Georgia Annotated, relating to health, so as to prohibit certain licensed, certified, or registered professionals from engaging in certain acts upon minors; to provide for a short title; to provide for definitions; to provide for exceptions; to provide for a penalty and private cause of action; to explicitly waive sovereign immunity, qualified immunit, and official immunity for such a private cause of action; to provide for related matters; to provide for an effective date and for applicability; to repeal conflicting laws; and for other purposes. Here are some of the cruelest things in this bill: This is the part where the bill denies minors recognition of their gender. It also prevents minors from accessing the gender-affirming health care they want. …’Sex’ means the biological state of being female or male, based on sex organs, chromosomes, or endogenous hormone profiles……no health care professional shall engage in any of the following practices upon a minor, or cause such practices to be performed, for the purpose of attempting to affirm the minor’s perception of such minor’s sex, if that perception is inconsistent with such minor’s sex:(1) Performing any surgery that sterilizes, including, but not limited to, castration, vasectomy, hysterectomy, oophorectomy, metoidioplasty, orchiectomy, penectomy, phalloplasty, or vaginoplasty;(2) Performing a mastectomy;(3) Removing any otherwise healthy or nondiseased body part or tissue; or(4) Administering or supplying medications that induce transient or permanent infertility, including, but not limited to:(A) Puberty-blocking medication to stop or delay normal puberty;(B) Supraphysiologic doses of testosterone to females; or(C) Supraphysiologuc doses of estrogen to males…. Here’s the part where the bill takes away parent’s rights to make decisions that would allow their minor child to recieve gender-affirming health care: The chapter shall not apply to the medical decision of a parent or guardian of a minor born with one of the following medically verifiable genetic disorders of sex development:(1) A minor with external biological sex characteristics that are irresolvably ambiguous, such as a minor born with 46 XX with virilization or 46 XY with undervirilization; or a minor with both ovarian and testicular tissue; or(2) When a physician has otherwise diagnosed a sex development order, in which the physician has determined through genetic testing that the minor does not have the normal XY sex chromosome structure for a male or XX sex chromosome structure for a female. Here’s the part that criminalizes health care professionals who provide gender-affirming health care to a minor who wants it and whose parent wants them to have it: …(a) Any health care professional who violates this chapter shall be held guilty of a felony and, upon conviction thereof, shall be punished by imprisonment for not less than one nor more than ten years.(b) Within ten days of a conviction, a health care professional who is convicted of violating this chapter shall notify in writing the applicable licensing board for his or her licensure, certification, registration, or other authorization to conduct such health care professional’s occupation. Upon being notified and notwithstanding any law, rule, or regulation to the contrary, the appropriate licensing board shall revoke the license, certification, registration, or other authorization to conduct such health care professional’s occupation… February 27, 2020: Center for American Progress posted a press release titled: “Virginia Legislature Removes Medically Unnecessary Barriers to Abortion Access”. Today, the Virginia General Assembly passed the Reproductive Health Protection Act, which will expand access to abortion care by repealing medically unnecessary restrictions that have made it more difficult for Virginians to access safe and legal abortion care for years.The Act strikes down the following restrictions:The Two-Trip Mandatory Delay Law: A law forcing pregnant people to undergo an unnecessary ultrasound, listen to state-mandated biased counseling, and then wait at least 24 hours before their procedure. This means pregnant people are unnecessarily delayed in accessing care because they must make at least two trips to the clinic, creating onerous burdens – especially for poor and low-income people – seeking care in the Commonwealth.The Licensing Law: A law targeting abortion providers that subjects them to a burdensome, medically unnecessary regulatory scheme that applies to no other medical professionals and has no legitimate medical bias.The Physicians Only Law: A law prohibiting trained and qualified advanced practice clinicians from providing first-timester abortion care… March March 2, 2020: President of the American Federation of Teachers (AFT) Randi Weingarten, posted a press release titled: “AFT President Randi Weingarten on the U.S. Supreme Court Decision to Grant Cert on the Affordable Care Act”. From the press release: Randi Weingarten, president of the American Federation of Teachers, whose 1.7 million members include nurses and healthcare professionals, issued the following statement after the Supreme Court’s decision today to accept review of another challenge to the Affordable Care Act:“The fact that yet another challenge to the ACA has been brought by President Trump and Republican governors to the Supreme Court demonstrates their continued callous disregard to the healthcare needs of Americans. This is a ‘which side are you on?’ moment. The Republican Party wants to deny coverage for anyone with a pre-existing condition and then pretend they will not be pauperized because of their or a family member’s cancer, asthma, diabetes or any of the pre-existing conditions that millions of Americans have. Because the White House was unsuccessful in its attempt to repeal the ACA in Congress, it will use any means to destroy our country’s prevailing healthcare law.“It is sadthat the Republicans are not even honest about their strategy; they should at the very least have joined with Democrats in their motion to expedite having the case heard and decided before the 2020 election. Instead, the Republicans have lied about their intent in public, presumably because they, too, know the public is against them. But the decision by the Supreme Court to hear the case offers an opportunity to stop this assault on the ACA, working people and individuals with pre-existing conditions.“During this moment while we are dealing with the coronavirus and an international health crisis, we need to expand access to healthcare, not restrict it, as President Trump and the GOP have tired to do more than 50 times with their lawsuits against the ACA. High-quality, affordable healthcare should be a human right guaranteed to all; people with underlying health conditions and those in underserved communities are especially at risk.“More than 70 percent of Americans support the ACA and its protections for people with pre-existing conditions. Rather than seek to eliminate coverage, President Trump and the Republicans could work with Senate Democrats to lower drug costs; the House has already passed H.R. 3, The Elijah E. Cummings Lower Drug Costs Now Act.“If Donald Trump is re-elected and Republicans have free rein on the government, they will strip these protections from millions of Americans. It is up to voters to turn the tide on the insidious policies of this administration so that countless Americans facing an affordability crisis are no longer forced to exist in perpetual instability.” March 3, 2020: ABC News posted an article titled: “Virginia bans conversion therapy for LGBTQ minors”. It was written by Ella Torres. From the article: Virginia became the 20th state in the country to outlaw conversion therapy for LGBTQ minors after Gov. Ralph Northam signed the ban into law on Monday.Conversion therapy is described as a practice to forcibly change an individual’s sexual orientation or gender identity.“Conversion therapy sends the harmful message that there is something wrong with who you are,” Northam said in a statement. “This discriminatory practice has been widely discredited in studies and can have lasting effects on our youth, putting them at a greater risk of depression and suicide.”……LGBTQ youth who had undergone conversion therapy were more than twice as likely to attempt suicide compared to those who did not, according to the organization.The other states that have banned conversion therapy for minors are California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, Maine, Nevada, New Jersey, New Hampshire, New Mexico, New York, Oregon, Rhode Island, Utah, Vermont and Washington.The Virginia bill outlaws any health care provider in any profession licensed by a regulatory board of the Department of Health from engaging in conversion therapy, according to a copy of the bill.The bill also notes that no state funds will be allocated for the purpose of conversion therapy.It goes into effect July 1. March 3, 2020: CBS News posted an article titled: “Roe v. Wade might not matter after Supreme Court decides this case”. It was written by Katie Smith. From the article: For nearly 50 years, access to abortion has been largely protected by Roe v. Wade, the 1973 Supreme Court deicision that legalized abortion nationwide. But a case before the high court this week could erode the landmark decision without ever challenging it directly.The Supreme Court will hear oral arguments Wednesday for June Medical Services v. Russo, a case that challenges a 2014 Louisiana law. The result coudl impact abortion access across the country, and advocates fear the relatively recent additions of two conservative justices make it more likely that the court upholds the law.Known as the Louisiana “Unsafe Abortion Practice Act,” the law requires doctors who provide abortions to have privileges to admit patients at a nearby hospital. Supporters of the law say its designed to improve patient safety, but critics say it’s intended to shut down clinics that provide abortion.When the law was signed in 2014, only one of the state’s six abortion clinocs at the time had a physician who was compliant with its regulations. The law has been largely blocked from implementation, but was briefly allowed to go into effect in early 2016, prompting the closure of two of the state’s remaining clinics.Today, Louisian has just three abortion clinics across the state. If the Supreme Court finds Louisiana’s law constitutional, all of them would stop offering the procedure, as first reported by CBS News. The court’s ultimate decision is expected early this summer……The Supreme Coirt isn’t expected to make a decision in June Medical Service v. Russo until later this year. When it does, abortion rights supporters warn that if the court upholds the law, the ramifications would go beyond Louisiana and could create a patchwork of abortion access across the country… March 3, 2020: Representative Barbara Lee tweeted: “Instead of working to improve residents’ health, Louisiana lawmakers are blocking access to abortion with a clinic shutdown law. Let me be clear: Abortion is #MyRightMyDecision, regardless of income, zip code, or the opinions of anti-choice politicians”. The tweet included a link to an article from The New York Times. March 3, 2020: ABC News posted an article titled: “Mississippi seeks abortion ban for race, sex, genetic error”. It was written by Emily Wagster Pettus. From the article: Mississippi’s Republican-led Legislature is trying to restrict the reasons women may seek abortion, after federal courts blocked time limitations that the state tried to put on the procedure the past two years.Abortion would be prohibited if a woman is seeking one because of the race, sex or genetic abnormality of the fetus, under a bill that passed a state House committee Tuesday. The only exception would be in a case of a medical emergency. Other states have been sued over similar laws, and opponents questioned whether Mississippi is inviting another lawsuit over abortion.House Bill 1297 moves to the full House for more debate……Anyone who performs an abortion because of race, sex, or genetic abnormality could face one year to 10 years in prison. The woman having the abortion would not face penalties.Democratic Rep. Sonya Williams-Barnes of Gulfport voted against the bill.“Women should have a right to make a choice for themselves whether they want to have a child or not,” Williams-Barnes said after the committee meeting.She questioned whether women would even know about potential genetic abnormalities early enough in a pregnancy to consider abortion. Mississippi law bans abortion at 20 weeks, about the midpoint of a full-term pregnancy. Speaking of the genetic abnormality portion of the bill, Wiliams-Barnes said: “My concern is, you make the woman have the child that has these deficiencies, but yet are you going to give her any medical aid or home care assistance for the child?”… March 4, 2020: Representative Jackie Speier tweeted: “Abortion is extremely safe. The risk of complication is lower than from a colonoscopy, wisdom tooth removal, or a tonsillectomy, which do not require admitting privileges. The law before #SCOTUS is all about chipping away at Roe, NOT about protecting women. #MyRightMyDecision” The tweet included a video of Representative Jackie Spier speaking with a reporter as representatives gathered to walk to the Supreme Court. March 4, 2020: Congresswoman Ayanna Pressley tweeted: “Today SCOTUS is hearing a case on Louisiana’s clinic shutdown law. Today, we are reaffirming that abortion care IS healthcare. Every person, regardless of income, sexual orientation, or gender, deserves equitable access to comprehensive medicine. #MyRightMyDecision”. March 4, 2020: New York Attorney General Letitia James tweeted: “We took action in this case because in this nation women have a constitutional right to reproductive freedom, and New York will always defend that right. #MyRightMyDecision”. The tweet included a tweet of her’s from December 3, 2019, in which she states: “I’m fighting in the Supreme Court to ensure women across the nation aren’t denied their constitionally-protected right reproductive freedom”. It includes a screenshot of the lawsuit. March 4, 2020: Representative Jerrry Nadler tweeted: “Today, the Supreme Court considers Louisiana’s admitting privileges law, a nearly identical alw to the one SCOTUS struck down as unconstitutional in 2016. If this law is upheld, Roe v. Wade will be gutted. What’s a constitutional right if you can’t exercise it? #MyRightMyDecision”. Jerry Nadler followed that tweet with a second tweet: “This case is not an isolated attack. It’s another effort by national anti-abortion groups to chip away at abortion rights and exert control over women and their bodies. As the Supreme Court already found in 2016, these laws don’t make abortion safer, they just shut down clinics.” Jerry Nadler also posted a third tweet in this thread: “If this law stands, there would only be one clinic in all of Louisiana. So much is on the line, but it’s really quite simple: the Supreme Court must follow precident and strike down the law. For everyone, abortion must be #MyRightMyDecision.” March 4, 2020: Center for Reproductive Rights tweeted: “Abortion is a human right, one that the majority of Americans support and want people ot have access to. This is not a controversial issue, it’s basic health care. We’re fighting to protect abortion access at #SCOTUS. #MyRightMyDecision”. The tweet included a photo of the outside of the Supreme Court building, filled with people, many of whom are holding up signs in support of abortion access. March 4, 2020: Ilyse hogue, president of NARAL Pro-Choice America, tweeted: “It’s a beautiful day to defend abortion rights and demand women’s freedom from the Kavenaugh Court. #MyRightMyDecision”. The tweet included a photo from outside the Supreme Court building. A large gathering of people are there. Several are holding signs. March 4, 2020: Senator Chuck Schumer tweeted: “#MyRightMyDecision SCOTUS just heard the 1st big case on a woman’s right to make her own health care decisions since Justices Kavanaugh & Gorsuch It looks at 1 of 100s of draconian, anti-choice restrictions states tried to pass. We’re here to send a message: Not on our watch!” The tweet includes a video of Senator Chuck Schumer speaking at a podium outside of the Supreme Court. March 4, 2020: CAPWomen, the Women’s Initiative at American Progress, tweeted: “We’re here at the Supreme Court today rallying in support of abortion rights because abortion is healthcare. #MyRightMyDecision” The tweet included a photo of about ten people, all of who are holding up signs in support of abortion access. March 4, 2020: Alexis McGill Johnson, Acting President and CEO of Planned Parenthood Action Fund and Planned Parenthood Action, tweeted: “Today is about our right to control our own bodies. To imagine our futures. To be free. I promise you this: Planned Parenthood will never stop fighting to keep abortion safe and legal. We will never stop fighting to make it more accessible. The tweet included a selfie-style photo of herself in front of the outside of the Supreme Court building. A crowd of people are behind her. March 4, 2020: Planned Parenthood Action tweeted: “Abortion is health care. We will not stop fighting for the basic right to control our own bodies, lives, and futires. We are down at the Supreme Court today, adding our voice. #MyRightMyDecision”. The tweet included a photo from the outside of the Supreme Court. A crowd of people are holding up signs. The largest one in the photo says “Trust Women”. March 4, 2020: Reprsentative Sylvia Garcia tweeted: “Proud to march with my comrade @RepEscobar and @HouseDemocrats as we make it clear to the #SCOTUS that we stand for a woman’s right to choose. #MyRightMyDecision”. The tweet included three photos. One is of herself with Representative Escobar. Another is a group of Representatives, wearing light blue scarves, and holding signs, are standing in a group. The third photo is of Representative Ayanna Pressley speaking behind a podium in front of the outside of the Supreme Court. March 4, 2020: NPR posted an article titled: “Beginning Of The End For Roe? Supreme Court Weighs Louisiana Abortion Law”. It was written by Nina Totenberg. From the article: Abortion rights are on the chopping block Wednesday as the Supreme Court hears arguments in a case nearly indentical to one decided just four years ago.It’s the first major abortion case to come before the court since the 2018 retirement of Justice Anthony Kennedy, making it the first time the majority of justices hearing an abortion case have anti-abortion-rights judicial records.In 2016, the justices struck down a Texas law that required abortion-clinic doctors to have admitting privileges at a nearby hospital. In that case, Texas argued that admitting privileges, which allow doctors to admit and care for their patients in hospitals, would protect the health and safety of women seeking abortions.The justices, however, concluded that rather than protecting women’s health, these requirements simply created unconstitutional obstacles to abortion access by making it difficult or impossible to staff abortion clinics.Before the court is a Louisiana admitting privileges law that the state conceeds is identical to the Texas law……Even though the law has not gone into effect, Louisiana argues that requiring admitting privileges for abortion providers really would make women safer.But every major medical group in the country – from the American Medical Association to the American College of Obstetricians and Gynecologists – contradicts that assertion. Indeed, although the Trump administration is backing Louisiana in this case, the federal government iteself recently eliminated privilege requirements for doctors who treat Medicare and Medicaid patients at outpatient surgical centers. The federal government found admitting privilege requirements to be burdensome and unnecessary……There is one new twist in Wednesday’s case. For the first time, Louisiana and the Trump administration, are claiming that doctors and clinics do not have the legal standing to challenge an abortion law on behalf of patients.“The doctors who are seeking to have less oversight and reduce regulations upon them do not share the same interests as women,” Louisiana Solicitor General Murrill said of the doctors and clinics who bring lawsuits on behalf of their patients.For more than 40 years, the Supreme Court has recognized the rights of doctors to challenge abortion laws, not just on behalf of themselves, but on behalf of their patients, too……In short, abortion providers see thsi new procedural challenge as a backdoor way to prevent future challenges to anti-abortion laws, or a wolf in sheep’s clothing….…No court has found that the Hope clinic in Shreveport, which is at the center of Wednesday’s case, to be unsafe. It has long provided about 3,000 abortions a year, and the district court found that in the past 23 years, only four patients had to be transfeerred to a hospital because of a complication… March 4, 2020: Center for Reproductive Rights posted a press release titled: “U.S. Supreme Court Hears Pivotal Abortion Rights Case”. From the press release: Today, the U.S. Supreme Court heard oral arguments in June Medical Services v. Russo – the first abortion rights case to be heard under the current makeup of the Supreme Court. The case challenges a Louisiana law that would shut down every abortionclinic in the state except for one. The law (Act 620) bans doctors from providing abortion care unless they have admitting privileges at a hospital within 30 miles.In a 2016 case also brought and won by the Center – Whole Woman’s Health v. Hellerstedt – the Supreme Court struck down an identical law in Texas, finding that admitting privilege requirements pose an “undue burden” on the right to abortion and are medically unnecessary. In the courtroom today, Center for Reproductive Rights’ Senior Litigation Director Julie Rikelman argued to the Justices that Act 620 should meet the same fate, as nothing has changed since 2016 that would justify a different outcome. Rikelman also argued that the law would close an even greater percentage of clinics in Louisiana than in Texas, and that the medical consensus opposing this kind of law has only grown stronger since 2016.The Center also argued against Louisiana’s claim that abortion providers and clinics lack legal standing to fight for their patients’ rights in court. Rekelman argued that the state’s attack on standing contradicts 40 years of precedent, and is designed to insulate unconstitutional abortion restrictions from being challenged in court. Nearly all abortion cases today are brought by doctors and clinics. If they did not have third-party standing, patients would have to initiate court proceedings themselves and file a case while still pregnant, at the same time they are urgently seeking abortion care.Act 620 and the State’s challenge to standing have been denounced by a coalition of leading voices of medicine, law, and public policy who joined with abortion patients and advocates to submit 27 amicus briefs to the Supreme Court in support of the Center’s case.While the Supreme Court heard arguments, thousands of supporters gathered outside the courthouse to rally against a growing tide of political attacks on women’s reproductive rights. More than 40 speakers addressed the crowd including: celebrities Elizabeth Banks and Busy Phillips; legislators such as Senator Charles Schumer (D-NY.), representatives Diana DeGette (D-CO.), Barbara Lee (D-CA.), Ayanna Pressley (D-MA.), and Judy Chu (D-CA.); abortion providers; faith leaders; and women who have had abortions and experienced first-hand the barriers created by anti-abortion laws. March 4, 2020: The Guardian posted an article titled: “Abortion rights case is first test for right-leaning US supreme court.” It was written by Jessica Glenza. From the article: The US supreme court, and its new conservative majority, will hear one of the most consequential abortion rights cases in decades. Oral arguments in the case, called June Medical Services LLC v Russo, take place Wednesday morning.The case represents the first test for how the nine-member court, which has swung toward the right, will handle a high-profile reproductive rights case. The case hinges on whether doctors performing abortions at standalone clinics should be required to have “admitting privileges” at local hospitals. If such a law were upheld, it could close abortion clinics across the country and severely limit women’s access to the procedure, without improving women’s health in the process.Already, the case in question breaks with precedent. The supreme court rarely takes cases similar to recent rulings. Oral arguements Wednesday will focus on a law identical to one the court overturned just four years ago……Attorneys for the case will answer questions from the nine justices for one hour. Justices will have the rest of the spring to review briefs, and issue a ruling in June. There is no limit on how broadly or narrowly the court may rule……The latest case, June Medical Services v Russo, stems from a law in Louisiana called HB 620. The law required doctors who preform abortions at clinics to have “admitting priviliges” at hospitals within 30 miles.Such privileges allow a doctor to admit a patient for treatment, but are difficult to obtain. Doctors who have them are typically employed as members of the hospital staff. In rural settings, a clinic may be more than 30 miles from the nearest hospital.Finally, in America’s private healthcare system, hospitals operate independently and are sensitive to the political concerns of the community. Many actively avoid connections with abortion clinics or doctors who perform them, and won’t grant the doctors the admitting rights they need to continue performing abortions….…In the June Medical Services case, the government also asked the justices to weigh in on a less high-profile question: should doctors be able to sue states that pass abortion restrictions, on behalf of their patients? Doctors have been able to sue on behalf of women seeking abortions since at least the 1973 Roe v Wade landmark.The question is a matter of what is called “standing”,or rights to sue, in legal communities. If justices find doctors cannot sue on behalf of women seeking abortions, it could make it far more difficult to challenge even patently unconstitutional anti-abortion laws. March 6, 2020: Virginia Mercury posted an article titled “Virginia General Assembly caps costs at $50 a month”. It was written by Kate Masters. From the article: One of the biggest bills of the year is one nobody is talking about, Del. Mike Mullin, D-Newport News, wrote in a tweet on Friday – a hard cap on the price of insulin in Virginia.Insurers are now limited to chargin a maximum of $50 a month for the drug after Del. Lee Carter, D-Manassas, urged colleagues to accept a Senate amendment to his bill. This price is a little higher than his original cap of $30, but still the lowest ceiling for insulin in the country, he said on the House floor……There have been Congressional hearings over the rising costs, but federal regulators have still haven’t settled on a solution to lower prices. Virginia is the third state to pass a law limiting the cost of insulin.The bill will go to Gov. Ralph Northam for final approval…The legislation prohibits Virginia insurers from setting a patient’s cost-sharing payment for insulin above $50 a month – including deductibles and copays. The bill was supported by the Medical Society of Virginia and the American Association of Retired Persons, but, unsurprisingly, not by the Virginia Association of Health Plans, which argued that the cap on the cost-sharing payments would be offset by a rise in premiums… March 11, 2020: Human Rights Watch posted an article titled: “US State Department Again Ignores Women’s Reproductive Rights”. It was written by Acting Co-Director, Women’s Rights Division, Amanda Klasing. From the article: The US State Department released its annual human rights Country Reports today. For careful readers of the reports issued under the Trump administration, the glaring gaps will seem familiar.For the past two reports, Human Rights Watch and other human rights and reproductive rights organizations have decried the Trump administration’s cutting of most mentions of key human rights abuses that disproportionately impact women and girls, including country analyses of maternal mortality rate, and unmet contraceptive needs. It’s not just an editorial cut – this deliberate exclusion has repercussions for the promotion of women’s human rights globally.That record is clear: From the “global gag rule” to a domestic gag rule, the defunding of United Nations Populations Fund, the extraordinary threat of vetoing a UN Security Counsil resolution on women, peace and security becaues it mentioned survivors’ sexual and reproductive health and rights, to the establishment of the Commission of Unalienable Rights that apepars to directly threaten sexual and reproductive health and rights, to the Women’s Global Development and Prosperity initiative that completely disregards the need women and girls have to access health care to succeed in their own economic empowerment.The administration is also playing an invidious role at international forums, recruiting other anti-choice governments to push back on the global consensus around sexual and reproductive health and rights.Frankly, it is exhausting to have to continue, 25 years after the Beijing women’s conference, to fight so hard to have basic recognition that women’s rights are human rights. Individuals, organizations, and the US Congress should not relent, despite the constant assault. Without delay, the Global HER Act, repealing the global gag rule permanently, and the Reproductive Rights are Human Rights Act, requiring the State Department to report on violations of women’s reproductive rights, should be passed. THIS BLOG WILL BE UPDATED WHENEVER ADDITIONAL CREDIBLE INFORMATION IS FOUND. A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Four is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on PayPal.me. Thank you!...
- Still Always at the Doctor’s Office
  December 28, 2019Doctor Appointments / Out of SpoonsPhoto by Abby Anaday on Unsplash Earlier this year, I wrote a blog post called Always at the Doctor’s Office because it seemed like I had been spending an increasing amount of time there. That blog post covered January to the end of May of 2019. This blog picks up where the first one left off. The main reason I am writing this is to track how often I go to the doctor, as well as how sick I had become before going to one. July Sometime in early July, I used telemedicine for the first time ever. I had yet another sinus infection, and has been trying to fight it off. My bad immune system was eventually overwhelmed, and I had to seek out medical attention. My health insurance covers telemedicine – where you contact a doctor from your home, and the doctor calls you to hear about your symptoms. The “clinic for the poor people” had been hit or miss when it comes to scheduling appointments. So, I tried telemedicine. It turns out that sinus infections are one (of many) things that the doctors can diagnose over the phone. I’d had more sinus infections than I can count, so I knew exactly what it was. The doctor was nice. She contacted the pharmacy of my choice and told them to fill my prescription for a “Z-pack” (the generic version). I do pretty well on that antibiotic, so I knew it would work. It also knew it would make me extra tired not only while I was taking it, but also for at least a week after that. On July 22, 2019, I wrote on Mastodon: “I’m over here, taking some CBD, because I did a whole lot of cleaning today and my fibromyalgia is making my muscles hurt now. CBD stops the pain. I’ll still be sick tomorrow due to allergen exposure. There are other drugs for that.” On July 26, 2019, I went outside. At the time I am writing this blog post, I don’t remember what it was that I went outside to do. The very next day, I wrote the following on Mastodon: “Yesterday, I went outside. Long story short, this fucked up my fibromyalgia, and I ended up in a whole lot of pain for the rest of the day/night.” “Today, slept in. Still not recovered yet. So, I have to spend a bunch of time trying to get my body to be functional enough to do some paid work. It’s annoying.” August On August 7, 2019, I had a doctor’s appointment with my rheumatologist. The purpose was to see what the results of the blood tests were. Based on the results, I was told that I do have the RH factor, but do not have any signs of rheumatoid arthritis. This is good news, because rheumatoid arthritis eats your cartilage and makes it increasingly difficult for your joints to move as they should. The unexpected news was that I didn’t actually have any other type of arthritis, either. The bad news (which I was honestly expecting) was that I definitely had fibromyalgia. I was prescribed a low dose of a pain medication, which I started researching on my phone while still in the doctor’s office. The pain medication was not an opioid. It also wasn’t something specifically made to treat fibromyalgia. There doesn’t appear to be any medication that is specifically designed for my disease. I’m cynically figuring that the reason is because the majority of people who have fibromyalgia are women, and modern medicine has a terrible track record when it comes to not only ignoring women who tell the doctors that they are in pain, but also in actually treating their pain appropriately. Either that is the reason there are no drugs designed to treat fibromyalgia, or the pharmaceutical companies don’t think women who are in chronic pain are going to make them a significant amount of money. If I remember correctly, the drug I was prescribed is one designed to treat depression and anxiety. I have neither of those, and I told that to my rheumatologist. All he could say was that this drug has helped some patients who have fibromyalgia. So, I scrolled through my phone, doing preliminary research about the medication I was being prescribed. Right away, I found that two of the inactive ingredients were coconut (or derived from coconut.) I am allergic to coconut, so there was absolutely no way I could safely take this medication. I pointed that out to my rheumatologist. “You don’t know all of my allergies,” I explained. He agreed, “You’re right. I don’t.” My rheumatologist means well. It’s not his fault that he doesn’t have any other options for me. When we were done, he recommended that I seek out my general practitioner for help with fibromyalgia (instead of him). We both agreed that he had done everything he was able to for me. On August 20, Fall pollen season started. I start struggling when the pollen count hits 7.0 or higher. I don’t bounce back until long after a pollen season ends. There is no way to know how long it will last. On August 30, I realizes that I had lost two pounds since the end of July. That brought me to a total of 50 pounds since I started trying to lose weight. That effort began in 2017. The weight loss had been increasing, in part, because I have a history of getting really sick and losing too much weight, too quickly. I weighed myself that day because I had gotten sick, again, and had been sick for a while. What caused it? There’s no way to know for certain, but going to doctor’s offices tends to result in me getting sick. Little did I know that this was the start of a long, lingering, sickness that was affected by multiple factors. In short, my terrible immune system was already under attack. September On September 5, 2019, out of the blue, my fibromyalgia decided to flare up at the two points on the back of my shoulders. This was new! It was quick, and strong, and felt like very localized electrical shocks. Fortunately, my bottle of CBD was right there on my desk and within easy reach. I used some, and waited for it to kick in and stop the severe pain. At the time, I assumed that this was my body’s way of reminding me that I’m trying to do too much while the pollen count is too high. It was 9.0 that day, and had been in the nines for more than a week straight. The reason I am doing too much is because I’m desperately trying to make money. I’m a freelance writer who gets paid to post things on other people’s blogs. Freelance writers don’t get paid sick days. We either get the work done, or we starve. On September 6, 2019, I posted the following on Mastodon: “Right now, I am using a heating pad across the back of my shoulders (sort of) because I moved and my fibro flared up there. Also using a straw to finish my iced tea so I don’t have to tilt my head to drink it. I have an acupuncture appointment in a few days.” The pollen count that day was 9.0 (again). When the pollen count hits nine, it affects people who don’t even have allergies. For me, days where the pollen count is at nine are days where I’m in horrific pain. In the past, it was mostly in my sinuses. This year, the inflammation caused by pollen exposure had started triggering my fibromyalgia. On September 10, 2019, the pollen count went down to 7.3. This is not good for me, and I would struggle while on the way to and from my acupuncturist’s office. I don’t have any memory about what we talked about before starting treatment, or what points she put needles in. This is what happens when I’ve been sick for too long from a too high pollen count, without time to recover. This lack of memory thing is referred to as “fibro fog”. It makes people like me forget most or all of the things that happened while we were in pain and struggling. I do remember that I took an excellent nap on the acupuncture table, and a really long, good, nap after I got back home. On September 18, 2019, I made the mistake of eating food from a local sandwich shop that does have gluten-free bread. They make tasty subs, and their workers are trained to put on a new pair of gloves before touching the gluten-free bread. Subs made with gluten-free bread are made in a separate area, far away from where the “regular” (full of gluten) bread is made. This is admirable, and I’m happy they do that. There’s just one problem. When the worker is done carefully cutting the gluten-free bread in a safe area, and putting the meat on it, the worker then hands the sandwich to the worker who puts on the veggies (and condiments). That worker has been handling “regular” bread all day, which means that the veggies are cross-contaminated with gluten. I got really sick after eating the (so-called) gluten-free sandwich from this sub shop. Exposure to gluten is painful, and really messes up my digestive system. It takes at least a week or two to fully get out of my system, no matter what I do. This is when I decided to become extraordinarily picky about the restaurants that I am willing to eat food from. I do this in self-defense. if they don’t care enough to prevent me from getting sick, then I don’t care enough to give them my money. October On October 4, I wrote on Mastodon: “I’ve been sick for about… two months or so now. Starting to feel better. So, if you’re wondering why I’m responding to old toots… that’s why. I cannot keep up with this world.” Toots, for those who do not know, are what posts on Mastodon are called. Also on October 4, 2019, at around 5 in the morning, I wrote on Mastodon: “Gonna go to sleep for a while. If I feel ok after I wake up, I might attempt to do some Inktober art. I no longer have the energy to do a “one thing every day” project, so I’m just gonna do whatever I can, on my own timeframe. Blame it on the fibromyalgia.” I remember being very sad about writing that toot. In 2017, I was able to complete one tiny pen & ink drawing, on a specific theme, every day in October. In 2018, I only was able to make it about half-way through the themes. This year, I was seriously struggling to do any art at all. All of my energy was going towards sleeping in the hopes of feeling better, trying to get my body to function properly and actually be able to move, and desperately trying to get paid work done. I was exhausted, and starting to get scared that from this point onward, my body would continue to decline. I had a couple of dental appointments in October. One was to remove a broken cap that my dentist put in not long ago. I guess he, or one of the dental technicians, did something wrong with it. The good news was that I wasn’t being charged any money to have them replace it. The process required me to have the old cap removed – which is unpleasant but something I can tolerate. I also had to have a mold made for the new permanent cap, and had to get a temporary cap put in. I was exhausted when I left because the physical experience was not painful when it was happening, but set off my fibromyalgia after I left. The temporary cap greatly limited what I was able to safely eat – and that’s before considering all the foods I cannot eat due to food allergies. I lost some weight in the previous month because I was really sick, and then lost more waiting for my permanent cap to be ready. The permanent cap was put in a few days before my husband and I were scheduled to leave for a short vacation. It is unpleasant to have a temporary cap removed, and then to have gums already irritated by dental work to have a permanent cap put on. This left me exhausted because all of that pounding on my jaw triggered my fibromyalgia Fortunately, I got lucky and was able to mostly recover by the time my husband and I were going to take a short vacation. We saved up our money and decided that this year’s anniversary present would be a trip to LA to see The Who at the Hollywood Bowl, followed by a trip to Anaheim to visit the Star Wars section of Disneyland. (Our wedding anniversary is not in October – but that’s when the concert was.) To make this work, we had to give up on funding some of the home improvement projects that were in various stages of incompleteness. Nothing serious, just a few things that needed some work. The concert was wonderful! It was an outdoor arena, at night, which meant that there wasn’t any pollen to worry about. There also wasn’t any smoke effects coming from the stage (which makes it hard for me to breathe). The bench seating was surprisingly comfortable. Unfortunately, the air in LA was terrible, and my sinuses were on fire the whole time. I suspect this had something to do with the pollution in the air. I’ll write a separate blog about Disneyland, but for now, I’ll point out that Disneyland lets people rent wheelchairs. For me, this was great and awful at the same time. Without a (manual) wheelchair, I would not have had the ability to walk from the gate to the Star Wars section. My fibromyalgia would have caused leg cramps and muscle spasms long before I got there. Shawn was able to push my rented wheelchair around, and that made visiting Disneyland together possible. The awful part was that the experience made me realize just how disabled I am. I honestly needed that wheelchair. When I had to leave the wheelchair behind in order to get on a ride, I had a hard time walking just a few feet. When we turned in the wheelchair, I had great difficulty standing. The workers noticed, and gently suggested I could take my time. Was this a glimpse of my future? How long do I have before I can’t walk? On October 17, 2019, after returning from vacation, I wrote this on Mastodon: “I’m back from vacation. It was really fun. Unfortunately, I encountered gluten twice because restaurants can’t be bothered to give a fuck about people like me who get super sick from gluten. I’m never eating anything from any restaurant ever again.” “Also, this trend of scented hotel rooms needs to die. My sinuses are still on fire from that.” “There needs to be a law – nationwide – that FORCES food preparers to learn about allergies and cross-contamination before they can finish school/get a job working with food. If they fuck it up after that – and make even one person sick -they should never be allowed to prepare food for a living ever again.” “And hotels should be FORCED to use unscented, allergy friendly, cleaning products. AND have allergy friendly soap/shampoo. It won’t happen, though, because no one cares.” Guess what? It’s pretty much impossible to find safe food for me to eat while on vacation. I brought safe food with me, but it wasn’t enough to last the few days we would be away from home. In other words, after just barely recovering enough to go on vacation, I was now sick again. The mobile home park we live in started tearing apart all of the roads within the park on the day we left for vacation. We returned to ripped up roads, construction equipment, and all the particulate matter and odors that come with it. The project was supposed to last three weeks. A few days before October 31, 2019, I woke up with a sore throat. At first, I assumed it was allergies, and figured it would go away if I drank lots of water and took allergy medication. Instead, it got worse. The throat pain reminded me when I had tonsilitis in 2017. The difference was that this time, the pain was mostly on one side. When I tried to make a doctor’s appointment, I was told that my regular doctor did not have any appointments open. The receptionist was able to get me an appointment on Halloween with a doctor I’d never seen before. I took it! The doctor was very nice, and seemed knowledgeable. He looked into my throat, nose, and ears, and declared that everything was red. His diagnosis was strep throat, which would require an antibiotic. I was exhausted, and in pain, but I sort of remember what the doctor told me. He said we could do a strep test, but that would cost more money. From what he could see, he was very certain it was strep. I was going to end up with the same antibiotic anyway. I opted to trust his judgement and skip the strep test. The doctor said I would need take two antibiotics a day until I ran out. I should call for another appointment if the medication didn’t help. Previous to planning our anniversary vacation, we had considered going to BlizzCon. It was a good thing that didn’t happen, because I wouldn’t have been able to get a doctor’s appointment before going and would have spread strep throat to everyone who attended. November On November 8, 2019, I wrote on Mastodon: “Hi people! I haven’t been on here much lately because I’m trying to see how quickly I can get my freelance writing work done. While on antibiotics. Because I have/had? strep throat. Through daylight savings time. I don’t recommend doing this, but I’m still gonna give it a try.” I was pushing myself to try and get as much paid work done as possible, in part because I was concerned that I wouldn’t be able to make enough money to help pay the bills if I rested. With all my chronic illnesses, it was impossible to feel “good” anyway. I was also starting to worry that the Trump Administration would – by going through the courts – rip away the only chance I had at getting affordable health care. At the time, the Republican’s Obamacare case was heading to the Supreme Court. I’m always at the doctor’s office. Lack of access to affordable health care would kill me. So, I tried to make what money I could before that happened. It’s not the best idea, and I wouldn’t recommend other “spoonies” try it. But, I know that many of us are afraid right now about what could happen when we can’t see a doctor anymore (or pay for medications, or blood tests, or whatever else we need). Most of November was blurry. I was exhausted from the antibiotics. Somewhere along the way, I re-read the bottle and learned that I was supposed to have been taking one pill three times a day, not twice like my doctor said. Perhaps I had the generic, and that made the dosage different? I felt like I was failing at taking my medication. There was another thing that was stealing away my energy. The mobile home park construction project did not end by the three week mark we were promised. It took six weeks to complete. Every day, I was exposed to more allergens and dust and dirt. Shawn developed a bad cough. Our portable air conditioner, and my air cleaner, were no match for the ever present construction crew. On November 21, 2019, I wrote this on Mastodon: “What was supposed to be three weeks of construction work very close to my home had turned into six weeks. There is no end in sight. This is my life now.” “I am physically overwhelmed by the constant dust (and other particulate matter) that is constantly in the air now. A neighbor next door did some additional work the other day. Two more nearby are making indoor and outdoor renovations.” “I am tired of being sick and exhausted from stuff I cannot control.” I was on antibiotics for the majority of November. It took a while longer for my body to “bounce back” to use a phrase that I’ve heard healthy people use after completing antibiotics. I did not “bounce back”. I slowly crawled back towards what passes for “healthy-ish” for me. December On December 19, 2019, I was fortunate enough to get to have an acupuncture appointment. I hadn’t been there in a couple of months, and really needed to go. Why didn’t I go sooner? Because I was too sick to do so. Acupuncture can help treat the symptoms of several kinds of illnesses. This time, I was there to deal with stress and chronic pain. My fibromyalgia had been acting up a lot, and I figured it had something to do with inflammation. As someone with both allergies, and fibro, I struggle with that. My wonderful acupuncturist knew just what to do, as always. I was able to take a really good nap after the needles had been put into the appropriate locations. My husband and I took a Lyft to the office, but when I was done with my appointment, I was able to walk home. My acupuncturist recommended I get more liquid Vitamin D3 from her (mine had run out). She also said I should stay away from sugar, which causes inflammation. For me, dairy does that as well. Shawn went to visit with his family on Christmas Eve, and returned home on Christmas day. I love his family, but their house is filled with allergens. I’m not saying their house is dirty – it is probably cleaner than our home is. They typically get a real Christmas tree, and I am allergic to that (no matter if it is pine or fir, my body stopped being able to tell the difference between them a long time ago). They have multiple (adorable) little dogs, and chickens in the backyard. Celebration can sometime include grilling on the patio, on burning wood, that makes me sick. Or, it includes food that I cannot safely eat due to my many food allergies. Their home is often scented by candles which make me cough. In the past, I was able to drive out there on Christmas day, and then return home. It got to the point where I was so sick after visiting that driving was difficult, and I was exhausted. I could not take Benadryl until after safely arriving home. As such, I don’t visit their home on or around Christmas anymore. I am extremely lucky that they understand. They drove Shawn home on Christmas day, and brought both his and my presents with. I honestly love everything they got for me. Soft pajamas and slippers, an electric throw to keep me warm. Fuzzy socks. “Spoonie” things! The Christmas scents clung to the presents, and all clothing needed to be washed immediately. I was sick for days afterwards, with burning sinuses. This isn’t their fault. Most people can safely handle all the scents that come with Christmas, and they have the right to make their home smell however they please. If my immune system was better, it wouldn’t be a problem. I’m going to be optimistic and assume I won’t get sick – again – in the last remaining days of 2019. If it happens, then I will update this blog post. Still Always at the Doctor’s Office is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on PayPal.me. Thank you!...

Other Video Games

- My Pokédex – Unova Region
  February 13, 2020Other Video Games / Pokémon GOPokémon GO began releasing Pokémon from the Unova Region on January 10, 2020. Here is a look at the ones I have caught (so far). This blog post will be updated whenever I catch a Unova Region Pokémon that is new to me. The Sinnoh Region of Pokémon ended on number 477. The Unova region begins with number 494. Where did all the numbers in between go? It remains a mystery. 504 Patrat 506 Lilipup 509 Purrloin 515 Panpour 519 Pidove 529 Drilbur 543 Venipede 550 Basculin 590 Foongus 607 Litwick 613 Cubchoo 616 Shelmet My Pokédex – Unova Region is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on PayPal.me. Thank you!...
- Seekers Notes: Family Heirlooms Collection
  February 2, 2020Other Video Games / Seekers NotesSeekers Notes is a game where the player becomes the Seeker and tries to solve mysteries and locate lost items. The game has an interesting story line and cast of characters. These screenshots were taken in 2018. Helen: Seeker, I think it could be in your interest to visit the train station, but today I receive the unfortunate news that the key to it is missing. You must find it to reach the train station. The game includes a bunch of unique areas in which a player can hunt for hidden objects. Whenever the story line leads to a new location, the player must find the corresponding key. In this case, the player is directed to visit the Mayor’s Office location. I found the Train Station key. Helen: They say that every day a ghost train appears at the train station accompanied by the sound of screeching wheels and whistling pipes. And then it disappears. The Curse must have resurrected ghosts from the past. I wonder what happened at the station all those years ago. Lady Byron: Hello, Seeker. I’m Ursula Byron, a direct descendant of the Founders of our great town of Darkwood. I’ve heard quite a bit about you and your appearance. It’s a shame you met the mayor before meeting me. Lady Byron is referring to Mayor Felix Smallcat, whom the player met while working on the quests connected to the Stationary Kit Collection. I hit Level 4! Lady Byron: Who wouldn’t be overjoyed to hear that you’ve been appointed to such an honored position? After all, we haven’t had a Seeker in… hmm… well, several decades. I believe you can help me, but we’d better talk somewhere more private. The quest text gives a hint to the player: Search the Station. I used the train station key to unlock the Train Station location. I was able to find all of the required hidden objects in the Train Station location. Doing so will always result in at least one useful item. Lady Byron: I’m glad you got here so quickly. Almost no one comes here since we were afflicted by the Curse. You see, the last train left Darkwood and never came back. Lady Byron: If you can find our family’s oak walking stick I’ll be convinced that you’re just the man Darkwood needs. I am aware that there is an old phrase that goes: “You’re the man for the job.” It’s possible that Lady Byron is simply using that phrase. It seems to me that Darkwood has been under a Curse for a long time, and it’s possible that the phrase hasn’t gone out of style yet. Darkwood is very isolated. That said, it bothers me that the story line of the game is written in a way that presumes that the player is male. I think it would have been better if Lady Byron said “…you’re just the person Darkwood needs.” I found the Old Walking Stick. Lady Byron: That you could find my family heirloom in a such a short span of time is certainly praiseworthy. Now listen – the Curse that has afflicted our town appeared very suddenly. Nothing like it has ever happened before… and this terrifies us. Lady Byron: Please try to find a bag with a false bottom – it belonged to my father. I found the Bag with a false bottom. Lady Byron: As you know, Darkwood was founded by the Founding Fathers. Legend has it there was a reason they chose this place to found the town. Collector Achievement: You have assembled 1 collection. What Collection did I assemble? That would be the Stationery Kit Collection. Completing the Collector Achievement unlocks a new trophy. It also gives the player a ruby – which can be used to buy an item that can help players find one item in any location. Helen: You can get a reward from a trophy every 12 hours! Continue unlocking achievements to upgrade trophies you have and get new ones! Lady Byron: You really are a talented Seeker. Sometimes Smallcat gets things right. I’m convinced you’re just the person to find my great-grandmother’s lost antique chest. Why does Lady Byron look so disapproving in the above screenshot? It is because the characters can blink. I took the screenshot at exactly the wrong moment. This quest requires player to go to the Cafe location. That location must be in Silhouette mode, or it won’t drop the item that Lady Byron wants the player to find. If you are lucky, the Cafe will be in the Silhouette mode. If not, then you will have to play through it – and finish it successfully – a few times before the Silhouette mode will appear. I found the antique chest. Lady Byron: A lot of things changed in our town once Smallcat came to power. I think the Curse appeared precisely because of him! Lady Byron is very likely the richest person in Darkwood. She’s also among the oldest people who live there. It is not unusual for older people to fear change. That’s understandable. However, it’s rather petty of Lady Byron to tell the Seeker that she thinks that the Curse was somehow caused by Mayor Smallcat. Put that together with what she said earlier, that it was a shame that the Seeker visited the Mayor before visiting her. It sounds like Lady Byron was hoping to get the Seeker alone so she could influence them to dislike Mayor Smallcat as much as she does. Her words and attitude make her seem distrustful. Lady Byron: I remember that my mother always wore an antique medallion. Do you think you could find it? This quest requires the player to solve the Treasure Box puzzle. I found the antique medallion. Lady Byron: Thank you for finding the medallion! You’ve done me a real kindness, Seeker. I reached Level 5! Doing so increases my maximum amount of energy by 5. A player uses energy every time they play a location. It is a limited resource that returns slowly, in real time. I also got 1 ruby. Players who reach Level 5 can unlock the Fortune Teller (which is a crafter), and the Mosaic (which is a puzzle). Lady Byron: We used to have a seal in the shape of our family crest that my uncle simply adored. Unfortunately, it was lost after the last member of our family left the post of mayor of Darkwood. To find this item, the player must explore the Train Station. Lady Byron’s uncle used to be the Mayor of Darkwood. He left the post (for reasons she doesn’t explain). I found the Crest-Shaped Seal. Lady Byron: In my opinion Darkwood was founded by a Byron. That means his descendant should be sitting in the mayor’s seat! Unfortunately, many people in Darkwood love Smallcat and have forgotten our town’s history. In general, mayors are elected. Lady Byron doesn’t seem to like that idea. She thinks that it should always be one of her family members that holds the position of mayor, for no reason other than it was Byron who founded the town. I’m not one to look kindly upon those who think they are entitled to an elected position due to nepotism. I’m not sure if Seekers Notes was intending to make Lady Byron unlikable – but that’s what they have achieved. I have now found all of the items that are part of the Family Heirlooms Collection. This collection also requires an additional item before it can be completed. Fortunately, I had plenty of those. Completing this collection uses up all of the items that are part of it. The result is a ring. Here are the rewards for completing the Family Heirlooms Collection. Lady Byron: Oh, just look, Seeker! It has our family crest on it! This is it – it’s the very ring! As a sign of my gratitude, please take my advice: the Curse has brought the very darkest aspects of Darkwood to light. Be careful. It seems to me that one of the “darkest aspects of Darkwood” is Lady Byron’s attitude! Then again, it’s entirely possible that her bad attitude predates the Curse. Completing this quest chain – and the collection it produces – adds information about Lady Byron into the Seekers Journal. Her chapter is called “The Noble Lady”. I had a meeting with Ursula Byron, head of the Byron family, one of the most influential and respected families of Darkwood. Lady Byron was very wary of my appointment to the position of Seeker and therefore wanted to test my abilities. Fortunately, I passed her tests brilliantly. I think I’m starting to get used to my abilities, and my Map is very helpful. But back to Ursula Byron. From the conversation it became clear that things are strained between the Byrons and the Smallcats. Lady Byron argues that a true descendant of the Founders should be in charge of the city. Hopefully, in the future we will be able to reconcile the two families. Seekers Notes: Family Heirlooms Collection is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on PayPal.me. Thank you!...

TV & Movie Reviews

- Grace and Frankie – Season One
  June 2, 2017TV and Movie ReviewsGrace and Frankie is a show on Netflix. It is a Netflix Original. Grace (Jane Fonda) is married to Robert (Martin Sheen). Frankie (Lilly Tomlin) is married to Sol (Sam Waterson). In the very first episode, right at the start, the husbands announce they want to divorce their wives. The reasons why the men want divorces is because they have fallen in love… with each other. And they want to get married. Warning: There are tons of spoilers. Episode 1: The husbands announce they want to divorce their wives because they have fallen in love with each other and want to get married. Robert: “We can do that now.” When Robert married Grace, and Sol married Frankie, same-sex marriage wasn’t legal anywhere in the United States. Robert and Sol have been having a secret love affair for the past 20 years. Later, Sol and Frankie are alone back at their home. Frankie asks Sol if that is why he got Cialis. Sol answers: “Everyone gets Cialis at my age.” Robert and Grace are alone at their home. She is sad. Robert tries to console her. “Were you ever really happy with me?” he asks. Grace thinks about it. She says they didn’t have the most romantic life. “But I thought we were normal”. This indicates that Grace and Robert hadn’t had a sex life together in a very long time. Grace thought the end of their sex life was a normal part of being a couple, or maybe because of their age. Now, she discovers that wasn’t so. She DOES NOT say she was happy with Robert. Robert says that he “wanted more.” The implication is that he wasn’t happy in his marriage with Grace, and found what he needed with Sol. * Both couples have children who are now adults. Sol and Frankie’s sons (Coyote and Nwabudike) try and console their mother. They repeat a lot of the positive encouraging phrases she must have told them. She tells them all that is “bullshit”. Grace and Robert’s daughters, (Brianna and Mallory) are angry about what happened. They immediately take their mother’s side, and don’t want to talk to their father right then. Mallory has kids. She asks “How am I going to explain this to my kids?” I don’t think this question is entirely about her father’s relationship with Sol. It’s also about the sudden divorce. * A chair is delivered to Robert and Grace’s house. She opens the box, and finds a chair that has a photo of Ryan Gosling’s face on the seat. Robert is delighted that the chair arrived so quickly and explains it is a joke between him and Sol. * For the first time, Grace notices that Robert’s office has a framed drawing of a nude man. She notices a small frame on the shelf that contains a old photo of two men, one of whom has taken the arm of the other (as a man might do with a woman). She sees books on the shelf, one of which is called “The Male Member”. And suddenly, she realizes she’s missed all these signs. * Grace and Frankie get into an argument over which one of them is more upset. Frankie says “I lost my best friend. You never liked Robert.” * Robert says he can finally breathe again – now that he’s divorcing Grace to be with Sol. Sol says he feels really guilty because he devastated someone he loves very much. It’s clear that Sol and Frankie were not just spouses, but also good friends. Grace and Robert were not friends. * Grace freaks out about the divorce. “I did everything right. I played by the rules.” She is angry. Grace asks Frankie why she isn’t angry. Frankie says she is heartbroken. * Later, Frankie acknowledges that there were times she “knew” but ignored it. She says Sol once asked her to wear a dildo. She and Grace think that could only mean that Sol was gay. Episode 2: * Sol and Robert spent the night together and are still snuggling in bed. Sol says he wants to go up on the roof and shout: “I am a homosexual and I am in love with Robert Hanson, who is also a homosexual.” Robert smiles, and jokingly talks him out of it. * As the men are getting ready to go to work, Robert says “Just because we’re out now doesn’t mean we’re gonna be gay with a vengeance.” * Two of Frankie’s friends come over to console her and take her to lunch. One of the friends is gay. Sol and Robert aren’t the only gay men in Frankie’s life. Sol sent the two friends over because Frankie won’t answer her phone when he calls her and he was worried about her. * Robert cuts off Grace’s credit card (which she discovers while trying to pay for lunch). It turns out Sol cut off Frankie’s credit card, too. Robert feels absolutely nothing about doing this to Grace – citing that he and Sol are divorce lawyers and that’s what people who are divorcing are supposed to do. Sol feels terrible about it and is upset that he knows Frankie will be upset when she finds out. * Robert asks Sol, “Which is better, feeling terrible with me, or without me.” Sal says “with you.” * Grace sends her daughters to her (and Robert’s) home to get some of her things. (She’s staying at the beach house). The daughters notice the remains of breakfast on the table and realize that Sol spent the night there. They look sad. * Frankie has a fight with Sol and kicks him out of their house. She tells him to go live with Robert. Sol says they weren’t ready to move in together yet. * Later, Frankie asks: “Was any of it real?” That’s a normal question people ask after a breakup. But, Frankie is also asking if her marriage to Sol, who had been having an affair with Robert for 20 years, was ever real. Episode 3: * Robert and Sol are having their children over for dinner. Sol is nervous. Robert tries to calm him by saying they’ve already had lots of dinners together. Sol responds: “That was before I became their new stepmother.” * Mallory and Brianna arrive together for dinner. They wait at the door of the house they grew up in. Brianna wants to just walk in. Mallory stops her and says they can’t do that because it’s not their house anymore. Brianna responds “I’ve lost both of my virginities in that house” and proceeds to just walk right in. * During dinner, Robert and Sol hold hands for a brief moment. Robert’s daughters and Sol’s sons stare at them – not really knowing how to feel about that. * Coyote tells Mallory (who is mad at him) “We’re step people now.” * Brianna and Bud have a conversation in the kitchen. Bud is preparing a cake. Brianna mentions something about how Bud seems fine with what their dad’s are doing. She asks “Would you be cool with it if they had cheated with women?” * After returning to the table, after everyone starts eating cake, an argument ensues where the kids let out some of their anger and frustration. Bud says he is “not allowed to be mad”. When Sol asks why not, Bud answers “because you’re gay.” Episode 4: * Someone who worked with Robert and Sol has died. They are going to the funeral. Sol says that this will be the first time people see him without his wife by his side. Robert says the funeral “is not our coming out party.” * Meanwhile, Grace is pushing Frankie to get ready to go to the funeral early – so they can leave before it becomes Robert and Sol’s coming out party. * Grace and Frankie see Robert and Sol – as a couple – for the first time at the funeral reception. It makes Grace and Frankie sad. * Grace notices that Sol is wearing a tie that she gave to Robert as a Father’s Day present. This makes her angry. Frankie is angry too. “They can’t leave us AND share clothes!” * Robert and Sol haven’t decided what to call each other. Robert think’s they’re too old for boyfriend. “Soulmate?” Sol asks. Robert responds, “No! I don’t even like that one with straight people.” At the funeral reception, Sol tries to use the word partner, but then awkwardly explains that they are business partners at the law firm, but also partners with each other. He confuses the people he was speaking to. * A very old man who must have worked at the same company as the deceased tells Robert and Sol that he knows they are a couple – and that they are brave. He then asks: “When did you know you were attracted to men?” He goes on to say that he had “an experience” when he was in Korea. Sol kindly walks away with him and answers the man’s question. * Robert’s sister tells Grace that she had no idea that her brother was gay. * Later, Robert’s sister accidentally mentions that her daughter is having a baby shower. It becomes clear that Grace was not invited. Robert’s sister explains that the aunties would be there (Robert’s family is Irish) and that there would be drama and it was the daughter’s day. She asks if Grace understands. Grace says of course she understands, it’s for family. After Robert’s sister walks away, Grace looks sad. * Robert gets frustrated with Sol and yells at him for talking to the widow for too long. He yells at Sol about his shoes (that Robert doesn’t like). Robert yells “You’re just not doing anything right.” Sol responds: “Oh my god. You’re angry that I’m not Grace.” Robert sits down and starts to sob. It’s probably the first time he’s cried about the divorce. Sol consoles him, saying something like he “has one, too”. Robert apologizes, and they start using the word “boyfriend”. * Frankie speaks with the widow. The widow says to her: “Oh, I think your situation is much worse than mine.” The widow points out that Frankie might live another 20 years. The implication is that Frankie will be spending those 20 years alone. * As they are leaving the funeral reception, Grace tells Robert she is so mad at him. “I’ve lost everything,” she says. She lost her husband, her house, her family… * Frankie, upset by what the widow said, and by an unfortunate comment Grace said to Robert about Frankie when Grace was expressing her anger at Robert, leaves the funeral with Grace trailing behind her. Sol drives up in his car – to pick up Robert. Frankie gets into the passenger seat out of habit. She quickly realizes what she has done, gets out, and tells Robert “I think this is for you.” Episode 5: * Brianna tells her mother, Grace, that Grace needs a boyfriend. Grace tells her daughter, Brianna “I’m sending that sentence right back to you.” Brianna is single. Her sister, Mallory, is married with two kids. * Brianna shows Grace a profile of a handsome doctor on a dating website, in an effort to convince Grace to make a profile there. Brianna says she has used dating websites and has met some “passable” guys. Brianna mentions that one of the guys had a micropenis. Apparently, Brianna still considered him “passable”. * Grace tries to make a profile on the dating site. She struggles to describe herself. Brianna sees that Grace listed her age as 70 – which is her age. Brianna argues that Grace should say she is 65, because she looks 65. Grace says that wouldn’t be honest. Brianna says it is honest because that’s the age Grace looks. * Grace doesn’t know what to put in the section of the profile marked “turn-ons”. Frankie walks past the couch Grace and Brianna are sitting on and suggests: “That he’s NOT gay!” Brianna tells her mother to say she is “open minded”. Grace hesitates, concerned that it might mean some “weird sex thing”. * Later in the episode, Grace apologizes for saying something unkind about Frankie at the funeral. Frankie accepts her apology, but wants Grace to treat her better. Frankie points out that she is Grace’s friend. Frankie also says “I’m the other person this happened to” – meaning both she and Grace are going through divorces because their husbands are gay and their husbands want to marry each other. * Grace eventually finished filling out her dating profile and posting it. * During the episode, Grace drives Brianna and Frankie to the frozen yogurt shop (at their request). Both Brianna and Frankie are high. Brianna notices that the cashier is named Brian, and that he and her have the same name – except for the “na”. Later, Brianna tells Grace and Frankie that Brian sent her friend request on Facebook. She says “That must have taken a lot of stalking,” followed by “That was sweet.” She smiles. Episode 6: * Someone on the dating website wants to have lunch with Grace. The two of them have been briefly talking on the website for a while. The man wants to have lunch with Grace today – and she doesn’t want to go because she thinks she isn’t ready for that yet. She tells Frankie she likes the attention she gets on the dating website – and likes that she can get that attention and stay home. Frankie encourages her to go to lunch with the man from the dating website. Grace says she doesn’t know him. Frankie informs her that this is what going to lunch is for – to get to know him and to get laid. * Grace realizes that this will be her first date in 40 years. * Frankie gives Grace some condoms. Grace says she doesn’t need them because she’s well past being able to get pregnant. Frankie tells Grace that because of the “penis drugs”, older people are having sex and aren’t using condoms – and are spreading STDs. Frankie says she read that in an AARP article. There is, in fact, an AARP article from 2010 that explains why older people should use condoms. The article is written by Dr. Pepper Schwartz. * An earthquake happens, and Frankie freaks out. Robert and Sol had just made plans for dinner. (They plan to order paella from a restaurant). Immediately after the earthquake is over, Sol tells Robert that Frankie is terrified of earthquakes and that he needs to go help her calm down. Sol says: “It’s her first quake alone, and she only has Grace to comfort her.” Robert immediately responds: “Go!” * Coyote rides his bike over to Mallory’s house to deliver a children’s book called And Tango Makes Three. The book was written by Justin Richardson and Peter Parnell and was published in 2005. The story is about three Chinstrap penguins at the Central Park Zoo, and is based on something that really happened. Roy and Silo were two male penguins in the zoo’s penguin exhibit. Roy and Silo liked to do everything together. A zookeeper noticed that they built a nest together, just like the other penguins couples do. But, Roy and Silo could not lay an egg. One day, the zoo had an extra Chinstrap penguin egg that was produced by another penguin couple who could not care for it. The zookeeper gave the egg to Roy and Silo, who took turns keeping it warm until the egg hatched. The zookeeper named the baby penguin Tango because “it takes two to tango”. Tango is a girl. Coyote takes the book to Mallory because he remembered that Mallory said that her kids were having a difficult time understanding what was happening with their grandfather and Sol. Coyote is working as a substitute teacher, so it makes sense that he had heard of this children’s book. * Grace’s date does not go well. After they are seated, she asks Charles if he’s “done it a lot”. He gives her a funny look. She clarifies that she means “this” and gestures at the table. She wanted to know if he goes to lunch with women he met on the dating website a lot. He obviously thought she was asking him if he had a lot of sex. * Charles tells Grace to watch out for liars on the dating website. It’s an odd comment to start out a new (potential) relationship with. He gives the example of someone who said she loved to play tennis – but he later learned that she was in a wheelchair. It’s hard to know if Charles was making up that example, or if he met someone like that. As the lunch date goes on, Charles gets stranger and stranger. He doesn’t seem to understand the subtle social cues Grace gives him indicating she doesn’t think he’s funny. He tells her if he’s too much to say: “Charlie it’s too much.” Grace immediate responds: “Charlie, it’s too much.” Charlie laughs and doesn’t take her seriously. Not long after that, Charlie starts making inappropriate, and gross, comments about Grace’s mouth and the steak she is eating, and this makes Grace so uncomfortable that she quickly ends the lunch date. * After helping Frankie calm down, Sol asks if she would like to get a bite to eat. They go to lunch. Sol texts Robert that he is going to be late (which leads to a misunderstanding – more on that in a bit). During lunch, Frankie asks Sol how it started with Robert. Sol is a bit taken aback. He didn’t expect to be sharing that today. Frankie honestly wants to know, so Sol tells her. Robert and Sol were at a law conference together, and later got drunk together at the hotel bar. They rode the elevator together. Sol says Robert gave him this look that scared him. The look gave him a feeling. Robert kissed Sol. Frankie asked if it was a big kiss. Sol says they kept kissing until the elevator stopped at their floor – the 26th floor. Sol says his whole body became alive. Frankie asks if that’s when their relationship started. Sol says no, that he and Robert didn’t talk about what happened. Frankie asks: “Why not?” Sol says they couldn’t talk about it – they didn’t know how to talk about it. The relationship between Robert and Sol evolved from sex to love. Sol didn’t want to tell Frankie about it because he loved her, and he loved their family, and he didn’t want to hurt them or lose them. * Grace returns home after the awful lunch date and finds one of Frankie’s art students in the kitchen, eating a ham sandwich. Grace has seen all three of Frankie’s students once before, the day she was trying to rush Frankie to get ready for the funeral. Grace knows the men in Frankie’s art class are all “ex-cons.” Grace is surprised and asks how he got in there. She tells him Frankie wasn’t home. The man says he found the studio empty so he went inside the house to make sure Frankie was ok. The man starts flirting with Grace. She is so surprised, she drops her purse. The condoms Frankie gave her fall out, and the man sees them. He makes a comment, and Grace clarifies that Frankie put those into her purse. It is clear that Grace is attracted to the man. She is a bit flustered. He tells her that he knows about her husband and Frankie’s husband. He says: “Please tell me that if he wasn’t fucking you somebody else was.” Another earthquake tremor happens, and Grace and the man end up passionately kissing in the kitchen (which leads to them making out for a little while before Grace stops it). The man leaves. Grace is smiling. * Later, Grace tells Frankie that one of her students was in the kitchen, eating a ham sandwich. Frankie says “That must be Byron. He loves ham.” Grace doesn’t mention the kissing. * Sol comes home to Robert three hours late. Robert invited some friends over (Al and Eddie, who are a couple). They are eating Paella. Robert and Sol start bickering, and Al and Eddie run away. Robert and Sol have an argument. Robert asks “Why did we blow up our lives if you are just going to go running back to her?” Sol said he texted Robert that he would be late, and thought Robert said it was ok. It turned out there was a miscommunication. The two make up. Robert goes to get some food for Sol. While he isn’t looking, Sol texts Frankie “goodnight”. Episode 7: * Grace comes home from an awful date. Grace tells Frankie that she took her anecdote (about saving a little bird). Frankie isn’t thrilled with that. Grace goes on to say that her date’s anecdote was about his fatty lipoma. He had a tumor that he named Farley – and it had teeth. A lipoma is a slow-growing fatty lump that’s most often situated between your skin and the underlying muscle tissue. It can feel doughy. It is not cancer. * Grace says she has another date tomorrow. Frankie points out that would be three dates in one week. * Brianna is cooking because she has a date coming over. She calls Bud to help her. Bud points out that she destroyed the Brisket, so he’s going to help her make stew out if it. Brianna says stew isn’t a second date food. Bud infers her date is with “Racist Dave”. Brianna corrects Bud – “Border Patrol Dave”. Dave sends Brianna a text, in which he cancels the date. Brianna now calls him “Racist Dave”. Brianna says that she doesn’t know what she wants (meaning in a relationship). Bud says she wants what everyone wants “Someone you can come home to at the end of the day who is happy to see you.” Brianna says she is getting a dog. * A big part of this episode focuses on the Spelling Bee, which is televised. Frankie and Sol watch it every year (it’s one of their rituals). Frankie can’t get Grace interested in the Spelling Bee, and Sol can’t get Robert interested in it. Sol unexpectedly brings Frankie a bread maker and some laser discs. Frankie sees that as an excuse to come over. Sol asks her to come over and watch the Spelling Bee with him. Frankie hesitates, unsure if that’s a good idea now that they are getting a divorce. Sol wants to continue their rituals, like watching the Spelling Bee together. Frankie says that she will be strong and say “no”. * Brianna adopts a foster dog she saw on the internet. The man who is fostering the dog brings him over. The man is cute and near Brianna’s age. She flirts with him – badly. He doesn’t appear to be interested in her, but is excited to give this great dog a forever home. Brianna is not so enthused about the dog. The dog is shy, at first. Brianna says the dog is ugly, and asks if it is the dog she saw on the internet. The foster dog “dad” gives Brianna the food the dog has been eating, and his toys. He makes a joke (about the dog leaving his patio furniture and grill so the other dogs could use it) – which Brianna doesn’t get. Foster dog man says she can call him if she has any trouble. Brianna spends hours trying to get the dog to love her. She fails at it. So, she calls the Foster dog guy, who comes over. He doesn’t see any problem with the dog (who is happily waltzing down the hallway and checking out other rooms.). The Foster dog guy makes a comment implying he thinks Brianna called to get HIM to come over. She basically agrees. They have sex. He leaves right after. Brianna is sad – until the dog leaps into her arms and starts loving her. * Frankie ends up going over to Sol and Robert’s to watch the Spelling Bee with Sol. She brought popcorn and tea. He is thrilled! They have a great time until Robert comes home and looks upset. Frankie leaves. Robert is miffed about Sol hanging out with Frankie. Robert admits that he is scared about Sol’s relationship with Frankie. He didn’t like that Sol didn’t tell him Frankie was coming over. Sol said he didn’t know she was coming over. Sol tells Robert that Frankie will always be part of his life, and that Robert has nothing to worry about. Robert agrees to watch the Spelling Bee with Sol – and they both have fun! * Grace goes on date three (of the week). It is with a man who owns a yacht and is an architect. His “name” on the dating website is “yachtcatect”. Grace thinks that is clever. She gets a table where they are supposed to meet. Unexpectedly, she sees a friend whom she hasn’t seen in years. His name is Guy, and he is a world traveler. But now, he wants to settle down. The yacht guy shows up, but hasn’t seen Grace yet. He is dressed like a television captain – hat, coat, and all. Guy asks Grace if she wants to meet that man. She doesn’t. Guy offers to sneak her out of the restaurant if she will have ice cream with him. They have ice cream together. Guy says he thinks there has always been a spark between them. They slowly start a relationship. He takes Grace to her door, and Grace kisses him. Neither expected that. Frankie sees Grace kiss Guy through the window. She leaves the television on – and the Spelling Bee – and goes upstairs. Episode 8: * Grace lets Frankie know that Guy is coming over for dinner (and she wants Frankie to either leave or stay in her room). Frankie says that Grace and Guy are gonna have sex. Frankie asks Grace if she is worried “because it’s the first time a straight man has seen you naked in 40 years.” Grace says she isn’t worried because she will turn the lights out (and he won’t see her naked). Frankie asks Grace if she is worried about vaginal dryness. Grace responds: “I am now.” * Frankie gives Grace something Frankie refers to as her “secret weapon”. It is a jar of “Frankie’s homemade yam lube.” Frankie calls it “Vag-a-kadabra.” She keeps it in the refrigerator. Grace is disturbed because she’s been eating the yam lube on toast. Frankie reassures Grace that that is good, and that her gynecologist says “You shouldn’t put anything in your vagina that you wouldn’t put in your mouth.” Overall, this advice is not a bad idea. * Grace doesn’t want to hear about the yam lube. Frankie says “It’s not a dildo. It’s a facilitator!” Frankie also says that she makes dildos. * Grace tells Frankie that men and women cannot be friends. Frankie disagrees. She is friends with Sol, and several other men, including Jacob (who grows the yams Frankie uses in her lube). Grace later informs Frankie that Jacob was flirting with Frankie. This takes Frankie by surprise. * Guy comes over for dinner with Grace. They sit on the couch afterward making boring small talk. Eventually, Grace asks: “Do you want to have sex?” Guy responds: “Oh boy yes.” Grace does, in fact, keep the lights out and does not let Guy see her naked. * The next day, Frankie asks Grace how the sex was, and wants to hear details. Grace says Guy “was no slouch in the boudoir.” Cut scenes make it clear that Grace and Guy had sex, but it was far from being good sex. Frankie asks if the sex was bad. Grace doesn’t really answer. Frankie asks Grace if she had an orgasm. Grace angrily responds: “You’re a child!” Frankie concludes, “So, that’s a no.” * Later, Frankie tries to encourage Grace to tell Guy what she likes in bed. She asks if he knows that clitoral stimulation is important. Grace is mortified – and it’s only her and Frankie who can hear this conversation. Grace says she has never talked about her clitoris. * The next day, Grace gets off the phone and tells Frankie “Well, Guy and I made plans for him to have another orgasm tonight.” * Frankie realizes that Jacob is flirting with her. She tells Grace, who gives Frankie some advice – but Frankie isn’t skilled at flirting. Eventually, she let’s Jacob know that Grace thought he was flirting with her, and so she tried to flirt with him – but is bad at it. Jacob says he thought Frankie was having a heart attack. The two of them smoke pot together. Right before Jacob leaves, he tells Frankie that he WAS flirting with her. * Guy comes over. He says he brought a flashlight. (He injured himself trying to find the bed in the dark the other night). He wants to take Grace upstairs. She stops, plays some music, and guides Guy through dancing with her. This is the closest Grace has probably ever gotten to telling a sexual partner what she likes. The dance becomes a metaphor for sex. Episode 9: * Grace got an invite to Robert and Sol’s wedding. She and Frankie make fun of the script (which is florid and loopy and overdone). Frankie asks: “I wonder how they decided whose name goes on top.” That conversation quickly ends. Typically, wedding invitations go one of two ways: (1) The parents who are hosting the wedding are listed, followed by the parents who are not hosting the wedding – and then it states that the parents are inviting people to the wedding. (2) If the couple us hosting the wedding themselves, the name of the bride always appears first (or “on top”). Neither Grace nor Frankie want to consider which of their husbands is “on top” in the bedroom, or to wonder if the order of names on the invitation match that situation. * Frankie, after seeing the wedding invitation, asks Grace to pull her finger, which Grace refuses. Frankie was asking for help – because she tried to remove her wedding ring the day of the funeral but it was stuck on her hand. Grace helps Frankie take off the wedding ring. * Frankie is making another batch of her “Vag-a-kadabra” homemade yam lube. Brianna comes over (to pick up her dog that Frankie was babysitting). Brianna asks what Frankie is making, and Frankie tells her. Brianna responds: “M